부산대학교 도서관

Introduction. Endometriosis is a common gynecological condition among women of childbearing age, associated with chronic pelvic pain, dysmenorrhea, infertility and impaired quality of life. Although the internationally accepted gold standard is the diagnostic laparoscopy, the preoperative noninvasive diagnosis methods – clinical examination, transvaginal ultrasound and magnetic resonance imaging (MRI) – are an important step in the correct preoperative diagnosis of endometriosis. The aim of this paper is to determine the ideal method of preoperative noninvasive diagnosis depending on the symptoms and location of endometriosis lesions, whether clinical examination and transvaginal ultrasound are sufficient or when MRI examination is necessary. Methodology. We performed, on a group of 96 patients diagnosed with endometriosis, imaging examination by transvaginal ultrasound and MRI before the surgical treatment of the lesions, with the collection of biological samples for histopathological examination. The results obtained after the intervention were observed, comparing the lesions identified preoperatively with those excised during surgery. Results. MRI provides accurate information for the staging of deep endometriosis, especially when the case does not allow a transvaginal ultrasound examination – it is limited by chronic pelvic pain, virgo intacta or obese patient. MRI is used when the clinical examination and ultrasound do not identify lesions in symptomatic patients (parametric lesions, uterosacral ligaments). The association of MRI increases the sensitivity of transvaginal ultrasound in the diagnosis of endometriosis in these cases (70.3% compared to 11.3%). Large endometriosis lesions that can be easily identified on clinical examination and ultrasound do not require MRI (rectal nodules d≥2 cm, endometriomas d≥4 cm). For intestinal endometriosis, MRI and ultrasound have similar efficiency (83.78% and 87.75%). Discussion and conclusions. Although it is not a routine investigation in all patients suspected of having endometriosis, MRI is effective in identifying the lesions. It is necessary for the gynecologist to request an MRI investigation when the transvaginal ultrasound is insufficient or cannot be performed. The methods depend on the experience of the gynecologist and radiologist in making a preoperative assessment of the lesions, so that the surgical treatment is performed in the most complete way possible. [ABSTRACT FROM AUTHOR]