Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation
Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation
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DOI：
10.1148/radiol.2343031366
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发表时间：
2005-03-01
期刊：
影响因子：
19.7
通讯作者：
Fujii, S
中科院分区：
文献类型：
--
作者：
Kataoka, ML;Togashi, K;Fujii, S
目的：回顾性评价磁共振（MR）成像对子宫内膜异位症后囊尾闭塞的准确性。材料和方法：这项回顾性研究不需要机构审查委员会的批准，但所有患者都获得了知情同意。1989年1月至2000年12月间，经组织学证实的子宫内膜异位症的57名女性（平均年龄39岁，年龄范围26-52岁）的MR图像由四位放射科医生独立进行回顾性评估。所有患者在MR成像后1个月内均行开腹或腹腔镜检查。mri图像评估子宫内膜植入物和粘连的存在和位置。磁共振图像也对五项发现的存在进行评分：子宫后屈曲，阴道后穹窿升高，肠系缩或直肠系缩外观，子宫方向，子宫和肠之间的微弱线，以及覆盖子宫浆膜表面的纤维化斑块或结节。计算五项结果和死胡同闭塞的总体诊断的观察者间一致性。敏感性、特异性、准确性、阳性预测值和阴性预测值以及K统计量。确定。结果：30例患者开腹或腹腔镜检查发现后囊死闭塞。总体而言，四位放射科医生在磁共振成像中诊断子宫内膜植入物和粘连的平均准确率分别为89.0%和76.3%。总体而言，放射科医生诊断后囊死闭塞的平均敏感性、特异性、准确性和阳性预测值和阴性预测值分别为68.4%、76.0%、71.9%、76.6%和68.5%。在子宫浆膜表面发现纤维化斑块时，准确率最高（平均值64.5%）。63.2%-91.2%的读者同意这些观点。对于存在或不存在后囊死胡同闭塞的印象，观察者之间的一致性在严重和中度之间变化：观察者之间的平均一致性为78.4%（范围，70.2%-84.2%），平均kappa为0.57（范围，0.40-0.67）。磁共振成像诊断后囊死胡同闭塞的平均准确率为71.9%。结论：这些结果表明，使用所描述的磁共振成像结果可能有助于诊断后囊尾闭塞症。(c) rsna, 2005。
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 histologically 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 K 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 kappa 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. (C) RSNA, 2005.