Rectal endometriosis: predictive MRI signs for segmental bowel resection
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Rectal endometriosis: predictive MRI signs for segmental bowel resection Pascal Rousset 1,2,3 & Guillaume Buisson 1,2,3 & Jean-Christophe Lega 1,2,4 & Mathilde Charlot 2,3 & Colin Gallice 1,2,5 & Eddy Cotte 1,2,6 & Laurent Milot 1,2,3 & François Golfier 1,2,5 Received: 8 April 2020 / Revised: 31 May 2020 / Accepted: 7 August 2020 # European Society of Radiology 2020
Abstract Objective To retrospectively determine the accuracy of MRI rectal and pararectal signs in predicting the necessity for segmental resection in the case of lesions located in the rectum. Methods MR images of consecutive patients treated for rectal endometriosis over a 5-year period were reviewed in consensus by two blinded readers. A systematic analysis of 7 rectal (lesion length, transverse axis, thickness and circumference, and presence of a convex base, submucosal oedema and hyperintense cystic areas) and 4 pararectal (posterior vaginal fornix, parametrial, ureteral and sacro-recto-genital septum involvements) signs was performed for each lesion. MRI results were compared to the surgical procedure performed (shaving versus segmental resection). Results Among 61 patients studied, 32 received a segmental resection and 29, a shaving. Receiver operating characteristic curve analysis allowed determining cut-off values for length (≥ 32 mm), transverse axis (≥ 22 mm), thickness (≥ 14 mm) and circumference (≥ 3/8 radii). The 7 rectal signs, and only the sacro-recto-genital septum pararectal sign, were significantly associated with segmental resection in univariate analysis, nodular thickness ≥ 14 mm and circumference ≥ 3/8 radii being the most predictive signs (odds ratio 94.5 and 60.4, respectively). These 2 signs remained positively associated with segmental resection in multivariate analysis and, when combined, were predictive of segmental resection with an accuracy of 90.2%. Conclusion Assessing MRI rectal and pararectal signs may accurately predict the need for segmental resection versus a more conservative approach such as shaving for rectal lesion management. Key Points • MRI analysis of rectal endometriosis, taking into account rectal and pararectal signs, may assist surgeons in the decisionmaking process, in counselling patients regarding the surgical procedure and in adequately allocating resources. • Among rectal signs, nodular thickness ≥ 14 mm and a circumference ≥ 38% were the most predictive signs of segmental resection. • Among pararectal signs, only the sacro-recto-genital septum involvement was significantly associated with segmental resection. Keywords Endometriosis . Rectum . Digestive system surgical procedures . Magnetic resonance imaging
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07170-4) contains supplementary material, which is available to authorized users. * Pascal Rousset [email protected] 1
Lyon 1 Claude Bernard University, Villeurbanne, France
2
Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495 P
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