DIAGNOSIS OF ENDOMETRIOSIS USING MRI BY DR SELMA BELDJORD AND DR SALIM BENABADJI

What isendometriosis?

Endometriosis is a complex disease whose multi-factorial origin is still poorly understood: it results from the combined action of genetic and environmental factors and factors linked to menstruation (early first period, short cycles, increased menstrual volume). It is caused by the abnormal accumulation of endometrial cells outside the uterus, generating chronic inflammation leading to haemorrhagic lesions and fibrosis, mainly in the peritoneum and genitals, and sometimes in the digestive and urinary systems. Although benign, it can cause recurrent disabling symptoms and profoundly affect quality of life.

Age range

Endometriosis can potentially affect all women in good health. It can sometimes begin as early as adolescence. The menopause allows the symptoms ofendometriosis to be cured.

How isendometriosis diagnosed?

Patients suffering from endometriosis have often been victims of misdiagnosis, resulting in a delay in diagnosis estimated at an average of 6 years, so it is essential to offer them rapid treatment.

A certain number of symptoms suggestive of endometriosis should raise the alarm, such as recurrent intense pain during menstruation (known as dysmenorrhoea), deep pain during sexual intercourse (known as dyspareunia), sometimes pain during defecation during menstruation, sometimes cyclical functional urinary signs during menstruation and infertility with or without pain.

Imaging

If symptoms and a clinical examination are suggestive, imaging tests are necessary to establish a positive diagnosis and, if necessary, to carry out an exhaustive work-up of the endometriosis lesions. The two most effective imaging techniques for diagnosing endometriosis are endo-vaginal pelvic ultrasound, provided it is carried out by a sonographer with experience of this pathology, and pelvic MRI. The diagnostic performance of imaging is excellent for detecting endometriosis cysts affecting the ovaries and for detecting so-called deep endometriosis lesions. Imaging is less reliable for detecting superficial lesions in the peritoneum.

What is the procedure for an endometriosis imaging test?

As mentioned above, pelvic endo-vaginal ultrasound and MRI are the two imaging modalities that can be prescribed to look for endometriosis. They are sometimes performed together as they provide complementary information.
The period of the cycle, and in particular the period of menstruation, does not improve the detection of endometriosis lesions, so it is not necessary to give priority to one time of the cycle for carrying out radiological examinations.

To improve the quality of pelvic MRI images and optimise diagnostic performance, a simple digestive preparation is prescribed, to be carried out at home before the examination. There is no need to inject gadoline contrast product to diagnose endometriosis. However, a subcutaneous or intravenous injection of intestinal antiperistalsis (Glucagen°) is recommended at the beginning of the examination; this reduces the movement of the digestive tract and significantly improves the quality of the images.

Endometriosis is a difficult pathology to diagnose, requiring the intervention of radiologists who are experts in endometriosis, as stated in the joint recommendations of the HAS and the French national college of gynaecologists in 2017.
Docteur BELDJORD and Docteur BENABADJI are the two radiologists specialising in the diagnosis of endometriosis at the Turin MRI. This expertise was acquired through their university training under the masters who founded endometriosis imaging in France.

Our centre is equipped with state-of-the-art technical facilities, including the latest versions of MRI scanners with excellent performance in the gynaecological field, giving us confidence and efficiency in our practice.