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When I launched this website, I saw it primarily as a platform for healthy lifestyle articles. Then, I started writing materials about endometriosis; a disease I have been confronting with for many years. That’s how I realized a lot of women worldwide are very much interested in this topic.

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The MRI exam was a very important medical investigation I did as it offered a complete picture of the severity of my disease. In this article, I will tell you more about the MRI for endometriosis. This is a little bit different than the standard MRI. It has a special protocol for endometriosis and implies an intravaginal and intrarectal gel instillation.

Dr. Denisa Tisea, Primary Physician in Radiology and Medical Imaging, offered us an interview about this MRI for endometriosis

Dr. Tisea is specialized in this type of MRI, especially “designed” for endometriosis and works in one of the most known endometriosis centers from Romania, Endo Institute.  Dr. Tisea is the doctor who also interpreted my MRI results 4 years ago, in March 2016.

Here you can find another article where I described my experience with this type of MRI, step by step.

What is endometriosis, what are endometriosis causes and its most frequent symptoms?

Endometriosis represents the presence of tissue similar to endometrium in some other parts of the body, in pelvic or extra pelvic regions. As this tissue functions the same as endometrium it is influenced by hormonal changes and by our monthly bleeding. Thus, at each period, these lesions outside the uterine cavity could bleed and could become inflamed. Endometriosis could got worse and worse with each period and could appear adhesions and endometriosic nodules.

Endometriosis causes are not clear and fully known. At this moment, there are only some theories that talk about the “inflammatory factor”, “the genetic factor”, “retrograde menstruation” or “estrogen dominance”.

Although not a very well-known disease, it is estimated that 1 in 10 women of reproductive age worldwide has endometriosis lesions.

Endometriosis is one of the primary causes of infertility. In fact, many asymptomatic patients discover this disease after a long time of trying to conceive, without success.

Among the most frequent symptoms of endometriosis are: pelvic pain, menstrual pain, abdominal pain, pain during intercourse, heavy period, pains on urinating, pain in defecating, gastro intestinal symptoms, irregular bleeding etc.

The MRI for endometriosis – an exam that includes intravaginal and intrarectal gel instillation

The medical anamnesis, the gynecological exam and the transvaginal ultrasound - all these performed by a doctor specialized in endometriosis - are usually enough for diagnosing and staging endometriosis. Yet, on severe cases the doctor could also recommend the MRI exam, with that special protocol for endometriosis. This protocol involves an extra step, to better highlight the endometriosis lesions.  

The MRI is a precise investigation in evaluating endometriosis. It does not replace the gynaecological exam or the ultrasound, but it brings valuable extra data on what it is already known.

What is the difference between a “classic” MRI and a MRI with a protocol for endometriosis?

Besides the steps of a “classic” MRI, including the administration of the contrast agent, this special MRI involves an intrarectal and intravaginal gel instillation. If the MRI is correctly done and interpreted by a radiologist doctor with experience in this type of MRI, the results could have a 90% - 100% accuracy rate.

Endometriosic adhesions and nodules tend to form more often in the vaginal and rectal regions. Therefore, this gel instillation - the extra step of the MRI - facilitates the investigation of these particular areas.

What are the advantages of an MRI with protocol for endometriosis?

-    it does not irradiate and it is not invasive
-    it can diagnose different forms of endometriosis: ovarian endometriosis, pelvic endometriosis, extra peritoneal endometriosis
-    it brings new information that can help in staging the disease and in developing a treatment plan

Dr. Denisa Tisea – the anwers to the most frequent questions regarding the MRI for endometriosis

Dr. Denisa Tisea, Primary Physician in Radiology and Medical Imaging, works in Timisoara, Romania and she is interpreting MRI’s from many other centers all over the country.

The Healthy Journal: During what period of menstrual cycle should this type of MRI be performed?

Dr. Denisa Tisea: For the MRI exam with intravaginal and intrarectal gel instillation it is recommend a certain period of menstrual cycle: between day 10-25. Yet, patients with bleeding or spotting can do this investigation outside this time frame. For these particular cases, it is better to perform the MRI exam when the bleeding is not very heavy.

The Healthy Journal: What blood tests are necessary before doing the MRI for endometriosis?

Dr. Denisa Tisea: During the MRI exam we administrate intravenously the contrast agent. Therefore, we must know Creativine levels, to check the renal function.

The Healthy Journal: How to do the preparation for the MRI with a protocol for endometriosis?

