EP916 - The Role of MRI in Predicting Colorectal Involvement of Endometriosis

Monday, May 11, 2026

1:52 PM - 1:57 PM ET

ePoster Presenter(s)

Iram S. Alam, MD (she/her/hers)

General Surgery Resident
NYU Langone Health
NYU Langone Health
Long Island City, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

DM

Damee Moon, n/a

MD/PhD Candidate
NYU Grossman School of Medicine
New York, New York, United States

Disclosure information not submitted.
Eren Esen, MD

Surgery Resident
NYU Langone Health
NYU Langone Health
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AP

Angelos Papanikolaou, MD

General Surgery Resident
NYU Langone
New York, New York, United States

Disclosure information not submitted.
BC

Betty Chang, MD

Resident
New York University
New York, New York, United States

Disclosure information not submitted.
JK

Jonah Klapholz, MD

Resident
New York University School of Medicine
New York, New York, United States

Disclosure information not submitted.
TL

Ted Teh Min Lee, MD

Director, Minimally Invasive Gynecologic Surgery
NYU Langone
New York, New York, United States

Disclosure information not submitted.

Senior Author(s)

chady Atallah, MD, FACS

Associate Professor
NYU Langone Hospital
New York, New York, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Iram S. Alam, MD: This individual has no financial relationships with ineligible companies.

Eren Esen, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: Colorectal endometriosis often requires surgical management, with options ranging from superficial shaving to discoid resection or segmental colectomy depending on depth and extent of bowel involvement. Preoperative magnetic resonance imaging (MRI) is widely employed to guide operative planning, yet its accuracy in predicting the extent of colorectal surgical intervention-particularly the need for segmental colectomy-remains uncertain.

Methods/Interventions: We retrospectively reviewed 112 patients undergoing colorectal endometriosis surgery between March 2023 and August 2025. After excluding 4 appendectomy-only cases, 108 patients were analyzed. MRI findings were categorized as tethering, mushroom cap, or mural involvement. Operative procedures were grouped into shave, discoid, or segmental colectomy. Positive and negative predictive values (PPV, NPV) were calculated for each MRI finding individually and in combination. Welch's t-test assessed whether most recent MRI-to-surgery interval influenced predictive performance.

Results/Outcomes: Shaving was the most frequent intervention (n=56), followed by segmental colectomy (n=27) and discoid (n=25). The absence of mural involvement on MRI demonstrated the greatest predictive value (NPV) for excluding the need for segmental colectomy (86.3%), while absence of mushroom cap yielded similarly high NPV (78.2%). Lack of each MRI finding (tethering, mushroom cap, or mural involvement) predicted a low likelihood of requiring discoid, with NPVs ranging from 73-80%. When none of the three findings were present, the NPV remained high for both discoid (76%) and segmental colectomy (88%). No MRI findings, individual nor combined, had significant PPV for the surgical interventions. The MRI-to-surgery interval (ranging from 16-552 days) did not significantly alter predictive accuracy (p=0.98).

Conclusion/Discussion: The absence of specific MRI findings, particularly mural involvement and mushroom cap, strongly predicts a lower likelihood of requiring more extensive colorectal surgery, such as discoid or segmental resection. An unremarkable MRI provides reassurance for the feasibility of shave excision, reinforcing its role as a noninvasive triage tool in operative planning and offering patients greater confidence in anticipating a less invasive procedure. Furthermore, the predictive value of these MRI findings does not change with increased time interval between imaging and surgery. These results highlight the value of MRI in reliably identifying those for whom limited colorectal surgical intervention will be sufficient.