Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis.

Aysun Fendal Tunca,Derya Ece Iliman,Aysegul Akdogan Gemici,Cihan Kaya

doi:10.1007/s00404-022-06451-1

Abstract

The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the #ENZIAN score. This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.

Highlights

Endometriosis is a benign chronic inflammatory disease characterized by the presence of endometrial tissue outside the uterus
magnetic resonance imaging (MRI) has higher sensitivity and specificity in showing the lesions of the compartments O, A, and B (100–100%, 100–100%, and 97–100%, respectively, p
We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B, and O

Summary

Introduction

Endometriosis is a benign chronic inflammatory disease characterized by the presence of endometrial tissue outside the uterus. Despite the different locations of the disease, dysmenorrhea, dyspareunia, dyschezia, pelvic pain, and infertility are common symptoms [2]. Even though the incidence of endometriosis is high, late diagnosis is common. It takes about 6–11 years from first symptoms to diagnosis due to the limitations of clinical experience and underestimation of the symptoms, especially in the adolescent population, and the lack of expertise in endometriosis sonography[3–4–5]. In 2014, Mederios et al published a meta-analysis in which the overall sensitivity and specificity of pelvic MRI was 83% and 90%, respectively [6]. Laparoscopy remains the gold standard for the diagnosis of the disease [1–6]

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Methods

Conclusion