rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2014-0-3-24-34rentrad-30Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS OF LITERATUREВОЗМОЖНОСТИ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ В ДИАГНОСТИКЕ ТАЗОВОГО ИНФИЛЬТРАТИВНОГО ЭНДОМЕТРИОЗАCAPABILITIES OF MAGNETIC RESONANCE IMAGING TO DIAGNOSE INFILTRATING PELVIC ENDOMETRIOSISПучковаЕ. Н.PuchkovaE. N.

к. м. н., врач-рентгенолог

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, Radiologist

Ivan’kovskoe shosse, 3, Moscow, 125367

milleyk@mail.ruМершинаЕ. А.MershinaE. A.

к. м. н., заведующая отделением томографии

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, Head of Department of Tomography

Ivan’kovskoe shosse, 3, Moscow, 125367

СиницынВ. Е.SinitsynV. E.

д. м. н., профессор, директор Центра лучевой диагностики ЛРЦ

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, DSc, Professor, Director of Center of Radiology of Federal Center of Treatment and Rehabilitation 

Ivan’kovskoe shosse, 3, Moscow, 125367

ФГБУ «Лечебно-реабилитационный центр» Министерства здравоохранения РФРоссияFederal Center of Treatment and Rehabilitation, Ministry of Health of the RFRussian Federation201427022016032434Copyright © Пучкова Е.Н., Мершина Е.А., Синицын В.Е., 20162016Пучкова Е.Н., Мершина Е.А., Синицын В.Е.Puchkova E.N., Mershina E.A., Sinitsyn V.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/30

Глубокий инфильтративный эндометриоз – заболевание у женщин репродуктивного возраста, приводящее к хроническим тазовым болям различной степени выраженности и бесплодию, требующее хирургического лечения.

Целью исследования являлись определение возможностей магнитно-резонансной томографии (МРТ) в диагностике тазового эндометриоза, а также разработка оптимального протокола сканирования при подозрении на данное заболевание.

Согласно полученным результатам, МР-томография органов малого таза имеет высокую точность в диагностике эндометриоза и позволяет визуализировать большинство эндометриоидных имплантов, в том числе находящихся под спайками и в субперитонеальных отделах. Тем не менее врачу лучевой диагностики не следует забывать о достаточно низкой информативности МР-томографии в выявлении эндометриоза кишечника. В связи с этим при диагнозе глубокого инфильтративного эндометриоза МР-исследование целесообразно дополнять более информативным в данном случае трансвагинальным ультразвуковым исследованием для выявления эндометриоидных имплантов на стенках кишечника. 

Deep infiltrating endometriosis is a disease in reproductiveaged women, resulting in varying chronic pelvic pains and infertility, which requires surgical treatment.

Objective – to determine the capabilities of magnetic resonance imaging (MRI) to diagnose pelvic endometriosis and to elaborate an optimal scanning protocol if this disease is suspected.

Small pelvic MRI has a high accuracy in the diagnosis of endometriosis and can visualize most endometrioid implants, including those that are located under adhesions and in the subperitoneal regions. Just the same, a radiodiagnostician should not forget that MRI is of low informative value in identifying bowel endometriosis. Hence, when diagnosing deep infiltrating endometriosis, MRI should be complemented with transvaginal ultrasonography to detect endometrioid implants on the bowel walls as the informative value in this aspect is above.

