{"paper_id":"9503b7a3-1120-4b8e-8ce6-7c855ca0876d","body_text":"Abstract\nObjective\nTo assess the reproducibility and the diagnostic accuracy of MRI for the assessment of (#)ENZIAN classification in patients with deep endometriosis by means of a meta-analysis.\nMaterials and methods\nMEDLINE and EMBASE databases were searched for relevant articles from January 1, 2005, to January 1, 2025. Data on MRI reproducibility (interobserver/intraobserver kappa) were extracted for P (peritoneum), O (ovary), T (tubo-ovarian condition), A (vagina/rectovaginal space), B (utero-sacral ligaments), C (rectum/sigmoid colon), FA (F adenomyosis), FB (F bladder), FU (F ureter), FI (F intestinum), and FO (F other). Pooled sensitivity, specificity, PPV, and NPV were calculated for each compartment.\nResults\nTwelve articles (1024 patients) were included, of which 7 used ENZIAN and 5 used #ENZIAN. MRI-based (#)ENZIAN showed high reliability for O, A, B, and C, with substantial or excellent agreement in most studies. MRI-based (#)ENZIAN showed high diagnostic values for O, T, A, B, and C. Sensitivity and specificity for O were 97.5% and 96.4% and for T, 94.1% and 89.1%, respectively. Sensitivity values for A, B, and C were slightly lower, but remained high at 76.1%, 83.4%, and 79.1% respectively, and specificity values were high at 92.4%, 87.8%, and 94.8%. Sensitivity values for FA, FB, and FI were low, with values of 64.6%, 56.9%, and 66.8%. Data for P, FU, and FO were insufficient and could not be pooled.\nConclusion\nMRI-based (#)ENZIAN showed high reliability for compartments O, T, A, B, and C. Data for other compartments were either insufficient or the diagnostic accuracy was low.\nKey Points\nQuestion What is the diagnostic value of MRI in the assessment of (#) ENZIAN classification in patients with deep endometriosis?\nFindings MRI-based(#)ENZIAN showed high diagnostic values for compartments O, T, A, B, and C. Data on the remaining compartments were insufficient, or the diagnostic accuracy was low.\nClinical relevance MRI-based (#) ENZIAN can be used for assessing endometriosis located at the ovaries, tubal ovarian condition, vaginal-rectovaginal space, utero-sacral ligaments, and rectosigmoid. 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This study concerns a meta-analysis.\nEthical approval\nInstitutional Review Board approval was not required because the study concerns a meta-analysis.\nMethodology\n-\nThis study concerns a meta-analysis and was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and is reported following the PRISMA guideline (preferred reporting items for systematic reviews and meta-analyses statement)\nAdditional information\nPublisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary information\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nMohamed, Y., Kol, S.Q., Stoker, J. et al. Deep endometriosis: evaluation of ENZIAN and #ENZIAN classification systems by MRI compared with surgery—a meta-analysis. Eur Radiol 36, 4489–4502 (2026). https://doi.org/10.1007/s00330-025-12154-3\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-025-12154-3","source_license":"CC0","license_restricted":false}