The doctor felt a small painful nodule during the gynecological examination and had to add an MRI! You’ve got it wrong! One day, you come to the gynecology clinic for menstrual pain. Upon closer examination, you also have anal swelling during your period and difficulty in defecating, and you even have pain during intercourse. Then the doctor did a gynecological examination for you and found one or several small nodules at the back of the cervix or the posterior vaginal fornix, and you felt significant pain during the touching. Based on the clinical symptoms and the results of the gynecological examination, your doctor determined that you may have deep infiltrative endometriosis and gave you a magnetic resonance imaging (MRI) checklist with a recommendation for further testing. When I got the order, I wondered: Why did the doctor prescribe an MRI? What is it? It is so much more expensive than an ultrasound! Is it really necessary? What are the small nodules that the doctor felt? 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 by more than 5 mm and forming small nodules. The presence of small nodules 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 lining may also penetrate the entire rectal wall, and blood flows out along the intestine during menstruation, showing symptoms of blood in the stool. It is important to emphasize that clinicians have found in large sample studies that the conception rate of patients with deep infiltrating 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 surgery 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 surgery. How does the doctor know which condition the patient belongs to? Ultrasound is the most commonly used gynecologic imaging method and is well known, even in outpatient clinics where patients ask for ultrasound. ultrasound technology is also developing very fast and nowadays ultrasound can also do three-dimensional imaging. The latest guidelines for the management of endometriosis suggest that the role of 3D 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 a high soft tissue resolution and an accuracy of 94.9% to 96% in determining the presence of lesions in the intestine. 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 doctors 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 1. Is there any radiation and is MRI safe for women who are 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 you do not have 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 do MRI exams. 2.What do I need to prepare before MRI? You should also take off all your accessories and do not wear makeup. It is especially important to note that MRI exams 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. As mentioned above, patients with deep infiltrative endometriosis require multi-specialist consultation for multifaceted treatment. 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.