Objectives
To perform a systematic review of studies comparing the diagnostic accuracy of TVS and MRI in Deep Infiltrating Endometriosis (DIE) including only studies in which patients have been underwent both techniques.

Methods
An extensive search of papers comparing TVS and MRI in DIE was performed in Medline (Pubmed) and Web of Sciences from January 1989 to January 2016. Studies were considered eligible if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE using the surgical data as a reference standard. Quality was assessed using QUADAS-2 tool. A random-effects model was used to determine overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR–) and the diagnostic odds ratio (DOR).

Results
Of the 375 citations identified, 6 studies (n=424) were considered eligible. Pooled sensitivity, specificity, LR+ and LR– of MRI in detecting DIE in the recto-sigmoid for MRI were 0.85 (95% CI, 0.78–0.90), 0.95 (95% CI, 0.83–0.99), 18.4 (95% CI, 4.7–72.4) and 0.16 (95% CI, 0.11–0.24), respectively. Pooled sensitivity, specificity, LR+ and LR– of TVS in detecting DIE in the recto-sigmoid for TVS were 0.85 (95% CI, 0.68–0.94), 0.96 (95% CI, 0.85–0.99), 20.4 (95% CI, 4.7–88.5) and 0.16 (95% CI, 0.07–0.38), respectively. DOR was 116 (95% CI, 23-585) and 127 (95% CI, 14 - 1126), respectively.

Pooled sensitivity, specificity, LR+ and LR– of MRI in detecting DIE in the rectovaginal septum for MRI were 0.66 (95% CI, 0.51–0.79), 0.97 (95% CI, 0.89–0.99), 22.5 (95% CI, 6.7–76.2) and 0.38 (95% CI, 0.23–0.52), respectively. Pooled sensitivity, specificity, LR+ and LR– of TVS in detecting DIE in the rectovaginal septum for TVS were 0.59 (95% CI, 0.26–0.86), 0.97 (95% CI, 0.94–0.99), 23.5 (95% CI, 9.1–60.5) and 0.42 (95% CI, 0.18–0.97), respectively. DOR was 65 (95% CI, 21- 204) and 56 (95% CI, 11 - 275), respectively.

Pooled sensitivity, specificity, LR+ and LR– of MRI in detecting DIE in the uterosacral ligaments for MRI were 0.70 (95% CI, 0.55–0.82), 0.93 (95% CI, 0.87–0.97), 10.4 (95% CI, 5.1–21.2) and 0.32 (95% CI, 0.20–0.51), respectively. Pooled sensitivity, specificity, LR+ and LR– of TVS in detecting DIE in the uterosacral ligaments for TVS were 0.67 (95% CI, 0.55–0.77), 0.86 (95% CI, 0.73–0.93), 4.8 (95% CI, 2.6–9.0) and 0.38 (95% CI, 0.29–0.50), respectively. DOR was 32 (95% CI, 12- 85) and 12 (95% CI, 7- 24), respectively.

Wide confidence intervals of pooled sensitivities, specificities and DOR were present for both techniques in all the considered locations. Heterogeneity was moderate or high for sensitivity and specificity for TVS and MRI in most locations assessed. According to QUADAS2, the quality of the studies was considered good for most domains of the included studies.

Conclusions
Overall diagnostic performance of TVS and MRI for detecting DIE involving recto-sigmoid, uterosacral ligaments and rectovaginal septum is similar.

Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis.

