Endometriosis is a painful and debilitating disease affecting approximately 1/10 women and takes on average 7-10 years to diagnose. It occurs when tissue similar to the lining of the uterus grows outside of the uterus. This causes inflammation and pain in the abdomen. One of the main symptoms of endometriosis is dysmenorrhea which are severe menstrual cramps that can radiate to different parts of the body. Diagnosing endometriosis is not always straightforward and can be challenging to identify. Here we look at a recent Swedish paper "But It Is Only Menstrual Pain" just published in the Journal of Radiology Nursing which explored the two methods used to diagnose endometriosis: magnetic resonance imaging (MRI) and laparoscopy.
How is endometriosis usually diagnosed?
Currently the most common method to diagnosing endometriosis is through laparoscopy. This is a surgical procedure where a small camera is inserted into the abdomen to view the organs. Through this, doctors can to identify endometrial tissue outside of the uterus and to biopsy any suspected tissue for confirmation. However, this is a very invasive procedure that requires general anaesthesia. It can also be costly and time-consuming. Additionally, not all endometrial tissue is visible through laparoscopy which can make it challenging to diagnose even with it.
Can MRI's be used to diagnose endometriosis?
Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field and radio waves to create detailed images of the body's organs and tissues. MRIs are a non-invasive method that does not use radiation. It is generally safe for most people but can be expensive to get done. In recent years there has been a rise in interest in how MRI's can be used as an alternative method for diagnosing endometriosis which could speed up the diagnosis time.
In the recent Swedish paper on this, they conduct a systematic literature review of 15 research papers. This included 10 prospective studies, 4 retrospective studies, and 1 interrater agreement study. The researchers found that MRI's can correctly diagnose endometriosis in more hidden locations than laparoscopy. However, MRIs did not perform as well as other imaging alternatives for "superficial endometriosis", which makes up to 80% of all endometriosis diagnoses. In addition, the ability of using an MRI in order to diagnose endometriosis at all is highly dependant on the knowledge of the MRI operators and radiographer who interprets the images.
When are Laparoscopy's used to diagnose endometriosis?
Laparoscopy is currently considered as the gold standard for diagnosing endometriosis. This procedure allows doctors to visually view the abdominal cavity and identify any endometrial tissue outside of the uterus. Laparoscopy also allows doctors to biopsy (take a sample of) any suspected tissue in order to confirm the diagnosis of endometriosis. However, laparoscopy is an invasive procedure requiring general anaesthesia which leads to the wish to have less invasive diagnostic tools for endometriosis.
The literature review conducted by the recent Swedish paper suggests that MRI's can be a useful tool to diagnose endometriosis. This is particularly for deep infiltrating endometriosis which is hard to diagnose with a Laparoscopy. However, MRIs have limitations and may not be able to detect all types of endometriosis. It is also heavily dependant on the skill and knowledge of the radiographers in an area which is not commonly used to diagnose yet.
Laparoscopy remains the gold standard for diagnosing endometriosis. However given it is an invasive procedure that carries risks, it is not always accessible to all patients. MRIs can therefore be a useful alternative, especially for patients who cannot or are unwilling to undergo a laparoscopy.
Endometriosis is a painful and debilitating disease that affecting 1 in 10 women, yet takes up to 7 years on average to diagnose. This is because diagnosing endometriosis can be challenging and requires a surgical procedure. New methods such as the use of MRIs may provide an alternative to these invasive procedures like laparoscopy. While MRIs may not be able to detect all types of endometriosis, it can be a useful tool, particularly for types of endometriosis often missed by Laparoscopy.