A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

Fabio Barra, Ennio Biscaldi, Carolina Scala, Antonio Simone Laganà, Valerio Gaetano Vellone, Cesare Stabilini, Fabio Ghezzi, Simone Ferrero, Fabio Barra, Ennio Biscaldi, Carolina Scala, Antonio Simone Laganà, Valerio Gaetano Vellone, Cesare Stabilini, Fabio Ghezzi, Simone Ferrero

Abstract

(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2-59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.

Keywords: bowel endometriosis; bowel stenosis; computed colonography; intestinal segmental resection; rectosigmoid endometriosis; three-dimensional rectal water contrast transvaginal ultrasonography.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Same rectal endometriotic nodule (arrowheads) is shown in three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) (A) and computed tomographic colonography (CTC) (B, sagittal plane). The asterisk indicates the same rectal Houston’s valve. The nodule has largest diameter of 2.6 cm.
Figure 2
Figure 2
Rectal endometriotic nodule. (A) CTC: 3D reconstruction of dilated colon, showing rectal stenosis (arrow) by an endometriotic nodule. (B) CTC: sagittal 2D image, the rectal nodule (asterisk) causes stenosis of the intestinal lumen. (C) CTC: pseudoendoscopic view and 3D endoluminal fly-through reconstruction, showing normal rectal lumen. (D) CTC: pseudoendoscopic view and 3D endoluminal fly-through reconstruction, showing rectal stenosis by the endometriotic nodule. (E) 3D-RWC-TVS showing the rectal nodule (asterisk). The nodule has a largest diameter of 2.8 cm; the distance between the lower margin of the nodule and the anal verge is 10 cm.
Figure 3
Figure 3
(A) Difference (mm) between imaging methods and surgery in estimating the largest diameter of endometriotic rectosigmoid nodules; (B) difference (mm) between imaging methods and surgery in estimating the distance from the lowest endometriotic rectosigmoid nodule and the anal verge; (C) Difference (%) between imaging methods and surgery in estimating the stenosis of bowel lumen due to the endometriotic nodules (calculated in patients undergoing colorectal segmental resection). White circles: 3D-RWC-TVS; black triangles: CTC

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