Multidetector computerized tomography enteroclysis versus magnetic resonance imaging enteroclysis in the diagnosis of colorectal endometriosis

OBJECTIVE: To compare the accuracy of multidetector computerized to- mography enteroclysis (MDCT-e) and magnetic resonance enteroclysis (MR-e) in determining the presence and the mucosa layer involvement of sig- moid and rectal endometriotic nodules. DESIGN: Single-center, prospective study. MATERIALS AND METHODS: Women with symptoms suggestive of bowel endometriosis underwent MDCT-e and MR-e. After retrograde colonic distension and injection of the intravenous contrast medium, patients were scanned on a 16-row MDCT scanner. MR-e was performed on a 1.5 T magnet using an 8 channels phased array coil; the intestinal distension was achieved by introducing in the rectum 250-300 ml of ultrasonographic gel diluted with saline solution. Radiological findings were compared with sur- gical and histological results. The McNemar’s test with the Yates continuity correction was used to compare the accuracy of the two techniques in the diagnosis of intestinal endometriosis. RESULTS: Two hundred and sixty patients were enrolled in the study; surgery demonstrated that 176 women (67.7%) had bowel endometriotic nodules. There was no difference in the accuracy of MDCT-e (98.5%) and MR-e (96.9%) in the diagnosis of sigmoid and rectal endometriosis (p 1⁄4 0.248). The sensitivity, specificity, positive predictive value, nega- tive predictive value, positive likelihood ratio and negative likelihood ra- tio of MDCT-e and MR-e were respectively 98.3%, 98.8%, 99.4%, 96.5%, 81.59, 0.02 and 97.2%, 96.4%, 98.3%, 94.1%, 26.89, 0.03. MDCT-e accuracy had higher accuracy in determining the presence of endometriotic nodules infiltrating the mucosa layer compared with MR-e (p 1⁄4 0.041). CONCLUSION: Both MDCT-e and MR-e are accurate in the diagnosis of colorectal endometriosis. MDCT-e is more accurate than MR-e in deter- mining correctly the depth of endometriotic nodule penetration in the intes- tinal wall.