Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Lucia Manganaro,Roberta Ninkova,Stefania Maria Rizzo,Maria Grazia Porpora,Carlo Catalano,Giada Ercolani,Miriam Dolciami,Sandra Ciulla,Veronica Celli,Corrado De Vito

doi:10.3390/ijerph18199949

Abstract

Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo–ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI’s inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.

Highlights

In view of the fact that magnetic resonance imaging (MRI) may replace the preoperative laparoscopic examination in patients affected by endometriosis, our study aims to evaluate the applicability and reproducibility of the ENZIAN score on MRI and aims to highlight some limitations arising from the application of a laparoscopic score to radiological images
We enrolled in our study patients who fulfilled the following criteria: (a) tubo–ovarian and/or deep endometriosis suspected at physical examination or transvaginal sonography (TVS) during gynecologic clinical assessment, (b) availability of MRI adequate protocol, (c) all pelvic MRIs included were performed at our institute, (d) availability of histopathological results from laparoscopic or laparotomic treatment, (e) preoperative assessment by pelvic MRI, and (e) patients were not assuming estro-progestin or progestin therapy
Several studies reported that MRI evaluation is highly accurate for preoperative surgical planning [10], in accordance with the European Society of Urogenital Radiology’s (ESUR) guidelines 2017 [6]; many large centers utilize these studies routinely, especially in the case of equivocal recto–vaginal, ureteral, or bladder endometriosis [18,19,20]

Summary

Introduction

Endometriosis is a benign chronic multifocal inflammatory disease characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus. It affects 10–15% of women in reproductive age and may cause non-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and is frequently associated with infertility [1,2]. The peak of incidence is between 24 and 29 years old, and the clinical diagnosis of endometriosis is generally delayed by 6–7 years due to the broad spectrum of non-specific symptoms and psychosocial factors [3].

Methods

Discussion

Conclusion