To estimate the accuracy of pelvic magnetic resonance imaging (MRI) in the diagnosis of deeply infiltrating endometriosis (DIE). A comprehensive search of the Medline, Pubmed, Lilacs, Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, and ISI Web of Science databases was conducted from January 1990 to December 2013. The medical subject headings (MeSHs) and text words “deep endometriosis”, “deeply infiltrating endometriosis”, “DIE”, “magnetic resonance”, and “MRI” were searched. Studies that compared the parameters of pelvic MRIs with those of paraffin-embedded sections for the diagnosis of DIE were included. Twenty studies were analyzed, which included 1,819 women. Pooled sensitivity and specificity were calculated across eight subgroups: for all sites, these were 0.83 and 0.90, respectively; for the bladder, 0.64 and 0.98, respectively; for the intestine, 0.84 and 0.97, respectively; for the pouch of Douglas, 0.89 and 0.94, respectively; for the rectosigmoid, 0.83 and 0.88, respectively; for the rectovaginal, 0.77 and 0.95, respectively; for the uterosacral ligaments, 0.85 and 0.80, respectively; and for the vagina and the posterior vaginal fornix, 0.82 and 0.82, respectively. In summary, pelvic MRI is a useful preoperative test for predicting the diagnosis of multiple sites of deep infiltrating endometriosis.

Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis

Imaging in multiple myeloma: How? When?

Endometriosis represents a frequently diagnosed gynecological affliction in the reproductive timespan of women, defined by symptoms ranging from pelvic pain to infertility. A complex interplay between the genetic profile, hormonal activity, menstrual cyclicity, inflammation status, and immunological factors define the phenotypic presentation of endometriosis. To date, imaging techniques represent the gold standard in diagnosing endometriosis, of which transvaginal ultrasonography and magnetic resonance imaging bring the most value to the diagnostic step. Current medical treatment options for endometriosis-associated infertility focus on either stimulating the follicular development and ovulation or on inhibiting the growth and development of endometriotic lesions. Techniques of assisted reproduction consisting of superovulation with in vitro fertilization or intrauterine insemination represent effective treatment alternatives that improve fertility in patients suffering from endometriosis. Emerging therapies such as the usage of antioxidant molecules and stem cells still need future research to prove the therapeutic efficacy in this pathology.

https://www.mdpi.com/1648-9144/56/9/460/pdf

Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches.

Purpose To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for adolescents undergoing arthroscopic femoroacetabular impingement (FAI) surgery. Methods A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered as part of the registry. MCID was calculated using a distribution-based method, and SCB was calculated using a physical function anchor question. Receiver operating characteristic analysis with area under the curve (AUC) was used for psychometric analyses. Results Forty-seven adolescents were identified. The majority of patients were female (n = 32, 68.1%) with a mean age of 16.5 (±1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport, and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%), and 10.7 (94%), respectively. Ninety-two percent of adolescents reported some form of improved hip physical ability on the anchor question. The following 1-year absolute outcome scores were significantly representative of an SCB state on the mHHS, HOS ADL, HOS Sport, and mHHS, respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), and 85.9 (0.76). Conclusions Adolescents undergoing arthroscopic FAI surgery achieve clinically significant outcome improvement. We found that the vast majority of adolescents achieve MCID on hip-specific patient-reported outcome tools. However, although adolescents readily achieve MCID, a considerable improvement in postoperative outcome score is often needed to perceive a substantial benefit (SCB). The available hip outcome tools may be subject to ceiling effects for measuring clinically significant outcome improvement in adolescents. Level of Evidence Level IV, case series.

Arthroscopic Treatment of Femoroacetabular Impingement in Adolescents Provides Clinically Significant Outcome Improvement.

The imaging techniques have a fundamental role in the diagnosis of endometriosis. Ovarian endometriosis (endometrioma) and deep endometriosis can be recognized using transvaginal ultrasound and/or magnetic resonance imaging (MRI). Although transvaginal ultrasound is the first choice of imaging modality when investigating women with pelvic pain, MRI have a role for the wider field of visions. The reproducibility of both techniques has been investigated. The three-dimensional ultrasonography has been proposed. Also studies regarding unusual localizations are reported in the literature. New insights are present about the role of imaging in the detection of the malignant transformations. This review summarizes the current evidence on the diagnostic accuracy of these two techniques in the pre-surgical assessment of endometriosis.

Role of imaging in the management of endometriosis.

