One day, you come to the gynecology clinic because of menstrual pain. On closer questioning, you also have anal swelling and difficulty in defecating during your period, and you even experience pain during intercourse on a regular basis. Then your doctor performed a gynecological examination and found one or several small nodules at the back of the cervix or the posterior vaginal fornix, during which you felt significant pain when touched.
Tender nodule in the posterior vaginal fornix palpated during gynecological examination
Based on the clinical symptoms and gynecological examination results, your doctor determines that you may have deep infiltrative endometriosis and gives you a magnetic resonance imaging (MRI) test and recommends further investigation. You get the order and wonder: Why is the doctor prescribing an MRI? What is this? It is so much more expensive than an ultrasound! Is it really necessary?
What are the small nodules that the doctor feels?
The small nodules that “hurt when you touch them” during a gynecological examination are medically known as endometriosis lesions. This disease is called deep infiltrative endometriosis.
The endometrium that is supposed to grow inside the uterine cavity runs outside the uterus, usually settling at the lowest point of the pelvic cavity, invading the peritoneum up to 5 mm or more and forming small nodules. The presence of the nodule puts excess tension on the peritoneum and once the doctor touches it during gynecological examination, the patient feels significant pain. Similarly, if the male penis touches this nodule during intercourse, the patient will experience discomfort.
Like the normal endometrium, the ectopic endometrium at the nodule can shed blood during menstruation. The accumulation of blood increases the size of the tubercle and tends to compress the rectum, causing anal swelling and difficulty in defecation. In severe cases, the ectopic endometrium may also penetrate the entire rectal wall and blood flows down the intestine during menstruation, showing symptoms of blood in the stool.
Deeply infiltrating endometriosis penetrates the intestinal wall
It is important to emphasize that clinicians have found in large sample studies that the conception rate in patients with deep infiltrative endometriosis is close to 0%. Therefore, women of childbearing age need to be treated aggressively once deep infiltrative endometriosis is detected.
What is the purpose of MRI examination?
The management of small nodules is usually laparoscopic surgical treatment. After surgical treatment, the natural conception rate of patients with severe endometriosis can be increased to 52%-68%. However, before treatment, the gynecologist needs to make an adequate prognosis of the disease and determine the surgical approach. If the lesion has not invaded the intestinal wall and has only caused adhesions between the uterus and the intestine, the procedure can be done by the gynecologist alone; if the lesion has damaged the intestinal wall or even invaded the entire intestinal wall, the surgeon will need to treat the intestinal lesion and also prepare the intestine well before the procedure.
Laparoscopic treatment of deeply infiltrating endometriosis
How does the surgeon know which condition the patient is in? Ultrasound is the most commonly used gynecologic imaging method and is well known, even in outpatient clinics where patients request ultrasound. ultrasound technology is also developing very fast and nowadays it is possible to do three-dimensional imaging.
The latest endometriosis treatment guidelines suggest that
The role of 3-D ultrasound in the diagnosis of deeply infiltrating endometriosis has not been established. Vaginal ultrasound is highly dependent on operator skill but is usually inexperienced and is not recommended for the diagnosis of rectal endometriosis unless the surgeon performing the vaginal ultrasound is highly experienced. MRI is more objective, with high soft tissue resolution and an accuracy of 94.9% to 96% in determining the presence of lesions in the intestine.
Deeply infiltrating endometriosis lesion on MRI image
Not only that, but MRI images can also show whether pelvic organs such as the bladder and ureter are abnormal. If problems are found, the assistance of other specialists is also needed. Therefore, the MRI test recommended by your doctor is really multi-faceted and well-founded, and not just a cheap ultrasound test that can be substituted at will.
What you need to know about MRI exams
Does MRI have any radiation and is it safe for women preparing for pregnancy?
Even though you understand the importance of MRI, many of you have very serious concerns about MRI. In fact, although MRI (Magnetic Resonance Imaging) has the word “nuclear” in it, there is no radiation and there is no need to worry about it. Usually, when we do tests in the hospital, we are exposed to radiation from X-rays and CT, which are performed using X-rays. Unlike X-rays and CT, MRI exams do not require rays and can observe the human body only through the action of a magnetic field, which has almost no effect on people, so even if you are pregnant, it is safe to have an MRI exam.
What do you need to prepare before MRI examination?
1. The MRI examination process is noisy, so you can wear earplugs in advance.
2. you should also take off all your accessories and refrain from wearing makeup.
3. It is especially important to note that MRI examinations take a long time and require you to maintain a still posture so that the images made are clear and beneficial to the doctor’s judgment.
4. Other special requirements will be informed by a special doctor during the examination appointment.
As mentioned above, patients with deep infiltrative endometriosis need to be treated by multiple specialists. The best way to evaluate the condition before treatment is with an MRI. With adequate imaging evidence, the gynecologist can target and effectively communicate with the patient about treatment options.