Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France.
Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France.
Diagn Interv Imaging. 2021 Apr;102(4):255-263. doi: 10.1016/j.diii.2020.11.011. Epub 2020 Dec 15.
The purpose of this study was to retrospectively evaluate the performance of magnetic resonance imaging (MRI) in locating endometriosis implants within the bladder wall with assessment of ureteral orifice extension using surgical findings as standard of reference.
MRI examinations of 39 consecutive women (mean age: 31.2±5.5 [SD] years; age range: 22-42years) operated in 3 university hospitals for bladder endometriosis over a 6-year period were reviewed by 2 independent readers. Interobserver agreement was assessed using Kappa tests. Results of consensus reading were used to calculate sensitivity, specificity and accuracy of MRI for the diagnosis, location and extent of endometriosis implants using surgical findings as the standard of reference.
Mean bladder repletion volume was 134±110 [SD] mL (range: 21-479mL). The mean largest endometriosis implant diameter was 30±7 [SD] mm (range: 19-41mm). On MR images, 34/39 (87%) endometriosis implants were present in the two anterior thirds of the dome (k=0.45), 31/39 (79%) extended or were present in the posterior third pouch (k=0.92) and 25/39 (64%) extended into the bladder base (k=0.84) with sensitivities of 100% (31/31; 95% confidence interval [CI]: 89-100%), 100% (30/30; 95% CI: 88-100%) and 90% (19/21; 95% CI: 69-98%), respectively, specificities of 83% (5/6, 95% CI: 36-100), 88% (7/8, 95% CI: 47-100%), 87% (13/15; 95% CI: 52-96), respectively and accuracies of 97% (36/37, 95% CI: 86-100%), 97% (37/38; 95% CI: 86-100%), and 89% (32/36; 95% CI: 74-97%), respectively. In 9 (9/25; 36%) patients with bladder base involvement, a zero distance was reported between endometriosis implants and ureteral orifices, all but one presenting with low-to-moderate bladder volumes. In the two patients who needed ureteral resection-reimplantation, ureteral dilation was associated with a zero distance. External adenomyosis was reported in 26/39 (66%) patients (k=0.94).
A dedicated preoperative MRI work-up for bladder endometriosis helps accurately depict and locate endometriosis implants. Adequate bladder filling is needed to improve appropriate estimate of the distance between endometriosis implants and ureteral orifices to better predict requirement of ureteral resection-reimplantation.
本研究旨在回顾性评估磁共振成像（MRI）在定位膀胱壁内子宫内膜异位症病灶方面的表现，并通过手术结果评估输尿管口延伸情况作为参考标准。
对 39 名连续在 3 所大学附属医院因膀胱子宫内膜异位症接受手术的女性（平均年龄：31.2±5.5[标准差]岁；年龄范围：22-42 岁）的 MRI 检查进行回顾性分析，由 2 名独立的读者进行评估。采用 Kappa 检验评估观察者间的一致性。采用共识阅读结果计算 MRI 在诊断、定位和评估子宫内膜异位症病灶的范围方面的敏感度、特异度和准确度，以手术结果为参考标准。
膀胱充盈平均容量为 134±110[标准差]mL（范围：21-479mL）。最大子宫内膜异位症病灶直径平均为 30±7[标准差]mm（范围：19-41mm）。在 MRI 图像上，34/39（87%）的病灶位于穹窿的前 2/3 （k=0.45），31/39（79%）位于后 1/3 囊（k=0.92），25/39（64%）延伸至膀胱底部（k=0.84），其敏感度分别为 100%（31/31；95%置信区间[CI]：89-100%）、100%（30/30；95% CI：88-100%）和 90%（19/21；95% CI：69-98%），特异度分别为 83%（5/6；95% CI：36-100%）、88%（7/8；95% CI：47-100%）和 87%（13/15；95% CI：52-96%），准确度分别为 97%（36/37；95% CI：86-100%）、97%（37/38；95% CI：86-100%）和 89%（32/36；95% CI：74-97%）。在 9 名（9/25；36%）膀胱底部受累的患者中，报道子宫内膜异位症病灶和输尿管口之间的距离为零，其中 8 名患者的膀胱容量较低，1 名患者的膀胱容量中等。在需要进行输尿管切除和再植入的 2 名患者中，输尿管扩张与距离为零相关。26/39（66%）名患者报告存在外部腺肌症（k=0.94）。
术前进行专门的 MRI 检查有助于准确描绘和定位膀胱子宫内膜异位症病灶。需要充分充盈膀胱，以更好地评估子宫内膜异位症病灶与输尿管口之间的距离，从而更好地预测是否需要进行输尿管切除和再植入。
