Rectal endometriosis: predictive MRI signs for segmental bowel resection

Area of Science:

• Radiology
• Gastroenterology
• Gynecologic Oncology

Background:

• Rectal endometriosis poses challenges in surgical planning.
• Accurate prediction of surgical approach is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the accuracy of MRI findings in predicting the necessity for segmental resection versus shaving for rectal endometriosis.
• To identify specific MRI signs predictive of surgical intervention.

Main Methods:

• Retrospective review of MRI scans from 61 patients with rectal endometriosis.
• Analysis of 7 rectal and 4 pararectal signs by two blinded radiologists.
• Comparison of MRI findings with surgical procedures (shaving vs. segmental resection).

Main Results:

• Nodular thickness (≥ 14 mm) and circumference (≥ 3/8 radii) were highly predictive of segmental resection.
• Sacro-recto-genital septum involvement was the only significant pararectal sign associated with resection.
• Combined rectal signs achieved 90.2% accuracy in predicting segmental resection.

Conclusions:

• MRI assessment of rectal and pararectal signs aids surgical decision-making for rectal endometriosis.
• Specific MRI parameters can guide the choice between conservative shaving and segmental resection.
• This imaging approach supports patient counseling and resource allocation.