Feasibility of periprocedural decision on the administration of intravenous contrast media in MRI for endometriosis

Objectives Endometriosis is a significant cause of chronic abdominal pain and infertility in females, often overlooked due to its resemblance to other abdominopelvic pathologies. This study aims to compare the diagnostic performance and agreement rate between an abbreviated MRI protocol (aMRI) and a full MRI protocol (fMRI) for detecting pelvic endometriosis. Methods We retrospectively analyzed 446 consecutive MRI exams, including both full (fMRI) and abbreviated (aMRI) protocols, performed for suspected pelvic endometriosis. An expert radiologist assessed the presence of endometriosis at 14 distinct anatomical sites. Each MRI protocol was interpreted in random order, with a minimum two-week interval between sessions to minimize recall bias. Agreement between the protocols was evaluated using kappa statistics. Results The average age of the patients was 34.13 years. The highest incidences of endometriosis were found in the ovaries (88.8%) and the rectouterine pouch (65%). The MRI protocols demonstrated perfect agreement (kappa coefficient = 1) for the ovaries, bladder, uterus, and cesarean section scar. High agreement was also observed in the rectum and uterine ligaments (kappa coefficients of 0.98 and 0.97). Detection of malignant transformation in existing ovarian endometriomas showed substantial concordance with a kappa coefficient of 0.66. Conclusions An abbreviated non-contrast MRI protocol exhibits diagnostic accuracy comparable to that of a comprehensive protocol in detecting pelvic endometriosis, with similar confidence and reproducibility. Advances in Knowledge This study demonstrates that an abbreviated MRI protocol is as effective as a full protocol in diagnosing pelvic endometriosis, potentially allowing for quicker, cost-effective imaging without compromising diagnostic accuracy.

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Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement

Harth,

Kaya,

Zeppernick

et al. 2023

Front. Med.

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ObjectivesThe purpose of this investigation was to evaluate the inter- and intraobserver variability of the updated #Enzian classification of endometriosis on MRI and to evaluate the influence of reader experience on interobserver concordance.MethodsThis was a prospective single-center study. All patients were included who received an MRI of the pelvis for evaluation of endometriosis between March and July 2023 and who have provided written informed consent. Images were reviewed independently for endometriosis by three radiologists, utilizing the MRI-applicable categories of the #Enzian classification. Two radiologists had experience in pelvic MRI and endometriosis imaging. One radiologist had no specific experience in pelvic MRI and received a one-hour briefing beforehand.ResultsFifty consecutive patients (mean age, 34.9 years ±8.6 [standard deviation]) were prospectively evaluated. Interobserver agreement was excellent for diagnosis of deep infiltrating endometriosis (Fleiss’ kappa: 0.89; 95% CI 0.73–1.00; p < 0.001) and endometriomas (Fleiss’ kappa: 0.93; 95% CI 0.77–1.00; p < 0.001). For the experienced readers, interobserver agreement in the assessment of compartments A, B and C was excellent (κw ranging from 0.84; 95% CI 0.71–0.97; p < 0.001 to 0.89; 95% CI 0.82–0.97; p < 0.001). For the pairings of the experienced readers to the reader without specific experience in pelvic MRI, agreement was substantial to excellent (κw ranging from 0.64; 95% CI 0.44–0.85; p < 0.001 to 0.91; 95% CI 0.84–0.98; p < 0.001). Intraobserver variability was excellent for compartments A, B and C (κw ranging from 0.85; 95% CI 0.73–0.96; p < 0.001 to 0.95; 95% CI 0.89–1.00; p < 0.001).ConclusionWith sufficient experience, the #Enzian classification enables the achievement of excellent inter- and intraobserver agreement in MRI-based diagnosis of deep infiltrating endometriosis and endometriomas.

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Feasibility of periprocedural decision on the administration of intravenous contrast media in MRI for endometriosis

Cited by 4 publications

References 23 publications

Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol?

Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol?

Refining MRI protocols for endometriosis: a comparative study of abbreviated and full MRI sequences

Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement

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