INTRODUCTION INTRODUCTION • ENDOMETRIOSIS is a benign disorder ENDOMETRIOSIS is a benign disorder

characterised by proliferation of characterised by proliferation of endometrial tissues outside the endometrial tissues outside the endometrial cavity.endometrial cavity.

• Most commonly between 30 -40 yrs Most commonly between 30 -40 yrs

• 1/ 5 of all gynaecological cases 1/ 5 of all gynaecological cases

SITESSITES• Ovary , Cul de sac (MC )Ovary , Cul de sac (MC )

• Peritoneum covering the pelvic Peritoneum covering the pelvic organs organs

• GI and Urinary tract GI and Urinary tract

• Anterior abdominal wall Anterior abdominal wall

• Extra peritoneal sites (Lungs and Extra peritoneal sites (Lungs and brain ) very rarely brain ) very rarely

CLINICAL PRESENTATIONSCLINICAL PRESENTATIONS

• Pelvic pain Pelvic pain

• Dysmenorrhea Dysmenorrhea

• Dyspareunia Dyspareunia

• Pain with defecation Pain with defecation

• InfertilityInfertility

• Multiple small nodules palpable along Multiple small nodules palpable along the uterosacral ligament during a PV the uterosacral ligament during a PV examination examination

MRI MRI • Technique based on magnetic Technique based on magnetic

properties of hydrogen nuclei properties of hydrogen nuclei • In the presence of a large magnetic field In the presence of a large magnetic field

nuclear spin transition from ground nuclear spin transition from ground state to the excited state can be state to the excited state can be induced induced

• As the nuclei relax and return to the As the nuclei relax and return to the ground state energy is released in the ground state energy is released in the form of electromagnetic radiation which form of electromagnetic radiation which is detected and processed into an image is detected and processed into an image

Adnexal endometriosisAdnexal endometriosis

Rectosigmoid colon endometriosis: sagittal T2-weighted MRI showing complete obliteration of the cul-de-sac due to intestinal endometriosis (white arrow) associated with endometrioma (arrowhead)

• PUBMED PUBMED

• SCIENCEDIRECT SCIENCEDIRECT

• BIOSIS PREVIEWBIOSIS PREVIEW

• SPRINGERLINKSPRINGERLINK

• PATENTSEARCHPATENTSEARCH

• GOOGLE SCHOLAR GOOGLE SCHOLAR

• BANDOLIER BANDOLIER

LITERATURE REVIEWLITERATURE REVIEW• INTRODUCTIONINTRODUCTION

• Deep pelvic endometriosis (DPE) is defined Deep pelvic endometriosis (DPE) is defined as the presence of endometrial implants, as the presence of endometrial implants, fibrosis and muscular hyperplasia below fibrosis and muscular hyperplasia below the peritoneum. DPE involves, in the peritoneum. DPE involves, in descending order of frequency, the descending order of frequency, the uterosacral ligaments, the rectosigmoid uterosacral ligaments, the rectosigmoid colon, the vagina and the bladder . The colon, the vagina and the bladder . The exact incidence of DPE is unknown, but exact incidence of DPE is unknown, but DPE is diagnosed in about one in five DPE is diagnosed in about one in five women with pelvic endometriosis. women with pelvic endometriosis.

PROCEDURE MATERIALS PROCEDURE MATERIALS • MRI technique and analysisMRI technique and analysis

Patients fasted for at least 3 h before MRI and Patients fasted for at least 3 h before MRI and received an i.v. antispasmodic drug at the outset received an i.v. antispasmodic drug at the outset of the examination to decrease bowel peristalsis. of the examination to decrease bowel peristalsis. MR images were acquired on a 1.5 T device. The MR images were acquired on a 1.5 T device. The protocol always included sagittal and axial fast protocol always included sagittal and axial fast spin-echo T2-weighted images and gradient echo spin-echo T2-weighted images and gradient echo T1 images with and without fat suppression, T1 images with and without fat suppression, before and after injection of gadolinium. All before and after injection of gadolinium. All sequences were acquired with anterior and sequences were acquired with anterior and posterior saturation bands placed anteriorly and posterior saturation bands placed anteriorly and posteriorly to eliminate the high signal of posteriorly to eliminate the high signal of subcutaneous fat. Additional sequences could be subcutaneous fat. Additional sequences could be performed, especially for suspected rectal performed, especially for suspected rectal involvement. The performance of the different involvement. The performance of the different sequences was not compared. sequences was not compared.

