{"paper_id":"0f156340-6eb8-4590-89b4-76ef1e93d627","body_text":"Abstract\nIn light of the rising number of patients referred for magnetic resonance imaging (MRI) due to suspected endometriosis and the high expectations of these patients, there is a need for new imaging guidelines to optimally protocol and indicate MRI and transvaginal ultrasonography (TVUS) examinations. This is crucial for accurately addressing the inquiries of gynecologists, encompassing complete mapping and preoperative staging, and facilitating effective communication with patients. In this context, the development of a standardized lexicon, as well as dedicated imaging classifications, is recommended to aid in the comprehensive management of patients.\nClinical relevance statement\nThe radiologist should use a standardized lexicon and provide a score along with details about the specific compartments affected by endometriosis disease. This helps in offering clearer guidance to the surgeon.\nKey Points\n• An optimal staging is based on the combination of clinical examination, transvaginal US, and MRI.\n• MRI is able to detect location that is hidden at the beginning of a laparoscopic surgery and thus the need for dedicated MR classifications to correctly stage the disease.\n• Deep pelvic endometriosis index (dPEI) classification is externally validated and highly correlated with operating time, hospital stay, and postoperative complications.\nAbbreviations\n- DPE:\n-\nDeep pelvic endometriosis\n- dPEI:\n-\nDeep Pelvic Endometriosis Index\n- ESUR:\n-\nEuropean Society of UroRadiology\n- MRI:\n-\nMagnetic resonance imaging\n- PE:\n-\nPhysical examination\n- SAR:\n-\nSociety of Abdominal Radiology\n- SIFEM:\n-\nSociété d’Imagerie de la Femme\n- TVUS:\n-\nTransvaginal ultrasonography\n- USL:\n-\nUterosacral ligament\nReferences\nRoman H, Chanavaz-Lacheray I, Hennetier C et al (2023) Long-term risk of repeated surgeries in women managed for endometriosis: a 1,092 patient-series. Fertil Steril 120:870–879. https://doi.org/10.1016/j.fertnstert.2023.05.156\nNisenblat V, Bossuyt PMM, Farquhar C et al (2016) Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2:CD009591. https://doi.org/10.1002/14651858.CD009591.pub2\nRoditis A, Florin M, Rousset P et al (2023) Accuracy of combined physical examination, transvaginal ultrasonography, and magnetic resonance imaging to diagnose deep endometriosis. Fertil Steril 119:634–643. https://doi.org/10.1016/j.fertnstert.2022.12.025\nBazot M, Bharwani N, Huchon C et al (2017) European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 27:2765–2775. https://doi.org/10.1007/s00330-016-4673-z\nSadowski EA, Stein EB, Thomassin-Naggara I et al (2023) O-RADS MRI after initial ultrasound for adnexal lesions: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 220:6–15. https://doi.org/10.2214/AJR.22.28084\nNajdawi M, Razakamanantsoa L, Mousseaux C et al (2023) Resolution of pain after percutaneous image-guided cryoablation of extraperitoneal endometriosis. J Vasc Interv Radiol 34:1192–1198. https://doi.org/10.1016/j.jvir.2023.03.025\nGutzeit A, Sartoretti E, Reisinger C et al (2021) Direct communication between radiologists and patients improves the quality of imaging reports. Eur Radiol 31:8725–8732. https://doi.org/10.1007/s00330-021-07933-7\nRockall AG, Justich C, Helbich T, Vilgrain V (2022) Patient communication in radiology: moving up the agenda. Eur J Radiol 155:110464. https://doi.org/10.1016/j.ejrad.2022.110464\nEnzelsberger S-H, Oppelt P, Nirgianakis K et al (2022) Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): a prospective international multicenter study. BJOG. https://doi.org/10.1111/1471-0528.17235\nThomassin-Naggara I, Lamrabet S, Crestani A et al (2020) Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod 35:1589–1600. https://doi.org/10.1093/humrep/deaa103\nThomassin-Naggara I, Monroc M, Chauveau B et al (2023) Multicenter external validation of the Deep Pelvic Endometriosis Index Magnetic Resonance Imaging Score. JAMA Netw Open 6:e2311686. https://doi.org/10.1001/jamanetworkopen.2023.11686\nRousset P, Florin M, Bharwani N et al (2023) Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging. 104(3):95–112. https://doi.org/10.1016/j.diii.2022.09.004\nJha P, Sakala M, Chamie LP et al (2020) Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY) 45:1552–1568. https://doi.org/10.1007/s00261-019-02291-x\nFunding\nThe authors state that this work has not received any funding.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Isabelle Thomassin-Naggara.\nConflict of interest\nI. Thomassin-Naggara declares remunerated lectures by General Electric, Siemens, Canon, Guerbet, Fuji, incepto, iCAD, GSK, and punctual board participation with Guerbet, Bayer, Bracco, Bard.\nNo conflict of interest directly related to the article.\nThe remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nStatistics and biometry\nNo complex statistical methods were necessary for this paper.\nInformed consent\nWritten informed consent was not required.\nEthical approval\nInstitutional Review Board approval was not required.\nStudy subjects or cohorts overlap\nNot applicable.\nMethodology\n• performed at one institution\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nThomassin-Naggara, I., Rousset, P., Touboul, C. et al. Reasons why it is time to change imaging guidelines on endometriosis. Eur Radiol 34, 6175–6181 (2024). https://doi.org/10.1007/s00330-024-10595-w\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-024-10595-w","source_license":"CC0","license_restricted":false}