Diagnosis of Complete Cul-De-Sac Obliteration (CCDSO) by the MRI Jelly Method

Purpose: To evaluate the usefulness of MRI jelly method (jelly method). Materials and Methods: Fifty-five patients (32.7 +/- 5 years old) with endometriosis, treated with laparoscopic surgery between January and June 2005 with preoperative MRI using the jelly method. In imaging by the jelly method. 50 mL of jelly used for ultrasound was injected into the vagina. and 150 mL of jelly diluted twice with tap water was injected into the rectum. MRI were inspected for the following seven findings: (Finding 1) Uterine position (anteflexion or retroflexion); (Finding 2) Thickness of the posterior uterine wall (adenomyosis uteri); (Finding 3) Ascites in the Douglas' pouch: (Finding 4) Elevated posterior uterine fornix; (Finding 5) Thickening of the "Haustra": (Finding 6) Elevated anterior rectal wall; and (Finding 7) Douglas' pouch lesion visualized as a high-intensity area on a T1-weighted image. The latter four findings were enhanced with the jelly method. These seven findings were examined for their correlations with video findings of adhesion during surgery. Results: CCDSO was present in 30 of 55 patients. These seven findings had accuracies of 69.1%, 70.9%, 72.7%, 74.5%, 56.4%, 83.6%, and 81.8% respectively. Findings 6 and 7 showed high accuracy. Conclusion: These two findings could only be obtained using the jelly method, indicating the usefulness of this method for diagnosing CCDSO.