{"paper_id":"c850ad0a-7bfe-4fd2-95c6-7d23e83208e1","body_text":"Abstract\nEndometriosis presents a common and significant health burden affecting approximately 1 in 10 reproductive age patients who are assigned female at birth. Recently guidelines have begun shifting away from laparoscopy as the first-line diagnostic tool and instead recommend imaging for initial diagnosis and presurgical mapping of endometriosis. This shift places the radiologist in a central role for diagnosis and assessment of management efforts. During this comprehensive review article, we discuss the importance of MDC in the treatment of advanced endometriosis, the radiologist ‘s role at endometriosis MDC as well as the opportunities that exist for the radiologist to add-value in an endometriosis service.\nSimilar content being viewed by others\nData Availability\nNo datasets were generated or analysed during the current study.\nReferences\nEndometriosis. Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis\nKennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005, 20(10):2698–704.\nTomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, Horne AW, et al. An International Terminology for Endometriosis, 2021. J Minim Invasive Gynecol. 2021;28(11):1849–59.\nEskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):235–58.\nMeuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D’Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009; 92(1):68–74.\nBecker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022; 2022(2).\nNnoaham KE, Hummelshoj L, Webster P, D’Hooghe T, De Cicco Nardone F, De Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011; 96(2).\nSingh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, et al. Guideline No. 449: Diagnosis and impact of endometriosis—a Canadian guideline. Journal of Obstetrics and Gynaecology Canada. 2024; 46(5).\nEndometriosis: diagnosis and management NICE guideline. 2017. Available from: www.nice.org.uk/guidance/ng73\nFalcone T, Flyckt R. Clinical expert series clinical management of endometriosis. 2018. Available from: http://links.lww.com/AOG/B60\nYoung SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, et al. Society of radiologists in ultrasound consensus on routine pelvic US for endometriosis. Radiology. 2024; 311(1). https://doi.org/10.1148/radiol.232191\nMorar PS, Sevdalis N, Warusavitarne J, Hart A, Green J, Edwards C, et al. Research: Establishing the aims, format and function for multidisciplinary team-driven care within an inflammatory bowel disease service: a multicentre qualitative specialist-based consensus study. Frontline Gastroenterol. 2018; 9(1):29.\nFurini F, Carnevale A, Casoni GL, Guerrini G, Cavagna L, Govoni M, et al. The role of the multidisciplinary evaluation of interstitial lung diseases: systematic literature review of the current evidence and future perspectives. Front Med (Lausanne). 2019;6:246.\nBatchelor WB, Anwaruddin S, Wang DD, Perpetua EM, Krishnaswami A, Velagapudi P, et al. The multidisciplinary heart team in cardiovascular medicine: current role and future challenges. JACC Advances. 2023; 2(1):100160.\nProuse G, Robaldo A, van den Berg JC, Ettorre L, Mongelli F, Giovannacci L. Impact of multidisciplinary team meetings on decision making in vascular surgery: a prospective observational study. European Journal of Vascular and Endovascular Surgery. 2023;66(1):130–5.\nZamurovic M, Tomic A, Djordjevic K, Simanic S, Sopta J, Rasulic L, et al. Isolated deep infiltrating endometriosis of the sciatic nerve: a case report and overview of the literature. Medicina (B Aires). 2023;59(12):2161.\nPagano F, Schwander A, Vaineau C, Knabben L, Nirgianakis K, Imboden S, et al. True prevalence of diaphragmatic endometriosis and its association with severe endometriosis: a call for awareness and investigation. J Minim Invasive Gynecol. 2023; 30(4):329–34.\nNezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, et al. Thoracic endometriosis syndrome: a review of diagnosis and management. JSLS. 2019;23(3):e2019.00029.\nDridi D, Chiaffarino F, Parazzini F, Donati A, Buggio L, Brambilla M, et al. Umbilical endometriosis: a systematic literature review and pathogenic theory proposal. J Clin Med. 2022;11(4):995.\nCarsote M, Terzea DC, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020;17(4):536.\nNezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218(6):549–62.