Exploratory study of the interest of MR susceptibility-weighted imaging for the pre-operative assessment of pelvic endometriosis extent.

OBJECTIVE: To evaluate the performance of magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) in the assessment of endometriosis. MATERIAL AND METHODS: This prospective study was performed during the diagnostic step or the pre-operative assessment of endometriosis, between June 2017 and April 2018. The MRI was conducted with a 3T MRI device; protocol included T2W, T1W, with and without fat-saturation sequences completed with a SWI sequence: T2-star weighted angiography (SWAN). The diagnostic performance values of MRI and inter-observer agreement were first evaluated with a conventional MR protocol and then with the complementary SWAN sequence by 2 readers. MRI results were correlated with surgical findings in patients who underwent laparoscopy. RESULTS: 74 patients were included in the study, and among them 10 patients were treated by laparoscopy. 81% of the endometriosis lesions had signal losses on the SWAN sequence related to hemorrhagic character whereas only 52% of the lesions had T1-weighted hyperintense implants. Diagnostic performance of the MRI examination was improved by the use of the SWAN sequence compared to the conventional MR protocol (Se = 94% and Spe = 73% in complete protocol and Se = 88% and Spe = 69% in conventional protocol), especially for the involvement of torus uterinus, utero-sacral ligament and retro-cervical site. An excellent interobserver agreement (қ-value = 0,94) was noted between the two readers. CONCLUSION: SWI can improve the diagnostic accuracy of MRI by allowing the detection of hemorrhagic character of endometriosis lesions.

Outcome of patients with uterine fibroids after 3-month ulipristal acetate therapy.

OBJECTIVES: To determine the proportion and the characteristics of patients who did or did not respond after 3 months of ulipristal acetate (UPA) therapy. STUDY DESIGN: In this retrospective cohort study conducted in the University Hospital of Bordeaux (France) and University Medical Center Ljubljana (Slovenia), symptomatic non-menopausal patients with fibroids that qualified for surgery were pretreated by 3 months of oral UPA 5 mg/day. Clinical success was defined by normalization of the bleeding score, and/or regression of pelvic pain, and/or abdominal distension. Imaging success was defined by reduction in fibroid volume ≥ 25%. RESULTS: The clinical and imaging success rates were 54/66 (82%) and 39/66 (59%) respectively. The absence of previous pregnancy (p = 0.004) and the size of the dominant fibroid ≥ 80 mm (p = 0.004) were independent factors associated with clinical failure. Age <35 years (p = 0.02) was the only independent factor associated with imaging failure. CONCLUSION: Young women developing fibroids and/or women with large fibroids may be resistant to ulipristal acetate therapy.