• The MR images were analysed in real time by The MR images were analysed in real time by different radiologistsdifferent radiologists

DISCUSSIONDISCUSSION

Rectovaginal endometriosis: axial T2-weighted MRI passing through the lower limit of the cervix and showing an

irregular hypointense endometriotic lesion of the rectovaginal septum (arrow)

• Rectosigmoid colon endometriosis: sagittal T2-weighted MRI showing complete obliteration of the cul-de-sac due to intestinal endometriosis (white arrow) associated with endometrioma (arrowhead

Vaginal endometriosis: sagittal T1-weighted MRI showing hyperintense spots within the posterior vaginal fornix

(arrow)

Rectovaginal septum.—Rectovaginal septum.— Correlation between surgical and pathologic findings and MR Correlation between surgical and pathologic findings and MR

imaging results was evaluated. All lesions of the imaging results was evaluated. All lesions of the rectovaginal septum that were found during surgery were rectovaginal septum that were found during surgery were resected. Lesions at this site of involvement were always resected. Lesions at this site of involvement were always accompanied by lesions of endometriosis at other posterior accompanied by lesions of endometriosis at other posterior locations, such as USL (locations, such as USL (nn = 10), vagina ( = 10), vagina (nn = 7), or = 7), or rectosigmoid (rectosigmoid (nn = 10) . Rectovaginal septum involvement . = 10) . Rectovaginal septum involvement . Posterior deep pelvic endometriosis was diagnosed at MR Posterior deep pelvic endometriosis was diagnosed at MR imaging in two patients with MR imaging results that were imaging in two patients with MR imaging results that were false-negative for rectovaginal involvement. Discrepancies false-negative for rectovaginal involvement. Discrepancies between MR imaging and surgical findings were noted in between MR imaging and surgical findings were noted in regard to the precise anatomic location. The four false-regard to the precise anatomic location. The four false-positive results were observed in three patients with frozen positive results were observed in three patients with frozen pelvis (resection was not performed in two patients) and one pelvis (resection was not performed in two patients) and one patient in whom the precise extension of posterior patient in whom the precise extension of posterior involvement with endometriosis that was predicted with MR involvement with endometriosis that was predicted with MR imaging differed from that seen during surgery. The imaging differed from that seen during surgery. The sensitivity, specificity, positive and negative predictive sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for the diagnosis of values, and accuracy of MR imaging for the diagnosis of rectovaginal septum involvement compared with pathologic rectovaginal septum involvement compared with pathologic findings were 80% (eight of 10), 97.8% (181 of 185), 67% findings were 80% (eight of 10), 97.8% (181 of 185), 67% (eight of 12), 98.9% (181 of 183), and 96.9% (189 of 195), (eight of 12), 98.9% (181 of 183), and 96.9% (189 of 195), respectively. respectively. ( sample discussion , details in the report given )( sample discussion , details in the report given )

TATS IT FR OUR TATS IT FR OUR TOPIC !!TOPIC !!

GROUP MEMBERS GROUP MEMBERS

• SARIKA PALEPU -12SARIKA PALEPU -12

• ARKAPAL BANDYOPADHYAY – 95 ARKAPAL BANDYOPADHYAY – 95

• ARNAB DUTTA -97ARNAB DUTTA -97

• ANUSHA MULKA -11ANUSHA MULKA -11