Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification
Laurin Burla1, David Scheiner2, Andreas M Hötker3
1Department of Gynecology, University Hospital Zurich, Zurich, Switzerland. laurinburla@hotmail.com.
Purpose:
Proposal of a systematic approach to assess Deep infiltrating endometriosis (DIE) through pelvic Magnetic resonance imaging (MRI) using the Enzian classification and examination of inter-rater agreement.
Methods:
Three radiologists reviewed 23 MRI of patients with pelvic DIE at one tertiary referral center retrospectively and independently. Inclusion criteria were intraoperative confirmation of DIE and MR imaging according to ESUR (European Society of Urogenital Radiology) guidelines. Assessment of the anatomical pelvic compartments was performed using a manual based on the Enzian classification with step-by-step instructions using recommended planes and sequences presented here. Interrater agreement was measured using kappa statistics.
Results:
According to the intraoperative site lesions in 53 anatomical compartments were present. Interrater agreement was best for compartments A (0.255) and FB (0.642). For FI (0.204) and B (0.146) it was slight, there was poor agreement for C (- 0.263), FA (- 0.022), and FO (- 0.030), respectively, and as for FU, no ureter infiltration was described.
Conclusion:
MRI as a noninvasive diagnostic tool offers essential advantages regarding classification and therapy planning for patients with DIE. However, its assessment is difficult and a more systematic approach is needed. Our proposed manual based on the Enzian classification is reproducible and could support radiologists and gynecologists.
Insights
A systematic approach using Magnetic Resonance Imaging (MRI) and the Enzian classification improves assessment of Deep Infiltrating Endometriosis (DIE). This reproducible manual aids radiologists and gynecologists in DIE diagnosis and treatment planning.
Area of Science:
- Radiology
- Gynecology
- Medical Imaging
Background:
- Deep infiltrating endometriosis (DIE) poses diagnostic challenges.
- Accurate classification and therapy planning are crucial for DIE patients.
- Current MRI assessment lacks a standardized approach.
Purpose of the Study:
- To propose a systematic approach for assessing DIE using pelvic MRI.
- To evaluate the Enzian classification for DIE assessment.
- To examine inter-rater agreement for the proposed systematic approach.
Main Methods:
- Retrospective review of 23 pelvic MRI scans from patients with confirmed DIE.
- Independent assessment by three radiologists using a manual based on the Enzian classification.
- Inter-rater agreement measured using kappa statistics.
Main Results:
- The Enzian classification showed variable inter-rater agreement across different pelvic compartments.
- Best agreement was observed for compartments A and FB.
- Slight to poor agreement was noted for compartments FI, B, C, FA, and FO.
Conclusions:
- Pelvic MRI is a valuable noninvasive tool for DIE classification and therapy planning.
- A systematic approach, like the proposed Enzian-based manual, is needed to improve DIE assessment.
- The manual is reproducible and can support radiologists and gynecologists in DIE diagnosis.