\nUgwumadu L, Chakrabarti R, Williams-Brown E, Rendle J, Swift I, John B, et al. The role of the multidisciplinary team in the management of deep infiltrating endometriosis. Gynecol Surg. 201[cited 2024 Se7; 14(1):1–4. https://doi.org/10.1186/s10397-017-1018-0\nJohnson NP, Hummelshoj L, Consortium for the WESM, Abrao MS, Adamson GD, Allaire C, et al. Consensus on current management of endometriosis. Human Reproduction. 2013; 28(6):1552–68. https://doi.org/10.1093/humrep/det050\n25.Williams JC, Burnett TL, Jones T, Venkatesh SK, VanBuren WM. Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation. Abdom Radiol (NY). 2020;45(6):1637–44.\n26.Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2016; 47(3):281–9. https://doi.org/10.1002/uog.15662\n27.Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2015; 46(5):534–45. https://doi.org/10.1002/uog.15667\n28.Guerriero S, Saba L, Pascual MA, Ajossa S, Rodriguez I, Mais V, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2018;51(5):586–95. https://doi.org/10.1002/uog.18961\n29.Goncalves MO, Siufi Neto J, Andres MP, Siufi D, De Mattos LA, Abrao MS. Systematic evaluation of endometriosis by transvaginal ultrasound can accurately replace diagnostic laparoscopy, mainly for deep and ovarian endometriosis. Human Reproduction. 2021; 36(6):1492–500. https://doi.org/10.1093/humrep/deab085\n30.Lorusso F, Scioscia M, Rubini D, Stabile Ianora AA, Scardigno D, Leuci C, et al. Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings. Insights Imaging. 2021; 12(1):1–12. https://doi.org/10.1186/s13244-021-01054-x\n31.Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondossola ER, et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015; 291(3):611–21. https://doi.org/10.1007/s00404-014-3470-7\n32.Wei JJ, William J, Bulun S. Endometriosis and ovarian cancer: a review of clinical, pathologic, and molecular aspects. Int J Gynecol Pathol. 2011; 30(6):553–68.\n33.McDermott S, Oei TN, Iyer VR, Lee SI. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics, 2012; 32(3):845–63. https://doi.org/10.1148/rg.323115736\nVanBuren W, Feldman M, Shenoy-Bhangle AS, Sakala MD, Young S, Chamie LP, et al. Radiology state-of-the-art review: endometriosis imaging interpretation and reporting. Radiology. 2024; 312(3). https://doi.org/10.1148/radiol.233482\n35.Al-Arnawoot B, Chang S, Duigenan S, Kielar AZ, Leonardi M. CAR practice statement on advanced pelvic ultrasound for endometriosis. Can Assoc Radiol J. 2023;74(4):643–9. https://doi.org/10.1177/08465371231165986\n36.Alcázar JL, Eguez PM, Forcada P, Ternero E, Martínez C, Pascual M, et al. Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022; 60(4):477–86.\n37.Abrao MS, Gonçalves MODC, Dias JA, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Human Reproduction. 2007; 22(12):3092–7. https://doi.org/10.1093/humrep/dem187\n38.Young SW, Saphier NB, Dahiya N, Menias CO, Bridge AA, Czaplicki CD, et al. Sonographic evaluation of deep endometriosis: protocol for a US radiology practice. Abdominal Radiology. 2016, 41(12):2364–79. https://doi.org/10.1007/s00261-016-0886-5\n39.Young SW, Groszmann Y, Dahiya N, Caserta M, Yi J, Wasson M, et al. Sonographer-acquired ultrasound protocol for deep endometriosis. Abdominal Radiology. 2020; 45(6):1659–69. https://doi.org/10.1007/s00261-019-02341-4\nThomassin-Naggara I, Zoua CS, Bazot M, Monroc M, Roman H, Razakamantsoa L, et al. Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol? Eur Radiol. 2024, pp 1–11. https://doi.org/10.1007/s00330-024-10842-0\n41.Tong A, VanBuren WM, Chamié L, Feldman M, Hindman N, Huang C, et al. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdominal Radiology. 2020;45(6):1569–86. https://doi.org/10.1007/s00261-020-02483-w\n42.Sud S, Buxi TBS, Sheth S, Ghuman SS. Endometriosis and its myriad presentations: magnetic resonance imaging-based pictorial review. Indian Journal of Radiology and Imaging. 2021, 31(01):193–202. https://doi.org/10.1055/s-0041-1729670\n43.Barbisan CC, Andres MP, Torres LR, Libânio BB, Torres US, D’Ippolito G, et al. Structured MRI reporting increases completeness of radiological reports and requesting physicians’ satisfaction in the diagnostic workup for pelvic endometriosis. Abdominal Radiology. 2021, 46(7):3342–53. https://doi.org/10.1007/s00261-021-02966-4\n44.Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, et al. The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. 