Objectives: To evaluate the sacral nerve root features by the means of magnetic resonance imaging-diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery. Design: A cross-sectional, observational study (Canadian Task Force classification II-2). Setting: University hospital. Patients: Women (n = 76) with clinical suspicion of endometriosis. Interventions: Before surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients. Measurements and main results: Our findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE. Conclusion: The presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis.

The role of MRI-DTI in predicting pain related to endometriosis: a preliminary study / Porpora, Maria Grazia; Vinci, Valeria; De Vito, Corrado; Migliara, Giuseppe; Anastasi, Emanuela; Ticino, Adele; Resta, Serena; Catalano, Carlo; Benedetti Panici, Pierluigi; Manganaro, Lucia. - In: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY. - ISSN 1553-4650. - STAMPA. - 25:4(2018), pp. 661-669. [10.1016/j.jmig.2017.10.033]

The role of MRI-DTI in predicting pain related to endometriosis: a preliminary study

Porpora, Maria Grazia
Primo
;
Vinci, Valeria
Secondo
;
De Vito, Corrado;Migliara, Giuseppe;Anastasi, Emanuela;Ticino, Adele;Resta, Serena;Catalano, Carlo;Benedetti Panici,Pierluigi
Penultimo
;
Manganaro, Lucia
Ultimo
2018

Abstract

Objectives: To evaluate the sacral nerve root features by the means of magnetic resonance imaging-diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery. Design: A cross-sectional, observational study (Canadian Task Force classification II-2). Setting: University hospital. Patients: Women (n = 76) with clinical suspicion of endometriosis. Interventions: Before surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients. Measurements and main results: Our findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE. Conclusion: The presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis.
2018
MRI; tractography; endometriosis; pelvic pain,
01 Pubblicazione su rivista::01a Articolo in rivista
The role of MRI-DTI in predicting pain related to endometriosis: a preliminary study / Porpora, Maria Grazia; Vinci, Valeria; De Vito, Corrado; Migliara, Giuseppe; Anastasi, Emanuela; Ticino, Adele; Resta, Serena; Catalano, Carlo; Benedetti Panici, Pierluigi; Manganaro, Lucia. - In: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY. - ISSN 1553-4650. - STAMPA. - 25:4(2018), pp. 661-669. [10.1016/j.jmig.2017.10.033]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1082981
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