Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR
Marc Bazot1, Adeline Gasner, Clarisse Lafont
1Department of Radiology, Tenon hospital, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France. marc.bazot@tnn.aphp.fr
Objectives:
To determine the value of postcontrast MR imaging (MRI) in cases of suspected pelvic endometriosis by assessing interobserver variability of MR imaging according to the endometriotic locations.
Methods:
This retrospective study included 158 patients with clinical suspicion of endometriosis who had undergone surgery after MRI between January 2004 and April 2009. Three radiologists with different degrees of experience were independently asked to determine the presence of rectosigmoid colon, vaginal, and bladder endometriosis using both conventional and a combination of conventional and postcontrast MRI. Descriptive analysis, ROC analysis and interobserver agreements (kappa values) were calculated.
Results:
Rectosigmoid colon, vaginal, and bladder endometriosis was present in 65, 39 and eight patients, respectively. The accuracy of conventional assessment for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.2%, 74.1% and 96.8%, and 73.4%, 76.6% and 98.7%, and 86.1%, 88.6% and 99.4%, respectively. The accuracy of conventional and postcontrast MR images for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.8%, 78.5% and 98.1%, and 83.5%, 83.5% and 99.4%, and 87.3%, 89.2% and 99.4%, respectively.
Conclusions:
Interobserver variability of MRI using conventional MRI alone is excellent for the diagnosis of DPE. No significant benefit of intravenous gadolinium, rectal or vaginal administration has been demonstrated.
Insights
Conventional magnetic resonance imaging (MRI) alone provides excellent interobserver agreement for diagnosing deep pelvic endometriosis (DPE). Postcontrast MRI did not significantly improve diagnostic accuracy for DPE.
Area of Science:
- Radiology
- Medical Imaging
- Gynecology
Background:
- Pelvic endometriosis is a condition requiring accurate diagnosis.
- Magnetic resonance imaging (MRI) is a key tool for diagnosing endometriosis.
- The role of contrast enhancement in MRI for endometriosis diagnosis requires clarification.
Purpose of the Study:
- To evaluate the diagnostic value of postcontrast MRI for pelvic endometriosis.
- To assess interobserver variability in MRI interpretation for different locations of endometriosis.
- To compare conventional MRI with contrast-enhanced MRI.
Main Methods:
- Retrospective analysis of 158 patients with suspected endometriosis who underwent surgery.
- Three radiologists independently interpreted MRI scans using conventional and postcontrast techniques.
- Interobserver agreement (kappa values) and accuracy were calculated for rectosigmoid colon, vaginal, and bladder endometriosis.
Main Results:
- Conventional MRI showed excellent interobserver agreement for diagnosing deep pelvic endometriosis (DPE).
- Accuracy for rectosigmoid colon, vaginal, and bladder endometriosis with conventional MRI ranged from 74.1% to 99.4%.
- Postcontrast MRI did not demonstrate significant improvement in diagnostic accuracy compared to conventional MRI for these locations.
Conclusions:
- Conventional MRI alone is sufficient for excellent interobserver agreement in diagnosing DPE.
- Intravenous gadolinium, rectal, or vaginal contrast administration offers no significant diagnostic benefit for endometriosis.
- Standard MRI protocols are adequate for evaluating suspected pelvic endometriosis.
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