Diffusion Endometriosis MRI to Detect and Quantify Symptomatic Neurological Impairment in Pelvic Endometriosis

N/ANot Yet RecruitingNCT06908655

Assistance Publique - Hôpitaux de Paris110 enrolled

Overview

This research focuses on evaluating the ability of diffusion tensor imaging (DTI) to detect nerve damage in pelvic endometriosis. The primary objective is to visualize pelvic nerve plexuses to better understand the mechanisms of endometriosis-related neuropathic pain. Secondary objectives include comparing nerve damage between women with and without endometriosis. To answer this question, it is planned to include 110 women with symptoms compatible with endometriosis, in Paris hospitals (Hôpital Cochin and HEGP). This research is funded by Assistance Publique - Hôpitaux de Paris. The expected duration of the research is 2 years, with individual participation of 3 months. The research process will be as follows: * Visit 0 (V0): Initial consultation to assess your state of health, complete pain questionnaires (EHP5, EHP30, DN4, EVA), and obtain your informed consent. Prescription of MRI. * Visit 1 (V1): MRI with diffusion tensor imaging (DTI) within 60 days of V0. The MRI examination will be 10 minutes longer than the usual MRI. An intramuscular injection of glucagon hydrochloride will be given as part of the treatment. * Visit 2 (V2): Follow-up consultation at 3 months, where the results of the standard MRI sequences will be discussed. Research constraints and modalities: * The addition of the DTI sequence extends the routine MRI by 10 minutes. * You must attend each scheduled appointment. If you are unable to attend, please inform your doctor. * No additional medications, treatments or samples are required for this study. You will be expected to follow your usual endometriosis treatments, with no specific restrictions on the drugs used, but please report any use of alternative medicine to your doctor. No additional hospitalization is planned.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

110

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Women aged ≥ 18 years * Non-menopausal (menopause defined as absence of menstrual periods for 12 consecutive months) * Referred to the department for clinical suspicion of endometriosis on questioning Or known endometriosis * Requiring specialized MRI by a specialist in endometriosis and adenomyosis imaging for diagnosis or follow-up of endometriosis. * Patient affiliated to social security * Patient with signed informed consent * Patient with a good understanding of the French language Exclusion Criteria: * Pregnant or breast-feeding women * Contraindication to MRI: ocular metallic foreign body, pacemaker, mechanical heart valve, old vascular clips on cerebral aneurysm; * Claustrophobic patients * Contraindication to glucagen injection (anti-peristaltic); * Previous pelvic surgery; * Patient having participated in a therapeutic clinical trial involving a new molecule within 30 days prior to inclusion; * suffering from a severe chronic disease (cancer, HIV, renal failure, ongoing liver or biliary disorders, chronic inflammatory digestive disease, arthritis or other chronic respiratory disorders) or gastrointestinal disorders deemed incompatible with the conduct of the study by the investigator; * Vulnerable patients (legal protection, guardianship, curatorship); * Patients receiving State Medical Aid.

Outcomes

Primary Outcomes

At least one measurable parameter (yes/no) on tractography in patients with or without endometriosis.

Evaluate the ability of the diffusion tensor sequence to visualize normal or pathological pelvic nerve plexuses (hypogastric and sciatic) in pelvic endometriosis. These parameters will be measured on MRI tractography images.

Time frame: 3 months

Proportion of patients with at least one relevant parameter evaluated by MRI-based tractography, in patients with or without endometriosis

Number of patients (with or without endometriosis) in whom at least one parameter could be evaluated, divided by the total number of patients (with or without endometriosis) who attended an MRI-based tractography. Parameters expected to be evaluable with MRI-based tractography: * total volume * lengths * number of branches * tortuosity MRI will be exploited by independant readers, blinded from patients'clinical characteristics and diagnosis

Time frame: Between 7 and 60 days after inclusion

Secondary Outcomes

Proportion of patients with an individual relevant parameter evaluated by MRI-based tractography, in patients with or without endometriosis