Dr. Denisa Tisea: One day before examination, the patient must avoid fruits and vegetables that favour bloating (grapes, beans, cabbage, plums etc). One night before examination or in the morning of the exam (if the patient is not from the city where the MRI is performed), the patient will make a micro enema (bought from the pharmacy). In the day of the investigation, one should not eat or drink anything 1-2 hours prior to the MRI. Outside this time range, the patient can take her regular medication, if applicable, can eat something light in the morning and can drink coffee, tea or water.

The Healthy Journal: What are the contraindications for MRI?

Dr. Denisa Tisea: The MRI exam is contraindicated for patients with pacemaker, patients with artificial metal valves and patients with hearing aid, patients with metal prosthetics (in this case, they need to bring a note from their attending physician to verify the compatibility with the MRI). Besides, the MRI exam is not recommended for claustrophobic patients and also for pregnant women in the first quadmester.

The Healthy Journal: Can MRI be inconclusive? What are these situations?

Dr. Denisa Tisea: The MRI exam can be inconclusive if endometriosis is still on an early stage (1 and, sometimes, 2), or if the implants are microscopic, millimetre on the peritoneum. Another cause might be the deficient preparation of the patient: for example, if the patient does not make that micro enema or if she is very bloated. This investigation can be inconclusive also if the MRI machine is not advanced enough to perform this type of exam, if the exam was not correctly done or the scanning protocols were not optimized.

Dr. Denisa Tisea works in medical centres from Timisoara and Bucharest, Romania. Details about her activity you can find here.

The MRI with the protocol for endometriosis – references about it in studies or in other medical works

Because not so many endometriosis patients know about this type of special RMN, I will leave you below some of the studies or works in the medical field that discuss this subject. Over the years, there were several controversies regarding the necessity of this type of medical investigation for endometriosis.

Some doctors recognize its importance and “superiority”, others remain neutral, while some other category of doctors recommends the MRI exam with protocol for each patient with advanced endometriosis.
Moreover, a lot of patients haven’t even heard this investigation. Of course, your attending physician is the one who decides the final treatment plan recommendation, including the investigations needed. Yes, keep in mind a lot of top excision surgeons believe that the decision of operating must be taken only if the surgical procedure is absolutely necessary. The MRI exam can shed some light on this issue.

Study: Pelvic MRI: Is Endovaginal or Rectal Filling Needed?

In this complex study about the MRI with gel instillation, you will find a special section dedicated to endometriosis. Conclusions show the efficiency of this type of MRI is not very clear yet. However, the doctors involved in the study say that, from their own experience, the MRI with a protocol for endometriosis has the undeniable advantage of giving important and interesting data especially on deep infiltrating endometriosis  and  particularly for small vaginal lesions, lesions infiltrating posterior vaginal fornix and anterior rectal wall.

Study: Relevance of Imaging Examinations in the Surgical Planning of Patients with Bowel Endometriosis

This research also mentions the gel instillation procedure and describes in detail each step of this type of MRI exam. Although a complex research, specifically done for doctors, the conclusion is accessible to everyone. Deep infiltrating endometriosis usually requires a complex surgical treatment. The pre-operative preparation which also includes this MRI exam can offer a better image on the location and extent of the disease, which is the key point for the adequate surgical planning in these patients.

Study: Evaluation of the Usefulness of the MRI Jelly Method for Diagnosing Complete Cul-de-Sac Obliteration

The research made by the Japanese doctors showed that the MRI jelly method was shown to be a useful, beneficial, and minimally invasive approach in diagnosing CCDSO. The MR imaging jelly method should be recognized as a superior diagnostic approach by patients suffering from endometriosis, by gynaecologists who plan therapeutic strategies and treat these patients, by radiologists performing diagnostic imaging to provide important information for devising treatment strategies, and by all other personnel involved in the care of patients with endometriosis.

My experience with MRI exam with a protocol for endometriosis

In a further article (later edit: here it is) I will detail my experience with this type of MRI. I went through this investigation in March 2016, three months prior to my second endometriosis surgery. Now I am very well, I do not have a relapse, although in this period of time I confronted with other smaller gynaecological problems, which were not related to an endometriosis relapse. I mention I do not take birth control pills because I cannot tolerate them (I experienced severe reactions from them), I go to medical check-ups regularly, I keep the endometriosis diet and I always take some natural supplements for endometriosis (here more about it). I remind you I wrote about all these in the “Endometriosis journal” section.

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