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. 2014:2014:437962.
doi: 10.1155/2014/437962. Epub 2014 Apr 10.

Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration

Iwaho Kikuchi  1 , Ryohei Kuwatsuru  2 , Kana Yamazaki  2 , Jun Kumakiri  1 , Yoichi Aoki  1 , Satoru Takeda  1
Affiliations

Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration

Iwaho Kikuchi et al. Biomed Res Int. 2014.

Abstract

Objective: We conducted a single-center study to evaluate the usefulness of the magnetic resonance (MR) imaging jelly method for diagnosing endometriosis-associated adhesions in the Pouch of Douglas.

Methods: Thirty women with menstrual pain, dyspareunia, and chronic pelvic pain were enrolled in the study. All had been scheduled for laparoscopic surgery on the basis of pelvic and/or ultrasonographic (US) evaluation. All underwent MR imaging both with and without application of US jelly to the vagina and rectum. The images were compared and analyzed postsurgically in a random and blinded fashion by a radiology specialist and a radiology fellow. The radiologists' interpretations of the images were compared to the surgical findings recorded on DVDs.

Results: Adhesions in the Pouch of Douglas were found in 21 patients. The sensitivity and specificity of MR imaging without jelly administration were 85.7% and 55.6%, respectively, for the specialist and 81.0% and 55.6%, respectively, for the fellow; with jelly administration, values were 95.2% and 88.9% for the specialist and 90.5% and 66.7% for the fellow. Opacity produced by the jelly increased the sensitivity and specificity for both radiologists.

Conclusion: The MRI jelly method is a potentially useful, beneficial, and simple approach for diagnosing Pouch of Douglas adhesions.

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Figures

Figure 1
Figure 1
ROC curves. Greater sensitivity for a diagnosis of adhesions in the Pouch of Douglas was achieved for the specialist by MR imaging with jelly than by MR imaging without jelly. Greater sensitivity and specificity were achieved for the fellow by MR imaging with jelly.
Figure 2
Figure 2
(a) MR image obtained before jelly administration in a patient with endometriosis but no CCDSO. Ascites is seen in the Pouch of Douglas (white arrow). (b) MR image obtained after jelly administration in the same patient. The surface of the rectal wall has a smooth appearance, and the posterior vaginal vault (asterisk) is visualized along with the ascites in the Pouch of Douglas (white arrow). (c) Laparoscopic findings in the same patient. The posterior vaginal vault is easily visualized in the area where the handle of the manipulator (asterisk) is seen. The uterosacral ligaments are also apparent (white arrow).
Figure 3
Figure 3
(a) MR image obtained before jelly administration in a patient with ovarian cyst and CCDSO. (b) MR image obtained after jelly administration in the same patient. The posterior vaginal vault is tethered (black arrow). The rectal surface is tethered (asterisk). (c) T1WI from the same patient showing a high-intensity lesion (white arrow). (d) Pelvic laparoscopy findings in the same patient. The ovarian cyst and obliterated Pouch of Douglas are seen (white arrow).
See this image and copyright information in PMC

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