Takahashi Hiroaki, Burnett Tatnai L, Shahi Maryam, Wang Sherry S, Xiao Lekui, Colak Ceylan, Sheedy Shannon P, Bookwalter Candice A, Jha Priyanka, Feldman Myra K, Khan Zaraq, Cope Adela G, Johnson Matthew P, VanBuren Wendaline M
Mayo Clinic, Rochester, USA.
Stanford University, Stanford, USA.
Abdom Radiol (NY). 2025 May 29. doi: 10.1007/s00261-025-05021-8.
Rectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE.
We propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning.
The records of patients with bowel endometriosis treated surgically from May 2018 to June 2022 were retrieved. Surgery was classified as partial thickness discoid, full thickness discoid, or segmental resection. Each pre-treatment MRI was scored based on the mutual agreement of two abdominal radiologists (reference score). The MRI score was defined as (1) score 0: no evidence of RSE, (2) score 1: minimal tethering involving the serosal surface without MP involvement, (3) score 2: intermediate soft tissue thickening involving the rectosigmoid colon with indeterminate MP involvement, or (4) score 3: definite mushroom cap sign or definite MP involvement. In the reader study, two radiologists independently scored each exam. The area under the curve (AUC) was evaluated for predicting the need for segmental or full thickness discoid resection.
The cohort consisted of 95 patients (median age: 36 years); 16, 14, 30, and 35 patients had MRI score 0, 1, 2, and 3, respectively. Patients with MRI scores 3 and 2 underwent partial thickness discoid (6% vs. 50%), full thickness discoid (6% vs. 17%), and segmental resection (89% vs. 33%), respectively. All patients with MRI scores 1 or 0 either underwent partial thickness discoid resection or did not undergo rectosigmoid surgery. The AUCs were 92.2%, 84.5% and 93.9% for MRI scores of the reference, reader 1, and 2, respectively.
Our MRI scoring system based on suspected depth of bowel invasion showed good diagnostic performance to predict the type of surgical intervention needed.
直肠乙状结肠子宫内膜异位症（RSE）具有多种MRI表现，这会影响手术规划。目前尚未建立针对RSE的标准化报告和数据系统。
我们提出一种新型MRI评分系统，旨在预测RSE中固有肌层（MP）受累的可能性，进而影响手术规划。
检索2018年5月至2022年6月接受手术治疗的肠道子宫内膜异位症患者的记录。手术分为部分厚度盘状切除、全厚度盘状切除或节段性切除。每位患者术前的MRI由两名腹部放射科医生共同评分（参考评分）。MRI评分定义为：（1）0分：无RSE证据；（2）1分：仅累及浆膜表面的轻微粘连，无MP受累；（3）2分：直肠乙状结肠中度软组织增厚，MP受累情况不确定；（4）3分：明确的蘑菇帽征或明确的MP受累。在阅片者研究中，两名放射科医生分别对每次检查进行独立评分。评估曲线下面积（AUC）以预测节段性或全厚度盘状切除的必要性。
该队列包括95例患者（中位年龄：36岁）；MRI评分为0分、1分、2分和3分的患者分别有16例、14例、30例和35例。MRI评分为3分和2分的患者分别接受了部分厚度盘状切除（6%对50%）、全厚度盘状切除（6%对17%）和节段性切除（89%对33%）。所有MRI评分为1分或0分的患者均接受了部分厚度盘状切除或未进行直肠乙状结肠手术。参考评分、阅片者1和阅片者2的MRI评分的AUC分别为92.2%、84.5%和93.9%。
我们基于肠道侵袭疑似深度的MRI评分系统在预测所需手术干预类型方面显示出良好的诊断性能。
