Alsudairy Njood, Alsudairy Saad, Alahdal Alaa, Alkarimi Eman, Bakkari Alaa, Noorwali Alaa, Kiram Israa
Department of Radiology, The Second Jeddah Health Cluster, Jeddah, SAU.
Department of Obstetrics and Gynecology, King Abdullah Medical Complex - Jeddah, Jeddah, SAU.
Cureus. 2024 Jul 29;16(7):e65649. doi: 10.7759/cureus.65649. eCollection 2024 Jul.
Background Endometriosis is a prevalent gynecological disorder characterized by extra-uterine endometrial-like tissue, causing substantial morbidity, including chronic pelvic pain and infertility. Little is known about the correlation between imaging findings and pain severity in endometriosis. Methods We conducted a prospective observational study, enrolling 150 women diagnosed with endometriosis. Clinical, imaging (MRI and transvaginal ultrasound (TVUS)), and histopathological criteria were used for diagnosis. Pain severity was assessed using the Visual Analog Scale (VAS). Statistical analysis included multivariate regression to identify predictors of pain severity. Results Imaging revealed common sites of endometriosis involvement, predominantly ovaries (73.3%) and rectovaginal septum (40%). Deep infiltrating endometriosis (DIE) was present in 30% of patients, predominantly affecting uterosacral ligaments (66.7% of DIE cases). Patients with ovarian endometriomas and DIE exhibited significantly higher VAS scores (7.6 ± 1.5 and 8.0 ± 1.2, respectively) compared to those without (6.5 ± 1.9 and 6.9 ± 1.8, respectively). Surgical intervention led to a significant reduction in VAS scores (from 7.4 ± 1.6 to 3.2 ± 1.7, p < 0.001), correlating with reductions in lesion size and extent observed in follow-up imaging. Conclusion Advanced imaging techniques, particularly MRI and TVUS, play a critical role in assessing pain severity in endometriosis. Ovarian endometriomas and DIE are independent predictors of increased pain severity, guiding personalized treatment strategies. Surgical excision of lesions, particularly in cases of DIE, offers substantial pain relief and improves quality of life, emphasizing the integration of imaging in clinical decision-making for optimal endometriosis management.
子宫内膜异位症是一种常见的妇科疾病，其特征是子宫外出现类似子宫内膜的组织，可导致包括慢性盆腔疼痛和不孕在内的严重发病率。关于子宫内膜异位症的影像学表现与疼痛严重程度之间的相关性知之甚少。方法：我们进行了一项前瞻性观察研究，招募了150名被诊断为子宫内膜异位症的女性。采用临床、影像学（磁共振成像（MRI）和经阴道超声（TVUS））及组织病理学标准进行诊断。使用视觉模拟量表（VAS）评估疼痛严重程度。统计分析包括多变量回归以确定疼痛严重程度的预测因素。结果：影像学检查显示子宫内膜异位症的常见累及部位，主要为卵巢（73.3%）和直肠阴道隔（40%）。30%的患者存在深部浸润性子宫内膜异位症（DIE），主要影响子宫骶韧带（DIE病例的66.7%）。与没有卵巢子宫内膜异位囊肿和DIE的患者相比，有卵巢子宫内膜异位囊肿和DIE的患者VAS评分显著更高（分别为7.6±1.5和8.0±1.2）（分别为6.5±1.9和6.9±1.8）。手术干预导致VAS评分显著降低（从7.4±1.6降至3.2±1.7，p<0.001），这与随访影像学中观察到的病变大小和范围的减少相关。结论：先进的影像学技术，尤其是MRI和TVUS，在评估子宫内膜异位症的疼痛严重程度方面起着关键作用。卵巢子宫内膜异位囊肿和DIE是疼痛严重程度增加的独立预测因素，可指导个性化治疗策略。病变的手术切除，尤其是在DIE病例中，可显著缓解疼痛并改善生活质量，强调影像学在子宫内膜异位症最佳管理的临床决策中的整合。
