Magnetic Resonance Imaging of Deep Infiltrating Endometriosis: Comparison of 2DT2- and 3DT2-Weighted TSE Sequences

Abstract

Purpose The purpose of this study was to compare image quality and diagnostic confidence of 3DT2 (SPACE) and 2DT2 magnetic resonance (MR) imaging for the evaluation of deep infiltrating endometriosis (DIE). Methods A total of 121 patients, referred for MR imaging because of suspected DIE with bowel involvement, underwent both 2DT2 and 3DT2 MR imaging. Two independent readers assessed both datasets for presence of DIE, artefacts and overall image quality. Inter-rater agreement scores were calculated using Cohen's kappa, and image quality and diagnostic confidence scores were compared using the Wilcoxon rank sum test. Results Inter-rater agreement scores for diagnosis of DIE (located retrocervical/vaginal cuff, or involving the bowel or bladder) using both 3DT2 SPACE and 2DT2, or solely 3DT2 and 2DT2 were excellent. Diagnostic confidence scores were similar for 3DT2 and 2DT2. Analysis of the 3DT2 dataset in combination with 2DT2 showed significant higher diagnostic confidence compared with solely 2DT2 for 1 location, which differed per reader. In 2DT2, artefacts were significantly lower, and overall image quality was significantly higher (p<0.01 and p<0.001, respectively). Conclusions Although 3DT2 SPACE could replace routine 2DT2-weighted imaging, the authors prefer 2DT2 over 3D, because of significantly fewer artefacts and a higher overall image quality with almost similar diagnostic confidence scores. Thus 3DT2 might be added to the standard protocol in indistinct cases.