{"paper_id":"a5fcf47e-2a12-4d60-adda-d1a1091e80a7","body_text":"Best Practices: Ultrasound Versus MRI in the Assessment of Pelvic Endometriosis\nAbstract\nClinical Vignettes and Images\nThe Imaging Question\nBackground\nEpidemiology\nImaging Appearance\nRole of Imaging\nImaging Techniques\n| Sequence | Plane or FOV |\n|---|---|\n| T2-weighted TSE without FS | Axial (including small FOV) and sagittal, with or without coronal |\n| T1-weighted GRE in- and opposed-phase | Axial |\n| DWI with ADC mapping | Axial |\n| T1-weighted GRE with FS without IV contrast material | Axial and sagittal, with or without coronal |\n| T1-weighted GRE with FS with IV contrast material and subtraction | Axial and sagittal, with or without coronal |\n| T2-weighted SSFSE (optional) | Large FOV that includes the kidneys for evaluation of hydronephrosis |\nNote—TSE = turbo spin-echo, FS = fat suppression, GRE = gradient-recalled echo.\nSynopsis and Synthesis of Evidence\nLiterature Review\n| First Author [Reference] | Year | Risk of Bias | Applicability Concerns | |||||\n|---|---|---|---|---|---|---|---|---|\n| Patient Sel | Index Test | Ref | Flow and Timing | Patient Sel | Index Test | Ref | ||\n| Alborzi [21] | 2018 | High | High | High | High | High | High | High |\n| Alborzi [20] | 2023 | High | High | High | High | High | High | High |\n| Asgari [22] | 2022 | Low | UC | Low | UC | Low | Low | Low |\n| Bartlett [23] | 2020 | Low | Low | High | Low | Low | Low | Low |\n| Bazot [25] | 2009 | Low | Low | UC | UC | Low | Low | Low |\n| Bazot [24] | 2012 | Low | Low | High | UC | Low | Low | Low |\n| Chamié [26] | 2009 | Low | Low | UC | UC | Low | Low | Low |\n| Deslandes [27] | 2023 | Low | Low | High | High | Low | Low | Low |\n| Di Giovanni [28] | 2022 | Low | Low | UC | UC | Low | Low | Low |\n| Fratelli [29] | 2013 | Low | Low | High | Low | Low | Low | Low |\n| Goncalves [30] | 2021 | Low | Low | Low | UC | Low | Low | Low |\n| Guerriero [31] | 2008 | Low | Low | High | Low | Low | Low | Low |\n| Hernández Gutiérrez [32] | 2019 | Low | Low | UC | Low | Low | Low | Low |\n| Holland [33] | 2013 | Low | Low | Low | UC | Low | Low | Low |\n| Hudelist [34] | 2011 | Low | Low | High | Low | Low | Low | Low |\n| Kamkarfar [35] | 2022 | Low | UC | Low | UC | Low | Low | Low |\n| Krüger [36] | 2013 | Low | Low | High | Low | Low | Low | Low |\n| Manganaro [37] | 2012 | Low | UC | UC | UC | Low | Low | Low |\n| Mangler [38] | 2013 | Low | Low | UC | Low | Low | Low | Low |\n| Manti [39] | 2022 | Low | Low | UC | UC | Low | Low | Low |\n| Padmehr [40] | 2023 | High | High | High | UC | Low | Low | Low |\n| Pateman [41] | 2015 | Low | Low | High | UC | Low | Low | Low |\n| Pattanasri [42] | 2020 | Low | Low | High | UC | Low | Low | Low |\n| Piketty [43] | 2009 | Low | Low | UC | UC | Low | Low | Low |\n| Roditis [44] | 2023 | High | Low | UC | Low | Low | Low | Low |\n| Savelli [45] | 2009 | Low | High | High | Low | Low | Low | Low |\n| Savelli [46] | 2012 | Low | Low | High | UC | Low | Low | Low |\n| Siddiqui [47] | 2021 | High | Low | UC | UC | Low | Low | Low |\n| Sillou [48] | 2015 | High | Low | UC | UC | Low | Low | Low |\n| Stoppa [49] | 2023 | Low | Low | High | Low | Low | Low | Low |\n| Yap [16] | 2018 | Low | Low | High | Low | Low | Low | Low |\n| Yin [50] | 2020 | High | Low | UC | Low | Low | Low | Low |\n| Zhang [51] | 2019 | High | Low | UC | Low | Low | Low | Low |\nNote—Determinations were made by consensus of two reviewers. Sel = selection, Ref = reference standard, UC = unclear.