MRI as a promising tool for adhesion assessment in endometriosis: a feasibility study with laparoscopic correlation

To investigate the feasibility of magnetic resonance imaging (MRI) in detecting and classifying adhesions between pelvic organs caused by endometriosis, comparing MRI findings to those obtained by laparoscopy.

Prospective observational study conducted at two medical centres in Japan.

Tertiary referral centres for endometriosis and gynaecologic imaging.

Sixty-five women with suspected endometriosis scheduled for laparoscopic surgery were enrolled. A total of 55 were included in the final analysis following protocol compliance and image quality review.

MRI and laparoscopic assessments were independently performed to identify adhesions between the uterus, bladder, rectum, and ovaries. Adhesions were classified using a two-category scale (none vs. present) and a semi-quantitative three-category scale (none, mild, severe).

Agreement rates and Cohen's κ coefficients between MRI and laparoscopic findings for each adhesion site were assessed.

Each adhesion was identified in 1.8-67.3 % of 55 patients by MRI and 1.8-58.2 % by laparoscopy. In the two-category evaluation, overall agreement between MRI and laparoscopy was high (mean agreement rate: 77 %), though κ values ranged from - 0.02 to 0.50, indicating modest reliability. The three-category evaluation showed more variable agreement (mean agreement rate: 66 %; κ range: -0.02 to 0.41), with notable discrepancies in interpreting adhesions between the uterus and rectum, and between the ovary and rectum.

MRI could demonstrate potential to detect pelvic adhesions due to endometriosis, with moderate agreement compared to laparoscopically diagnosed results. While not yet a substitute for surgical diagnosis, MRI may serve as a non-invasive adjunct in preoperative planning and future therapeutic evaluation.