Utility of Magnetic Resonance Imaging in the Evaluation of Intraoperatively Confirmed Pelvic Adhesions.

OBJECTIVE: The aim of this study was to evaluate the ability of magnetic resonance imaging (MRI) to identify pelvic adhesions. DESIGN: This was an institutional review board-approved retrospective analysis. METHODS: Ninety-nine patients met inclusion criteria and constituted our study population. INCLUSION CRITERIA: patients who underwent MRI and subsequent gynecologic abdominal surgery within 6 months after MRI. All imaging and operative reports were reviewed for the presence of pelvic adhesions by independent and blinded specialists. The findings were compared to calculate MRI sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the evaluation of pelvic adhesions. RESULTS: The specificity of MRI in the detection of pelvic adhesions was greater than 90% in all locations with the exception of the posterior cul-de-sac. Accuracy was highest in the anterior cul-de-sac at 88%. The positive predictive value was greater than 85% for prediction of non-location-specific adhesions. CONCLUSIONS: Magnetic resonance imaging is very specific in the evaluation of pelvic adhesions.

Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility.

Endometriois has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. This article reviews the proposed mechanisms of endometriosis pathogenesis, its effects on fertility, and treatments of endometriosis-associated infertility. Theories on the cause of the disease include retrograde menstruation, coelomic metaplasia, altered immunity, stem cells, and genetics. Endometriosis affects gametes and embryos, the fallopian tubes and embryo transport, and the eutopic endometrium; these abnormalities likely all impact fertility. Current treatment options of endometriosis-associated infertility include surgery, superovulation with intrauterine insemination, and in vitro fertilization. We also discuss potential future treatments for endometriosis-related infertility.