Posterior cul-de-sac obliteration associated with endometriosis

MR imaging evaluation

Milliam L. Kataoka, Kaori Togashi, Toshihide Yamaoka, Takashi Koyama, Hiroyuki Ueda, Hisataka Kobayashi, Mahbubur Rahman, Toshihiro Higuchi, Shingo Fujii

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

PURPOSE: To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis. MATERIALS AND METHODS: Institutional review board approval was not required for this retrospective study, but informed consent was obtained from all patients. MR images obtained between January 1989 and December 2000 in 57 women (mean age, 39 years; age range, 26-52 years) with historically confirmed endometriosis were retrospectively evaluated by four radiologists independently. All patients underwent laparotomy or laparoscopy less than 1 month after MR imaging. MR images were evaluated for the presence and location of endometrial implants and adhesions. MR images were also scored for the presence of five findings: retroflexed uterus, elevated posterior vaginal fornix, intestinal tethering or tethered appearance of rectum in direction of uterus, faint strands between uterus and intestine, and fibrotic plaque or nodule covering serosal surface of the uterus. Interobserver agreement for each of the five findings and for the overall diagnosis of cul-de-sac obliteration was calculated. Sensitivity, specificity, accuracy, positive and negative predictive values, and κ statistics were determined. RESULTS: Laparotomy or laparoscopy revealed posterior cul-de-sac obliteration in 30 patients. Overall, the four radiologists had mean accuracies of 89.0% and 76.3% for diagnosing endometrial implants and adhesions, respectively, at MR imaging. Overall, the radiologists achieved mean sensitivity, specificity, accuracy, and positive and negative predictive values of 68.4%, 76.0%, 71.9%, 76.6%, and 68.5%, respectively, in diagnosing posterior cul-de-sac obliteration. The best accuracy (mean value, 64.5%) was obtained with the finding of fibrotic plaque in the uterine serosal surface. Readers agreed on the observations 63.2%-91.2% of the time. For the impression of the presence or absence of posterior cul-de-sac obliteration, interobserver agreement varied between substantial and moderate: Mean interobserver agreement was 78.4% (range, 70.2%-84.2%), and mean κ was 0.57 (range, 0.40-0.67). Mean accuracy of MR imaging for diagnosing posterior cul-de-sac obliteration was 71.9%. CONCLUSION: These results suggest that use of the described MR imaging findings may enable diagnosis of posterior cul-de-sac obliteration.

Original languageEnglish (US)
Pages (from-to)815-823
Number of pages9
JournalRadiology
Volume234
Issue number3
DOIs
StatePublished - Mar 2005
Externally publishedYes

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Endometriosis
Magnetic Resonance Imaging
Uterus
Magnetic Resonance Spectroscopy
Laparoscopy
Laparotomy
Uterine Retroversion
Sensitivity and Specificity
Research Ethics Committees
Informed Consent
Rectum
Intestines
Retrospective Studies
Radiologists

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Kataoka, M. L., Togashi, K., Yamaoka, T., Koyama, T., Ueda, H., Kobayashi, H., ... Fujii, S. (2005). Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology, 234(3), 815-823. https://doi.org/10.1148/radiol.2343031366

Posterior cul-de-sac obliteration associated with endometriosis : MR imaging evaluation. / Kataoka, Milliam L.; Togashi, Kaori; Yamaoka, Toshihide; Koyama, Takashi; Ueda, Hiroyuki; Kobayashi, Hisataka; Rahman, Mahbubur; Higuchi, Toshihiro; Fujii, Shingo.

In: Radiology, Vol. 234, No. 3, 03.2005, p. 815-823.

Research output: Contribution to journalArticle

Kataoka, ML, Togashi, K, Yamaoka, T, Koyama, T, Ueda, H, Kobayashi, H, Rahman, M, Higuchi, T & Fujii, S 2005, 'Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation', Radiology, vol. 234, no. 3, pp. 815-823. https://doi.org/10.1148/radiol.2343031366
Kataoka ML, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005 Mar;234(3):815-823. https://doi.org/10.1148/radiol.2343031366
Kataoka, Milliam L. ; Togashi, Kaori ; Yamaoka, Toshihide ; Koyama, Takashi ; Ueda, Hiroyuki ; Kobayashi, Hisataka ; Rahman, Mahbubur ; Higuchi, Toshihiro ; Fujii, Shingo. / Posterior cul-de-sac obliteration associated with endometriosis : MR imaging evaluation. In: Radiology. 2005 ; Vol. 234, No. 3. pp. 815-823.
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AU - Ueda, Hiroyuki

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N2 - PURPOSE: To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis. MATERIALS AND METHODS: Institutional review board approval was not required for this retrospective study, but informed consent was obtained from all patients. MR images obtained between January 1989 and December 2000 in 57 women (mean age, 39 years; age range, 26-52 years) with historically confirmed endometriosis were retrospectively evaluated by four radiologists independently. All patients underwent laparotomy or laparoscopy less than 1 month after MR imaging. MR images were evaluated for the presence and location of endometrial implants and adhesions. MR images were also scored for the presence of five findings: retroflexed uterus, elevated posterior vaginal fornix, intestinal tethering or tethered appearance of rectum in direction of uterus, faint strands between uterus and intestine, and fibrotic plaque or nodule covering serosal surface of the uterus. Interobserver agreement for each of the five findings and for the overall diagnosis of cul-de-sac obliteration was calculated. Sensitivity, specificity, accuracy, positive and negative predictive values, and κ statistics were determined. RESULTS: Laparotomy or laparoscopy revealed posterior cul-de-sac obliteration in 30 patients. Overall, the four radiologists had mean accuracies of 89.0% and 76.3% for diagnosing endometrial implants and adhesions, respectively, at MR imaging. Overall, the radiologists achieved mean sensitivity, specificity, accuracy, and positive and negative predictive values of 68.4%, 76.0%, 71.9%, 76.6%, and 68.5%, respectively, in diagnosing posterior cul-de-sac obliteration. The best accuracy (mean value, 64.5%) was obtained with the finding of fibrotic plaque in the uterine serosal surface. Readers agreed on the observations 63.2%-91.2% of the time. For the impression of the presence or absence of posterior cul-de-sac obliteration, interobserver agreement varied between substantial and moderate: Mean interobserver agreement was 78.4% (range, 70.2%-84.2%), and mean κ was 0.57 (range, 0.40-0.67). Mean accuracy of MR imaging for diagnosing posterior cul-de-sac obliteration was 71.9%. CONCLUSION: These results suggest that use of the described MR imaging findings may enable diagnosis of posterior cul-de-sac obliteration.

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