тазовый эндометриозглубокий инфильтративный эндометриозмагнитно-резонансная томографиядиагностикаpelvic endometriosisdeep infiltrating endometriosismagnetic resonance imagingdiagnosisReferencesChoudhary S., Fasih N., Paradatos D., Surabhi V.R. Unusual imaging appearances of endometriosis. Am. J. Roentgenol. 2009; 192 (6): 1632–44.Choudhary S., Fasih N., Paradatos D., Surabhi V.R. Unusual imaging appearances of endometriosis. Am. J. Roentgenol. 2009; 192 (6): 1632–44.Woodward P.J., Sohaey R., Mezzetti T.P. Jr. Endometriosis: radiologic-pathologic correlation. RadioGraphics. 2001; 21 (1): 193–216.Woodward P.J., Sohaey R., Mezzetti T.P. Jr. Endometriosis: radiologic-pathologic correlation. RadioGraphics. 2001; 21 (1): 193–216.Труфанов Г.Е., Панов В.О. (ред.) Руководство по лучевой диагностике в гинекологии. СПб.: ЭЛБИ-СПб; 2008. Trufanov G.E., Panov V.O. (eds). Radiologic guidelines in gynaecolo￾gy. St. Petersburg: ELBI-SPb; 2008 (in Russian).Труфанов Г.Е., Панов В.О. (ред.) Руководство по лучевой диагностике в гинекологии. СПб.: ЭЛБИ-СПб; 2008. Trufanov G.E., Panov V.O. (eds). Radiologic guidelines in gynaecolo￾gy. St. Petersburg: ELBI-SPb; 2008 (in Russian).Practice bulletin no.114: management of endometriosis. Obstet. Gynecol. 2010; 116 (1): 223–36.Practice bulletin no.114: management of endometriosis. Obstet. Gynecol. 2010; 116 (1): 223–36.Giudice L.C., Kao L.C. Endometriosis. Lancet. 2004; 364 (9447): 1789–99.Giudice L.C., Kao L.C. Endometriosis. Lancet. 2004; 364 (9447): 1789–99.Адамян Л.В., Кулаков В.И., Андреева Е.Н. Эндометриозы (Руководство для врачей). М.: Медицина; 2006. Adamyan L.V., Kulakov V.I., Andreeva E.N. Endometriosis (Gui￾delines for radiologist). Moscow: Meditsina; 2006 (in Russian).Адамян Л.В., Кулаков В.И., Андреева Е.Н. Эндометриозы (Руководство для врачей). М.: Медицина; 2006. Adamyan L.V., Kulakov V.I., Andreeva E.N. Endometriosis (Gui￾delines for radiologist). Moscow: Meditsina; 2006 (in Russian).Matalliotakis I.M., Arici A., Cakmak H., Goumenou A.G., Koumantakis G., Mahutte N.G. Familial aggregation of endometriosis in the Yale Series. Arch. Gynecol. Obstet. 2008; 278 (6): 507–11.Matalliotakis I.M., Arici A., Cakmak H., Goumenou A.G., Koumantakis G., Mahutte N.G. Familial aggregation of endometriosis in the Yale Series. Arch. Gynecol. Obstet. 2008; 278 (6): 507–11.Redwine D.B., Wright J.T. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil. Steril. 2001; 76 (2): 358–65.Redwine D.B., Wright J.T. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil. Steril. 2001; 76 (2): 358–65.Bulun S.E. Endometriosis. N. Engl. J. Med. 2009; 360 (3): 268–79.Bulun S.E. Endometriosis. N. Engl. J. Med. 2009; 360 (3): 268–79.Del Frate C., Girometti R., Pittino M., Del Frate G., Bazzocchi M., Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. RadioGraphics. 2006; 26 (6): 1705–18.Del Frate C., Girometti R., Pittino M., Del Frate G., Bazzocchi M., Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. RadioGraphics. 2006; 26 (6): 1705–18.Chapron C., Dubuisson J.B., Pancini V. et al. Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J. Am. Assoc. Gynecol. Laparosc. 2002; 9 (2): 115–9.Chapron C., Dubuisson J.B., Pancini V. et al. Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J. Am. Assoc. Gynecol. Laparosc. 2002; 9 (2): 115–9.Kirkpatrick A., Reed C.M., Bui￾Mansfield L.T., Russell M.J., Whitford W. Radiologic-pathologic correlation of Brooke Army Medical Center: endometriosis of the canal of Nuch. Am. J. Roentgenol. 2006; 186 (1): 56–7.Kirkpatrick A., Reed C.M., Bui￾Mansfield L.T., Russell M.J., Whitford W. Radiologic-pathologic correlation of Brooke Army Medical Center: endometriosis of the canal of Nuch. Am. J. Roentgenol. 2006; 186 (1): 56–7.Zhu L., Lang J., Wong F., Guo L. Perineal endometriosis without perineal trauma: a case report. Chin. Med. J. (Engl.). 