Number of patients (with or without endometriosis) in whom the individual parameter could be evaluated, divided by the total number of patients (with or without endometriosis) who attended an MRI-based tractography. Individual parameters expected to be evaluable with MRI-based tractography: * total volume * lengths * number of branches * tortuosity

Time frame: Between 7 and 60 days after inclusion

Total volume evaluated by MRI-based tractography

MRI stands for "Magnetic Resonance Imaging". In patients with vs without endometriosis: comparisons between patients with vs without endometriosis. In patients with endometriosis: comparisons according to (i) presence of endometriosis lesions (yes vs no), (ii) pain type (neuropathic vs other), (iii) endometriosis phenotype (endometriom vs deep endometriosis), (iv) localisation of lesions (pelvic wall vs sacro-rectus-genitourinary blade vs iliac incisure), all subgroups evaluated at inclusion.

Time frame: Between 7 and 60 days after inclusion

Length of branches evaluated by MRI-based tractography.

Time frame: Between 7 and 60 days after inclusion

Number of branches evaluated by MRI-based tractography.

Time frame: Between 7 and 60 days after inclusion

Tortuosity evaluated by MRI-based tractography.

Time frame: Between 7 and 60 days after inclusion

Proportion of patients with nerve lesions, in patients with endometriosis

Qualitative assessment of the presence of * localised lesions * diffuse lesions along the plexus

Time frame: Baseline

Inter-reader reproductibilty of nerve lesions, in patients with endometriosis

Cohen's Kappa for reproducibility between 2 readers who performed the qualitative assessment of the presence of * localised lesions * diffuse lesions along the plexus

Time frame: Baseline

Fractional Anisotropy, in patients with vs without endometriosis

Comparisons between patients with vs without endometriosis. Individual parameters : * mean diffusity * axial diffusity * radial diffusity

Time frame: Between 7 and 60 days after inclusion

Scores at EHP5 Quality of Life questionnaires, in patients with endometriosis

EHP-5 stands for "Endometriosis Health Profiles in 5 items". The higher the worse between 0 and 100. Sum of answer at each item divided by the number of answered items. Individual item of the EHP-5.

Time frame: Baseline

Scores at EHP30 Quality of Life questionnaires, in patients with endometriosis

EHP-30 stands for "Endometriosis Health Profiles in 30 core-items". The higher the worse between 0 and 100. Sum of score at each scale divided by the number of answered scales. Individual score at each scale of the EHP-30.

Time frame: Baseline

DN4-based and visual analog scale for pain assessment, in patients with endometriosis

DN4 stands for " Douleur Neuropathique en 4 questions " or " Neuropathic pain in 4 questions ". The higher the worse between 0 and 10. VAS stands for "Visual Analog Scale". The higher the worse between 0 and 10. Score at each part of DN4 pain questionnaire. Score at part 4 on deep pain augmented by 3 items: (i) search for sensation of vice, tightness, heaviness, (ii) search for sensation of digestive or bladder spasm, (iii) pelvic floor muscle tension Individual item of DN4 pain questionnaire. Individual VAS assessing the maximum pain in the 3 months preceding the MRI, on : * dysmenorrhea * deep dyspareunia * non-cyclic chronic pelvic pains * digestive pains * urinary pains

Time frame: Baseline

VAS for pain assessement at the end of MRI-based diffusion tensor sequence, in patients with vs without endometriosis

VAS stands for "Visual Analog Scale". The higher the worse between 0 and 10. MRI stands for "Magnetic Resonance Imaging".

Time frame: Between 7 and 60 days after inclusion

Total examination duration and MRI-based sequence acquisition duration, in patients with vs without endometriosis

Time frame: Between 7 and 60 days after inclusion

Diffusion Endometriosis MRI to Detect and Quantify Symptomatic Neurological Impairment in Pelvic Endometriosis

Overview

Conditions

Interventions

Eligibility

Locations (3)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts