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ESUR consensus MRI for endometriosis: indications, reporting, and classifications.

Isabelle Thomassin-Naggara1,2, Miriam Dolciami3, Luciana P Chamie4

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Updated endometriosis guidelines recommend magnetic resonance imaging (MRI) for diagnosis when ultrasounds are inconclusive. Standardized MRI reporting, including classifications, improves communication between doctors and patients for better endometriosis care.

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Area of Science:

  • Radiology
  • Gynecology
  • Medical Imaging

Background:

  • Endometriosis diagnosis and management require accurate imaging.
  • Previous European Society of Urogenital Radiology (ESUR) guidelines for endometriosis were published in 2017.
  • Advances in Magnetic Resonance Imaging (MRI) necessitate guideline updates.

Purpose of the Study:

  • To update the ESUR guidelines for endometriosis based on recent advancements in MRI.
  • To define updated indications for MRI in endometriosis diagnosis and management.
  • To establish consensus on standardized MRI reporting and classification systems.

Main Methods:

  • A Delphi process involving 20 gynecological imaging experts from 10 countries was employed.
  • Literature research and two rounds of surveys were conducted to achieve expert consensus.
  • The focus was on MRI indications, standardized reporting, and classification systems.

Main Results:

  • MRI is recommended for inconclusive or negative transvaginal ultrasounds in symptomatic patients, pre-surgery, or post-treatment if symptoms persist.
  • A standardized MRI report, particularly using a radiological score like the deep-pelvic endometriosis index (dPEI), is strongly favored by experts (95%).
  • Experts believe MRI classification significantly improves communication between radiologists and surgeons (100%) and aids in predicting surgical outcomes and complications.

Conclusions:

  • Standardized MRI reporting, incorporating classification systems, is crucial for endometriosis management.
  • The use of optional drawings in reports can further enhance communication with patients and surgeons.
  • Updated guidelines aim to optimize the use of MRI for comprehensive endometriosis mapping and patient care.