A small percentage of small bowel loops are also included within the field- of-view. Added MR cine sequences have been suggested to evaluate immobility from pelvic adhesions like the US sliding sign [97]. MR colonography has also been described as an accurate tool for evaluation of bowel lesions before surgery [98]. Endometriosis MRI Pelvis Without IV Contrast MRI pelvis without IV contrast is excellent for diagnosis of rectosigmoid endometriosis and for treatment planning as described in the preceding paragraph. Assessment of ovarian lesions, or other pelvic pathology, is a finding that is often seen in association with rectosigmoid endometriosis and is limited without IV contrast. US Pelvis Transabdominal Transabdominal US imaging cannot be used to evaluate rectosigmoid lesions but can be used as an adjunct to identify sites of bowel involvement beyond the pelvis including the appendix, terminal ileum, cecum, and sigmoid [14]. US Pelvis Transabdominal and US Pelvis Transvaginal A study evaluating a combined transabdominal US and TVUS protocol found excellent sensitivity and specificity for rectosigmoid lesions and slightly decreased sensitivity for sigmoid lesions. The study did not report data on more proximal lesions [80]. As described in the previous paragraph, other studies have shown that transabdominal pelvis US can be used to evaluate the appendix, terminal ileum, cecum, and sigmoid colon, and therefore the addition of transabdominal imaging is likely to be of benefit in evaluating lesions proximal to the rectosigmoid. US Pelvis Transrectal Transrectal pelvic US allows for evaluation of the bowel wall layers involved by an endometriotic lesion, which can help with surgical planning, as rectosigmoid endometriotic lesions involving the muscular layer may require discoid or segmental resection, whereas more superficial lesions can be treated with rectal shaving.
Endometriosis. A small percentage of small bowel loops are also included within the field- of-view. Added MR cine sequences have been suggested to evaluate immobility from pelvic adhesions like the US sliding sign [97]. MR colonography has also been described as an accurate tool for evaluation of bowel lesions before surgery [98]. Endometriosis MRI Pelvis Without IV Contrast MRI pelvis without IV contrast is excellent for diagnosis of rectosigmoid endometriosis and for treatment planning as described in the preceding paragraph. Assessment of ovarian lesions, or other pelvic pathology, is a finding that is often seen in association with rectosigmoid endometriosis and is limited without IV contrast. US Pelvis Transabdominal Transabdominal US imaging cannot be used to evaluate rectosigmoid lesions but can be used as an adjunct to identify sites of bowel involvement beyond the pelvis including the appendix, terminal ileum, cecum, and sigmoid [14]. US Pelvis Transabdominal and US Pelvis Transvaginal A study evaluating a combined transabdominal US and TVUS protocol found excellent sensitivity and specificity for rectosigmoid lesions and slightly decreased sensitivity for sigmoid lesions. The study did not report data on more proximal lesions [80]. As described in the previous paragraph, other studies have shown that transabdominal pelvis US can be used to evaluate the appendix, terminal ileum, cecum, and sigmoid colon, and therefore the addition of transabdominal imaging is likely to be of benefit in evaluating lesions proximal to the rectosigmoid. US Pelvis Transrectal Transrectal pelvic US allows for evaluation of the bowel wall layers involved by an endometriotic lesion, which can help with surgical planning, as rectosigmoid endometriotic lesions involving the muscular layer may require discoid or segmental resection, whereas more superficial lesions can be treated with rectal shaving.