Studies looking into specialized CT techniques that are not widely available, such as CT with colonic distention by water enema or CT colonography have found these methods to be accurate for identifying and characterizing gastrointestinal tract endometriotic lesions for surgical planning. Both of these techniques allow for detection of multifocal lesions and lesions proximal to the rectosigmoid beyond the field-of-view of TVUS [81-89]. CT Pelvis Without and With IV Contrast There is no relevant literature to support the use of standard CT pelvis without and with IV contrast in the evaluation of clinically suspected rectosigmoid endometriosis. CT Pelvis Without IV Contrast There is no relevant literature to support the use of CT pelvis without IV contrast for clinically suspected rectosigmoid endometriosis. Fluoroscopy Contrast Enema Fluoroscopic enema studies allow for evaluation of the entire colon, allowing for diagnosis of cecal lesions. These studies are less specific than other imaging modalities because the cause of the mass effect on the bowel wall is not directly visualized and cannot be characterized. A study comparing double-contrast barium enema to TVUS performed with rectal water contrast shows similar accuracy for both studies with slightly better tolerance of TVUS with bowel preparation compared to barium enema [90]. MRI Pelvis Without and With IV Contrast MR pelvis is an excellent modality to detect and classify rectosigmoid bowel endometriosis for surgical planning [42,91,92]. Surgical approach can be predicted based on morphologic characteristics of lesions and quantitative assessment of lesion length, thickness, and circumferential involvement of the bowel lumen [93,94]. This information can be used to predict the type of resection that will be needed, aiding in informed decision making and treatment planning [42,91,92,94-96]. The field-of-view for pelvic MRI includes the entire rectum and sigmoid colon. The cecum and terminal ileum are often included within the field-of-view.
Endometriosis. Studies looking into specialized CT techniques that are not widely available, such as CT with colonic distention by water enema or CT colonography have found these methods to be accurate for identifying and characterizing gastrointestinal tract endometriotic lesions for surgical planning. Both of these techniques allow for detection of multifocal lesions and lesions proximal to the rectosigmoid beyond the field-of-view of TVUS [81-89]. CT Pelvis Without and With IV Contrast There is no relevant literature to support the use of standard CT pelvis without and with IV contrast in the evaluation of clinically suspected rectosigmoid endometriosis. CT Pelvis Without IV Contrast There is no relevant literature to support the use of CT pelvis without IV contrast for clinically suspected rectosigmoid endometriosis. Fluoroscopy Contrast Enema Fluoroscopic enema studies allow for evaluation of the entire colon, allowing for diagnosis of cecal lesions. These studies are less specific than other imaging modalities because the cause of the mass effect on the bowel wall is not directly visualized and cannot be characterized. A study comparing double-contrast barium enema to TVUS performed with rectal water contrast shows similar accuracy for both studies with slightly better tolerance of TVUS with bowel preparation compared to barium enema [90]. MRI Pelvis Without and With IV Contrast MR pelvis is an excellent modality to detect and classify rectosigmoid bowel endometriosis for surgical planning [42,91,92]. Surgical approach can be predicted based on morphologic characteristics of lesions and quantitative assessment of lesion length, thickness, and circumferential involvement of the bowel lumen [93,94]. This information can be used to predict the type of resection that will be needed, aiding in informed decision making and treatment planning [42,91,92,94-96]. The field-of-view for pelvic MRI includes the entire rectum and sigmoid colon. The cecum and terminal ileum are often included within the field-of-view.