Cloverleaf Sign in Pelvic Magnetic Resonance Imaging for Deep Infiltrating Endometriosis: Association With Longer Operation Times, Greater Blood Loss, and Higher Rates of Bowel Resection

Objectives The aim of this study was to evaluate the significance of a new imaging sign, the “cloverleaf sign,” in diagnosing deep infiltrating endometriosis (DIE) with magnetic resonance imaging (MRI) in concordance to intraoperative findings. Materials and Methods This retrospective study included 103 patients operated during the January 2016 to June 2018 period with preoperative 1.5 T and 3 T MRI, with or without vaginal and rectal gel filling. Magnetic resonance imaging scans were read blinded to intraoperative findings by a specialized gynecologic radiologist and a junior radiologist, and then compared with intraoperative findings by looking at the operation report, postoperative diagnosis, and intraoperative images and videos by an experienced gynecologist surgeon specialized in endometriosis surgery. All endometriosis lesions were confirmed by pathology. The “cloverleaf sign” was defined as a cloverleaf-like figure in imaging morphology; the “leaves” formed by at least 3 different organs come together in the center of the figure formed by constrictive adhesions including T2-weighted (T2W) hypointense DIE. Operation times, intraoperative blood loss, and the frequency of DIE and bowel resections were analyzed in cloverleaf and noncloverleaf groups. The 2-sample Wilcoxon rank-sum (Mann-Whitney U) test and multivariate analysis of variance were used to calculate the significance of an overall impact of cloverleaf sign on operation t...
Source: Investigative Radiology - Category: Radiology Tags: Original Articles Source Type: research

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ConclusionAppendicular endometriosis can present as a submucosal tumor in the cecum without any abdominal symptoms. Appendicular endometriosis should be considered in the differential diagnosis of ileocecal submucosal tumor. Single-incision laparoscopic ileocolectomy was useful procedure for cecum tumor resection.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
AbstractWe have read the article entitled “Laparoscopic treatment of endometriosis and predictors of major complications: a retrospective cohort study” by Clarket al with great interest [1]. It has been reported that major complications following laparoscopic treatment of endometriosis are infrequent and difficult to predict by patient characteristics and preoperative imaging (magnetic resonance imaging (MRI) or ultrasound (US)).
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: LETTER TO EDITOR Source Type: research
Rationale: The purpose of this case report was to raise awareness regarding endometriosis on the surface of the uterus mimicking malignant tumor and thus manage it accurately. Patient concerns: A 40-year-old Asian woman with a 2-year history of lower abdomen pain was admitted to our department with elevated serum cancer antigen (CA) 125 level, weight loss, and pelvic mass from 20 days previously. Magnetic resonance imaging revealed a high volume of effusion in the pelvic cavity, an irregular occupying lesion on the surface of the fundus of the uterus, and multiple nodules. Diagnoses: Postoperative pathology confirm...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion Four types of USL endometriosis were summarized according to the ultrasound characteristics and the distribution of USL involvement was also concluded according to the results of surgery. TVS has significant value in diagnosis of USL endometriosis and can be used as a first-line tool for diagnosis. Ethics Statement The Medical Science Ethics Committee of Shenzhen People’s Hospital approved this study (No. 2018100). Each patient or an appropriate family member provided informed written consent to obtain clinical materials. Author Contributions YZ and BD conceived and designed the whole experiments and ...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
CONCLUSION: AWE should be kept in mind when pain or mass is detected on the abdominal wall of women who have cesarean section history. KEY WORDS: Abdominal wall endometriosis, Cesarean section, Radiology, Scar endometriosis. PMID: 30569910 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
ConclusionHIFU is a new and promising treatment option for patients with adenomyosis, but its efficacy, safety, cost‐effectiveness and fertility outcome must be evaluated by randomised control trials.This article is protected by copyright. All rights reserved.
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: State ‐of‐the‐art review Source Type: research
ConclusionsIn a tertiary referral center where about half of patients with rectosigmoid endometriosis were scheduled for conservative treatment more than eighty percent of these avoided surgery.This article is protected by copyright. All rights reserved.
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: Original Research Article Source Type: research
ConclusionPET/CT with [18F]FES was feasible and had greater accuracy than MRI, particularly in patients with previous surgery. Further studies are needed, however, to investigate its role in bowel endometriosis in sites other than recto‐sigmoid junction, nerve localization, and subcentimetric disease.
Source: Journal of Obstetrics and Gynaecology Research - Category: OBGYN Authors: Tags: Original Article Source Type: research
We report a case of a 40‐year‐old Japanese woman with a six year history of uterine leiomyoma. The patient was clinically and radiologically suspected to have degenerative uterine myoma with a possible malignant association and underwent a transabdominal total hysterectomy. Histopathological examination of the specimens revealed clear cell adenocarcinoma arising from the adenomyotic cyst. A literature review of clear cell adenocarcinomas arising from uterine adenomyotic cysts (cystic adenomyosis), emphasizes the clinically and radiologically important features of this very rare entity. Clear cell carcinoma association ...
Source: Journal of Obstetrics and Gynaecology Research - Category: OBGYN Authors: Tags: Case Report Source Type: research
Conclusions Adolescent endometriosis is not a rare condition. In our study a familial history was reported in more than one-third of patients. Among those patients treated for DIE, there was a trend for higher rates of recurrences (symptoms or lesions) that required repeat laparoscopy. However, the impact on subsequent fertility appeared to have been limited.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
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