MRI and rectal endoscopy sonography performance to diagnose the digestive depth infiltration of pelvic endometriosis

Arch Gynecol Obstet. 2023 Jan;307(1):51-58. doi: 10.1007/s00404-022-06532-1. Epub 2022 Apr 18.


Introduction: The main objective of this study was to evaluate the performances of MRI and rectal endoscopy sonography (RES) in predicting the depth of bowel wall infiltration by deep infiltrating endometriosis (DIE).

Material and method: We conducted a single center retrospective study from April 2014 to March 2020 including all patients who had undergone digestive tract resection (discoid or segmental) for DIE removal and who had benefited from full preoperative imaging workup based on both pelvic MRI and RES.

Results: Fifty two patients were enrolled in the study. Median age was 35.8 years (26.1-44.5 years). Indications for surgery mainly comprised chronic pelvic pain (94.2%) and infertility (36.5%). Overall, pathological examination showed digestive involvement in 92.3% of patients, while transmural infiltration was found in 38.4% of cases. In contrast, both MRI and RES suspected transmural involvement in 42 patients (80.8%). Corresponding sensitivity and specificity were 0.95 [95% CI (0.751-0.999)] and 0.28 [95% CI (0.137-0.467)], respectively. Our results revealed agreement between MRI and RES in 85% of cases with a kappa at 0.5 [95% CI (0.207-0.803), moderate agreement]. Subgroup analysis in patients with transmural MRI lesions showed a sensitivity of 0.95 [95% CI (0.740-0.999)] and a specificity of 0.13 [95% CI (0.028-0.336)].

Conclusion: Our study suggests that performing a second-line examination is not useful if there is no transmural impairment in MRI or RES. Nevertheless, the combination of these two preoperative examinations seems to be essential for the evaluation of the depth of digestive involvement of endometriosis to guide surgical management as effectively as possible. The constitution and training of multidisciplinary expert groups must be developed to be able to offer optimal patient management.

Keywords: Bowel infiltration; Deep infiltrating endometriosis; MRI; Rectal endoscopy sonography.

Publication types

  • Review

MeSH terms

  • Adult
  • Endometriosis* / diagnostic imaging
  • Endometriosis* / surgery
  • Female
  • Humans
  • Laparoscopy* / methods
  • Magnetic Resonance Imaging
  • Rectal Diseases* / diagnostic imaging
  • Rectal Diseases* / surgery
  • Rectum / diagnostic imaging
  • Rectum / pathology
  • Retrospective Studies
  • Sensitivity and Specificity