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

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.