Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification

Burla, Laurin; Scheiner, David; Hötker, Andreas M.; Meier, Andreas; Fink, Daniel; Boss, Andreas; Imesch, Patrick

doi:10.1007/s00404-020-05892-w

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…In this MRI and operative scores showed signi cant agreement regarding compartments A, B, O, and C, which was compatible with previous studies using the previous ENZIAN classi cation [10][11][12]. Our results demonstrated 100% speci city and sensitivity of MRI in the evaluation of rectovaginal septum and posterior vaginal fornix considering (compartment A) the #ENZIAN classi cation.…”

Section: Discussionsupporting

confidence: 90%

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis

Tunca

Ilıman

Gemici

et al. 2022

Arch Gynecol Obstet

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The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative ndings of deep in ltrating endometriosis using the #ENZIAN score. MethodsThis retrospective study included 64 patients who underwent surgery for deep in ltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classi cation. Operative scores were considered the gold standard, and the sensitivity, speci city, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. ResultsMRI has higher sensitivity and speci city in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p<0.001) compared to the other compartments. The lowest sensitivity, speci city, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). ConclusionWe demonstrated that the #ENZIAN classi cation in MRI reports has signi cant sensitivity and speci city in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.

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Section: Discussionsupporting

confidence: 90%

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis

Tunca

Ilıman

Gemici

et al. 2022

Arch Gynecol Obstet

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“…They found excellent inter-reader agreement for A and C compartments but poor agreement for the B compartment, in accordance with previous publications by Saba et al (2010) and Bazot et al (2011) [ 29 , 30 , 31 ]. On the other hand, the recent trial conducted by Burla et al (2020), which consisted of 21 cases of DIE, showed an overall lower concordance, with a particularly weak inter-rater agreement for compartment C [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Manganaro

Celli

Dolciami

et al. 2021

IJERPH

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Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo–ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI’s inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.

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“…Several studies have investigated use of the Enzian classification in conjunction with MRI, reporting good agreement rates between radiological and surgical findings except for B-compartment lesions ( Di Paola et al , 2015 ; Burla et al , 2019 ; Widschwendter et al , 2022 ; Fendal Tunca et al , 2023 ). Manganaro et al (2021) and Burla et al (2021) showed that the Enzian classification based on MRI findings is also reproducible. In addition, Thomassin-Naggara et al (2020) demonstrated that, for DE lesions in compartments A and C, using MRI in conjunction with Enzian classification was accurate in predicting operating time, hospital stay, and postoperative complications according to the Clavien–Dindo classification.…”

Section: Literature Reviewmentioning

confidence: 94%

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement,

Condous,

Gerges,

Thomassin-Naggara

et al. 2024

Human Reproduction Open

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The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers, and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling, and planning of surgical treatment strategies.

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Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification

Cited by 20 publications

References 25 publications

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement,

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