\n| Modality, First Author [Reference] | Year | Department | No. of Patients | Sensitivity (%) | Specificity (%) |\n|---|---|---|---|---|---|\n| US | |||||\n| Asgari [22] | 2022 | Gyn | 119 | 74.5a | 80.0a |\n| Deslandes [27] | 2023 | Rad | 53 | 84.0b | 89.3b |\n| Di Giovanni [28] | 2022 | Gyn | 4983 | 98.1c | 99.0c |\n| Fratelli [29] | 2013 | Gyn | 420 | 53.6c | 94.63c |\n| Goncalves [30] | 2021 | Rad | 120 | 88.5a | 94.23a |\n| Guerriero [31] | 2008 | Gyn | 88 | 62.7c | 92.3c |\n| Holland [33] | 2013 | Gyn | 198 | 52.2c | 98.7c |\n| Hudelist [34] | 2011 | Gyn | 129 | 78.8c | 84.2c |\n| Kamkarfar [35] | 2022 | Gyn | 80 | 71.0b | 96.4b |\n| Padmehr [40] | 2023 | Gyn | 170 | 58.8a | 67.8a |\n| Pateman [41] | 2015 | Gyn | 166 | 92.3b | 100.0b |\n| Pattanasri [42] | 2020 | Gyn | 119 | 49.1c | 88.2c |\n| Piketty [43] | 2009 | Gyn | 134 | 90.7b | 96.5b |\n| Savelli [45] | 2009 | Gyn | 490 | 44.0b | 100.0b |\n| Savelli [46] | 2012 | Gyn | 381 | 64.7 (88/136)b | 96.3 (236/245)b |\n| Yin [50] | 2020 | Rad | 198 | 85.9c | 90.8c |\n| Zhang [51] | 2019 | Rad | 118 | 95.3b | 90.9b |\n| MRI | |||||\n| Bazot [24] | 2012 | Rad | 83 | 83.3b | 98.6b |\n| Chamié [26] | 2009 | Rad | 92 | 79.6c | 93.7c |\n| Krüger [36] | 2013 | Rad | 152 | 78.0c | 79.2c |\n| Manganaro [37] | 2012 | Rad | 46 | 97.0b | 100.0b |\n| Mangler [38] | 2013 | Gyn | 79 | 41.0b | 83.0b |\n| Manti [39] | 2022 | Rad | 72 | 86.9a | 96.0a |\n| Siddiqui [47] | 2021 | Rad | 170 | 86.7 (85/98)b | 81.9 (59/72)b |\n| Sillou [48] | 2015 | Rad | 35 | 91.022b | 59.0b |\n| Stoppa [49] | 2023 | Rad | 77 | 80.0b | 35.0b |\n| Yap [16] | 2018 | Rad | 37 | 76.9 (103/134)b | 98.5 (451/458)b |\n| US and MRI | |||||\n| Alborzi [21] | 2018 | Gyn | 317 | ||\n| US | 83.3 (210/252)b | 46.1 (30/65)b | |||\n| MRI | 90.4b | 66.1b | |||\n| Alborzi [20] | 2023 | Gyn | 555 | ||\n| US | 56.9a | 84.9a | |||\n| MRI | 47.4a | 73.7a | |||\n| Bartlett [23] | 2020 | Rad | 83 | ||\n| US | 22b | — | |||\n| MRI | 61b | — | |||\n| Bazot [25] | 2009 | Rad | 92 | ||\n| US | 74.3c | 187.9c | |||\n| MRI | 82.9c | 90.3c | |||\n| Hernández Gutiérrez [32] | 2019 | Gyn | 48 | ||\n| US | 62.0a | 80.3a | |||\n| MRI | 57.2a | 80.8a | |||\n| Roditis [44] | 2023 | Rad | 178 | ||\n| US | 69.7c | 91.3c | |||\n| MRI | 56.6c | 64.1c | |||\n| Weighted mean | |||||\n| US studies | |||||\n| All | 82.9c | 94.2c | |||\n| Excluding outlierd | 65.1c | 88.5c | |||\n| MRI studies | 69.0c | 76.1c |\nNote—Dash (—) indicates value could not be calculated. Raw data for some performance measures are shown in parentheses. US = ultrasound, Gyn = gynecology, Rad = radiology.