The femoroacetabular impingement (FAI) is an impingement characterized by repetitive abutment between the femur and the acetabular rim during hip motion due to loss of joint clearance (Imam and Khanduja in Int Orthop 35(10):1427-1435, 2011; James et al. in AJR Am J Roentgenol 187(6):1412-1419, 2006). Femoroacetabular impingement (FAI) can be classified as either cam or pincer type, and it can be differentiated on the basis of a predominance of either a femoral or an acetabular abnormality (Pfirrmann et al. in Radiology 244(2):626, 2007; Ganz et al. in Clin Orthop Relat Res 466(2):264-272, 2008). In cases of cam FAI, the nonspherical shape of the femoral head at the femoral head-neck junction and reduced depth of the femoral waist lead to abutment of the femoral head-neck junction against the acetabular rim. In cases of pincer FAI, acetabular overcoverage limits the range of motion and leads to a conflict between the acetabulum and the femur. The most important role of preoperative MR evaluation in patients affected by FAI is the accurate assessment of the damage's extension.

Femoroacetabular impingement: role of imaging

This study compared the diagnostic value of Whole-Body Ultra Low-Dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) in identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM). Thirty-five patients with histologically proven MM underwent WBULDCT and dedicated SMRI. Unenhanced WBULDCT was performed on a 256-slice scanner, with 120 kV and 40 mAs. SMRI was performed on a 1·5T magnet, with T1-turbo spin echo and T2-short tau inversion recovery sequences on sagittal plane. WBULDCT was compared with SMRI in terms of lesion detection, pattern and bone marrow involvement. The overall concordance between WBULDCT and SMRI in lesion detection was 76·7%, detecting (25/35) or excluding (8/35) involvement of the axial skeleton, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement. The concordance in spinal distribution of lesions was 61·6% on cervical, 71·5% on dorsal, 86·4% on lumbar and 94·4% on sacral, while for the pattern of disease, it was 56·1% for the focal and 88·7% for the combined pattern. Cohen's kappa index was 0·85 (P < 0·001) assessing an excellent agreement. WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI.

Diagnostic value of whole‐body ultra‐low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma

The chronic ankle pain is a very frequent clinical problem, which is often characterized by a painful mechanical limitation of full-range ankle movement. A large amount of causes are involved in its pathogenesis, but the most common forms are secondary to an osseous or soft tissue abnormality. Especially for professional athletes, impingement lesions are the most important causes of chronic pain; however, this symptomatology can also affect ordinary people, mostly in those who work in environments that cause severe mechanical stress on the joints. This group of pathologies is characterized by a joint conflict secondary to an abnormal contact among bone surfaces or between bones and soft tissues. Diagnosis is mainly clinic and secondly supported by imaging in order to localize the critical area of impingement and determine the organic cause responsible for the joint conflict. Treatments for different forms of impingement are similar. Usually, the first step is a conservative approach (rest, physiotherapy, ankle bracing, shoe modification and local injection of corticosteroids), and only in case of unsuccessful response, the second step is the operative treatment with open and arthroscopic techniques. The aim of the study is to describe different MR imaging patterns, comparing our data with those reported in the literature, in order to identify the best accurate diagnostic protocol.

Diagnostic imaging of ankle impingement syndromes in athletes

Groin pain is a common condition in athletes, especially those who play certain sports, for instance soccer, ice hockey, fencing which request rapid acceleration and frequent changes of movement. This condition represents a diagnostic difficulty for the radiologist due to either the anatomical pubic region complexity than the many causes that can be a source of pain, because the groin pain can be determined by conditions affecting the bony structures, cartilage and muscle tendons that are part of the proper pubis but also from those involving the hip. The approach to the groin trough diagnostic imaging is multidisciplinary: The study of the patient is performed by traditional radiographs, ultrasound examination, magnetic resonance imaging or computed tomography, based on clinical suspicion, and each of these methods provides different results depending on the disease in question. The purpose of this article is to examine what are the optimal imaging techniques to investigate the various diseases affecting the patient with groin pain.

Imaging assessment of groin pain

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