2003; 116 (4): 639–40.Zhu L., Lang J., Wong F., Guo L. Perineal endometriosis without perineal trauma: a case report. Chin. Med. J. (Engl.). 2003; 116 (4): 639–40.Clement P.B. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv. Anal. Pathol. 2007; 14 (4): 241–60.Clement P.B. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv. Anal. Pathol. 2007; 14 (4): 241–60.Bazot M., Lafont C., Rouzier R., Roseau G., Thomassin-Naggara I., Daraї E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009; 92 (6): 1825–33.Bazot M., Lafont C., Rouzier R., Roseau G., Thomassin-Naggara I., Daraї E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009; 92 (6): 1825–33.Abrão M.S., Gonçalves M.O., Dias J.A. Jr, Podgaec S., Chamié L.P., Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum. Reprod. 2007; 22 (12): 3092–97.Abrão M.S., Gonçalves M.O., Dias J.A. Jr, Podgaec S., Chamié L.P., Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum. Reprod. 2007; 22 (12): 3092–97.Chamié L.P., Blasbalg R., Gonçalves M.O., Carvalho F.M., Abrão M.S., de Oliveira I.S. Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis. Int. J. Gynaecol. Obstet. 2009; 106 (3): 198–201.Chamié L.P., Blasbalg R., Gonçalves M.O., Carvalho F.M., Abrão M.S., de Oliveira I.S. Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis. Int. J. Gynaecol. Obstet. 2009; 106 (3): 198–201.Coutinho A. Jr, Bittencourt L.K., Pires C.E., Junqueira F. et al. MR imaging in deep pelvic endometriosis: a pictorial essay. RadioGraphics. 2011; 31 (2): 549–67.Coutinho A. Jr, Bittencourt L.K., Pires C.E., Junqueira F. et al. MR imaging in deep pelvic endometriosis: a pictorial essay. RadioGraphics. 2011; 31 (2): 549–67.Демидов В.Н., Зыкин Б.И. Ультразвуковая диагностика в гинекологии. М.: Медицина; 1990. Demidov V.N., Zykin B.I. Ultrasonography in gynaecology. Moscow: Meditsina; 1990 (in Russian).Демидов В.Н., Зыкин Б.И. Ультразвуковая диагностика в гинекологии. М.: Медицина; 1990. Demidov V.N., Zykin B.I. Ultrasonography in gynaecology. Moscow: Meditsina; 1990 (in Russian).Roseau G., Dumontier I., Palazzo L. et al. Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications. Endoscopy. 2000; 32 (7): 525–30.Roseau G., Dumontier I., Palazzo L. et al. Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications. Endoscopy. 2000; 32 (7): 525–30.Balleyguier C., Chapron C., Dubuisson J.B. et al. Comparison of magnetic resonance imaging and transvaginal ultrasonography in diagnosing bladder endometriosis. J. Am. Assoc. Gynecol. Laparosc. 2002; 9 (1): 15–23.Balleyguier C., Chapron C., Dubuisson J.B. et al. Comparison of magnetic resonance imaging and transvaginal ultrasonography in diagnosing bladder endometriosis. J. Am. Assoc. Gynecol. Laparosc. 2002; 9 (1): 15–23.Anaf V., Simon P., Fayt I., Noel J. Smooth muscles are frequent components of endometriotic lesions. Hum. Reprod. 2000; 15 (4): 767–71.Anaf V., Simon P., Fayt I., Noel J. Smooth muscles are frequent components of endometriotic lesions. Hum. Reprod. 2000; 15 (4): 767–71.Siegelman E.S., Outwater E.K. Tissue characterization in the female pelvis by means of MR imaging. Radiology. 1999; 212 (1): 5–18.Siegelman E.S., Outwater E.K. Tissue characterization in the female pelvis by means of MR imaging. Radiology. 1999; 212 (1): 5–18.Abrão M.S., Podgaec S., Dias J.A. Jr et al. Deeply infiltrating endometriosis affecting the rectum and lymph nodes. Fertil. Steril. 2006; 86 (3): 543–7.Abrão M.S., Podgaec S., Dias J.A. Jr et al. Deeply infiltrating endometriosis affecting the rectum and lymph nodes. Fertil. Steril. 2006; 86 (3): 543–7.Westney O.L., Amundsen C.L., McGuire E.J. Bladder endometriosis: conservative management. J. Urol. 2000; 163 (6): 1814–7.Westney O.L., Amundsen C.L., McGuire E.J. Bladder endometriosis: conservative management. J. Urol. 2000; 163 (6): 1814–7.Pérez-Utrilla Pérez M., Aguilera Bazán A., Alonso Dorrego J.M. et al. Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urology. 2009; 73 (1): 47–51.Pérez-Utrilla Pérez M., Aguilera Bazán A., Alonso Dorrego J.M. et al. Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urology. 2009; 73 (1): 47–51.Balleyguier C., Roupret M., Nguyen T., Kinkel K., Helenon O., Chapron C. Ureteral endometriosis: the role of magnetic resonance imaging. J. Am. Assoc. Gynecol. Laparosc. 2004; 11 (4): 530–6.Balleyguier C., Roupret M., Nguyen T., Kinkel K., Helenon O., Chapron C. Ureteral endometriosis: the role of magnetic resonance imaging. J. Am. Assoc. Gynecol. Laparosc. 2004; 11 (4): 530–6.Seracchioli R., Mabrouk M., Manuzzi L. et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J. Minim. Invasive Gynecol. 2008; 15 (4): 435–9.Seracchioli R., Mabrouk M., Manuzzi L. et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J. Minim. Invasive Gynecol. 2008; 15 (4): 435–9.Umaria N., Olliff J.F. Imaging features of pelvic endometriosis. Br. J. Radiol. 2001; 74 (882): 556–62.Umaria N., Olliff J.F. Imaging features of pelvic endometriosis. Br. J. Radiol. 2001; 74 (882): 556–62.Сидорова И.С., Коган Е.А., Унанян А.Л., Гуриев Т.Д. Клинико-морфологические особенности эндометриоза яичников. Акушерство и гинекология. 2005; 6. Sidorova I.S., Kogan E.A., Unanyan A.L., Guriev T.D. Clinical and morphological features of ovarian endometriosis. Akusherstvo i ginekologiya. 2005; 6 (in Russian).Сидорова И.С., Коган Е.А., Унанян А.Л., Гуриев Т.Д. Клинико-морфологические особенности эндометриоза яичников. Акушерство и гинекология. 2005; 6. Sidorova I.S., Kogan E.A., Unanyan A.L., Guriev T.D. Clinical and morphological features of ovarian endometriosis. Akusherstvo i ginekologiya. 2005; 6 (in Russian).Chamié L.P., Blasbalg R., Pereira R.M., Warmbrand G., Serafini P.C. Findings of pelvic endometriosis at transvaginal ultrasound, magnetic resonance imaging, and laparoscopy. RadioGraphics. 2011; 31 (4): 77–100.Chamié L.P., Blasbalg R., Pereira R.M., Warmbrand G., Serafini P.C. Findings of pelvic endometriosis at transvaginal ultrasound, magnetic resonance imaging, and laparoscopy. RadioGraphics. 2011; 31 (4): 77–100.Chapron C., Pietin-Vialle C., Borghese B., Davy C., Foulot H., Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil. Steril. 2009; 92 (2): 453–7.Chapron C., Pietin-Vialle C., Borghese B., Davy C., Foulot H., Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil. Steril. 2009; 92 (2): 453–7.Guerriero S., Ajossa S., Garau N., Alkazar J.L., Mais V., Melis G.B. Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography. Fertil. Steril. 2010; 94 (2): 742–6.Guerriero S., Ajossa S., Garau N., Alkazar J.L., Mais V., Melis G.B. Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography. Fertil. Steril. 2010; 94 (2): 742–6.Kataoka M.L., Togashi K., Yamaoka T. et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005; 234 (3): 815–23.Kataoka M.L., Togashi K., Yamaoka T. et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005; 234 (3): 815–23.Chamié L.P., Pereira R.M., Zanatta A., Serafini P.C. Transvaginal US after bowel preparation for deeply infiltrating endometriosis: protocol, imaging appearances, and laparoscopic correlation. RadioGraphics. 2010; 30 (5): 1235–49Chamié L.P., Pereira R.M., Zanatta A., Serafini P.C. Transvaginal US after bowel preparation for deeply infiltrating endometriosis: protocol, imaging appearances, and laparoscopic correlation. RadioGraphics. 2010; 30 (5): 1235–49Piketti M., Chopin N., Dousset B. et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum. Reprod. 2009; 24 (3): 602–7.Piketti M., Chopin N., Dousset B. et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum. Reprod. 2009; 24 (3): 602–7.

The authors declare that there are no conflicts of interest present.