\n| Studies Stratified by Imaging Modality, Performance Measure | Ovary | Bladder, VUP, Anterior CDS | Ureters | Pelvic SW, Ovarian Fossa | Vagina, RV Septum | PM, USLs, RC, Torus Uterinus | RS |\n|---|---|---|---|---|---|---|---|\n| No. of studies with US only | 9 | 9 | 4 | 3 | 7 | 13 | 11 |\n| No. of studies with MRI only | 3 | 4 | 4 | 1 | 4 | 6 | 4 |\n| No. of studies with US and MRI | 2 | 4 | 2 | 3 | 4 | 6 | 6 |\n| All US studies | |||||||\n| Sensitivity (%) | |||||||\n| All studies | 77.5 (35.0–100.0) | 56.8 (0.0–100.0) | 64.7 (0.0–100.0) | 39.0 (3.8–84.0) | 60.8 (34.0–86.4) | 82.3 (1.8–98.1) | 73.7 (0.0–100.0) |\n| Excluding outliera | 56.9 (1.8–96.5) | ||||||\n| Specificity (%) | |||||||\n| All studies | 84.4 (60.0–100.0) | 99.4 (0.0–100.0) | 99.3 (94.5–100.0) | 87.4 (74.7–100.0) | 95.5 (88.0–100.0) | 93.0 (0.5–99.0) | 92.5 (44.4–100.0) |\n| Excluding outliera | 82.9 (0.5–99.2) | ||||||\n| All MRI studies | |||||||\n| Sensitivity (%) | 67.8 (56.9–97.0) | 73.0 (9.4–100.0) | 82.1 (0.0–100.0) | 63.6 (33.4–66.9) | 69.9 (41.0–100.0) | 60.0 (30.2–100.0) | 68.6 (13.0–100.0) |\n| Specificity (%) | 83.2 (73.6–96.9) | 99.0 (94.7–100.0) | 97.5 (59.0–100.0) | 66.0 (45.7–98.1) | 89.3 (78.5–100.0) | 80.0 (35.0–100.0) | 87.4 (77.5–96.6) |\nNote—Except where otherwise indicated, values are weighted means with the range in parentheses. US = ultrasound, VUP = vesicouterine pouch, CDS = cul-de-sac, SW = sidewall, RV = rectovaginal, PM = parametria, USL = uterosacral ligament, RC = retrocervical, RS = rectosigmoid.\n| Studies Stratified by Imaging Modality, Performance Measure | East Asia and/or South Asia | Australia | Europe | West Asia | North America | South America |\n|---|---|---|---|---|---|---|\n| No. of studies with US only | 2 | 2 | 9 | 3 | 0 | 1 |\n| No. of studies with MRI only | 1 | 1 | 7 | 0 | 0 | 1 |\n| No. of studies with US and MRI | 0 | 0 | 3 | 2 | 1 | 0 |\n| US studies | ||||||\n| Sensitivity (%) | ||||||\n| All | 89.4 (85.9–95.3) | 59.9 (49.1–84.0) | 86.4 (44.0–98.1) | 66.5 (56.9–83.3) | 8.1 | 88.5 |\n| Excluding outliera | 61.5 (44.0–74.3) | |||||\n| Specificity (%) | ||||||\n| All | 90.8 (90.8–90.9) | 88.6 (88.2–89.3) | 97.9 (80.3–100.0) | 72.9 (46.1–96.4) | — | 94.2 |\n| Excluding outliera | 95.4 (80.3–100.0) | |||||\n| MRI studies | ||||||\n| Sensitivity (%) | 86.7 | 76.9 | 72.5 (41.0–86.9) | 63.0 (47.4–90.4) | 41.2 | 64.2 |\n| Specificity (%) | 81.9 | 98.5 | 77.3 (0.35–96.0) | 70.9 (66.1–73.7) | — | 97.0 |\nNote—Except where otherwise indicated, values are weighted means with the range in parentheses. The location of the study was defined as the location of the first author's affiliation. Dash (—) indicates value could not be calculated. US = ultrasound.\nSuperficial Endometriosis\nEndometriomas\nDE\nEvidence-Based Recommendations\nOutstanding Issues That Warrant Research\nSummary\nRecommendations for Best Practices\nRecommendations for Further Research\nAcknowledgment\nFootnotes\nSupplemental Content\n- Download\n- 829.05 KB\nReferences\nInformation & Authors\nInformation\nPublished In\nCopyright\nHistory\nKeywords\nAuthors\nMetrics & Citations\nMetrics\nCitations\nExport Citations\nTo download the citation to this article, select your reference manager software.","source_license":"CC0","license_restricted":false}