Magnetic resonance imaging for non-invasive diagnosis of various forms of endometriosis in women with infertility

BACKGROUND: Endometriosis is one of the most common causes of infertility, affecting approximately 6%–10% of women of reproductive age. For many decades, laparoscopic surgery has been considered the “gold standard” for diagnosing various forms of endometriosis. However, diagnostic laparoscopy, despite its widespread use, is an invasive and expensive procedure with certain risks. Current scientific literature increasingly shows that the methods of radiological diagnosis (ultrasound and magnetic resonance imaging [MRI]) are the main and most promising for verification of endometriosis. The advantages of MRI over ultrasound are multiplanar images, high tissue contrast, and smaller size of detectable heterotopias.

AIM: To assessing the sensitivity and specificity of MRI for diagnosing different forms of endometriosis.

METHODS: A retrospective analysis of the medical histories and instrumental studies of 129 women of reproductive age (mean age of the participants was 30.5±4.6 years) with a clinical diagnosis of infertility and suspected genital endometriosis was conducted. At the first stage of the study, the patients underwent a comprehensive MRI with one-stage magnetic resonance hysterosalpingography to assess the pelvis and tubal patency. Further, laparoscopic surgery (LS) was performed to confirm/refute the diagnosis of genital endometriosis, provide surgical treatment, or further search for possible causes of infertility. The results obtained with MRI and LS were compared, and the sensitivity and specificity of MRI for diagnosing external and internal genital endometriosis were assessed.

RESULTS: According to the data obtained, the specificity of MRI for diagnosing peritoneal endometriosis was 74% (95% confidence interval [CI], 57%–85%), and the sensitivity was 94% (95% CI, 87%–99%). Diagnostic accuracy of the technique was 86% (95% CI, 79%–91%). The most frequent localization of endometrioid heterotopias was retrocervical (41%). The specificity of this technique for diagnosing endometrioid ovarian cysts was 92% (95% CI, 82%–97%), and the sensitivity amounted for 98% (95% CI, 90%–100%). Diagnostic accuracy of the technique was 94% (95% CI, 88%–96%). The specificity and sensitivity of MRI for the diagnosis of adenomyosis were 96% (95% CI, 92%–99%) and 99% (95% CI, 87%–100%), respectively. Diagnostic accuracy of the technique was 97% (95% CI, 93%–99%). Our results were consistent with the literature data on the accuracy of MRI for diagnosing endometriosis.

CONCLUSIONS: Based on the results, MRI is a promising non-invasive method for diagnosing various forms of endometriosis. The performance of a comprehensive MRI allows obtaining sufficiently accurate information about the condition of the pelvic organs, detecting the manifestations of genital endometriosis, and reducing the time for examining women with infertility.