2021;100(7):1165–75. https://doi.org/10.1111/aogs.14099\n45.Hudelist G, Valentin L, Saridogan E, Condous G, Malzoni M, Roman H, et al. What to choose and why to use - a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis. Facts Views Vis Obgyn. 2021;13(4):331–8.\n46.Pausch AM, Filleböck V, Benli M, Witzel I, Hötker AM. MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes. Abdominal Radiology. 2024; 49(9):3241–50. https://doi.org/10.1007/s00261-024-04359-9\nHarth S, Kaya HE, Zeppernick F, Meinhold-Heerlein I, Keckstein J, Yildiz SM, et al. Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement. Front Med (Lausanne). 2023;10.\n48.Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023; 195(10):E363–71.\nChamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC. Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis. Abdominal Radiology. 2020; 45(6):1847–65. https://doi.org/10.1007/s00261-020-02434-5\n50.Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007;62(7):461–70.\n51.Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010; 94(5):1609–15.\nRollet Q, Bouvier V, Moutel G, Launay L, Bignon AL, Bouhier-Leporrier K, et al. Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival - a registry-based study. BMC Health Serv Res. 2021; 21(1).\n53.Burkett BJ, Cope A, Bartlett DJ, Burnett TL, Jones T, Venkatesh SK, et al. MRI impacts endometriosis management in the setting of image-based multidisciplinary conference: a retrospective analysis. Abdominal Radiology. 2020; 45(6):1829–39. https://doi.org/10.1007/s00261-020-02417-6\n54.Kent A, Shakir F, Rockall T, Haines P, Pearson C, Rae-Mitchell W, et al. Laparoscopic surgery for severe rectovaginal endometriosis compromising the bowel: a prospective cohort study. J Minim Invasive Gynecol. 2016;23(4):526–34.\n55.Mueller C, Luna Russo M, Schabl L, Kessler H. Multidisciplinary surgical management of severe posterior compartment endometriosis. Surg Endosc. 2024; 38(8):4677–9.\n56.Weyl A, Sevy V, Lepage B, Vidal F, Kirzin S, Legac YT, et al. Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis. Arch Gynecol Obstet. 2023;307(5):1459–68.\n57.Stratchko LM, Rossebo AE, Kisting MA, Hinshaw JL, Mao L, Meyer CA, et al. Unreimbursed costs of multidisciplinary conferences to a radiology department: a prospective analysis at an Academic Medical Center. Journal of the American College of Radiology. 2024; 21(4):668–75.\n58.Maharaj AD, Evans SM, Zalcberg JR, Ioannou LJ, Graco M, Croagh D, et al. Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework. BMJ Qual Saf. 2021; 30(10):792–803.\n59.Hoinville L, Taylor C, Zasada M, Warner R, Pottle E, Green J. Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members’ opinions about streamlining patient discussions. BMJ Open Qual. 2019; 8(2):e000631.\n60.Elias Z, Tarique U, Veit-Haibach P, Kielar AZ. standardizing multidisciplinary case conferences and improving communication between referring physicians and radiologists: a quality improvement initiative. Canadian Association of Radiologists Journal. 2024. https://doi.org/10.1177/08465371241281055\n61.Sivajohan B, Elgendi M, Menon C, Allaire C, Yong P, Bedaiwy MA. Clinical use of artificial intelligence in endometriosis: a scoping review. npj Digital Medicine 2022; 5(1):1–17.\n62.Bendifallah S, Puchar A, Suisse S, Delbos L, Poilblanc M, Descamps P, et al. Machine learning algorithms as new screening approach for patients with endometriosis. Sci Rep. 2022; 12(1):639.\n63.Chiorean DM, Mitranovici MI, Toru HS, Cotoi TC, Tomuț AN, Turdean SG, et al. New insights into genetics of endometriosis—a comprehensive literature review. Diagnostics 2023, 13(13):2265.\n64.Egorova A, Petrosyan M, Maretina M, Balashova N, Polyanskih L, Baranov V, et al. Anti-angiogenic treatment of endometriosis via anti-VEGFA siRNA delivery by means of peptide-based carrier in a rat subcutaneous model. Gene Therapy 2018; 25(8):548–55.\n65.Cooke CM, Flaxman TE, Sikora L, Miguel O, Singh SS. Individualized medicine using 3D printing technology in gynecology: a scoping review. 3D Print Med. 2023; 9(1):1–15. https://doi.org/10.1186/s41205-023-00169-9\nAuthor information\nAuthors and Affiliations\nContributions\nBB, ZE, PJ, AK wrote the main manuscript All authors edited the manuscript AK provided all figures Ania Kielar is president of the Canadian Association of Radiologsits.\nCorresponding authors\nEthics declarations\nConflict of interest\nThe authors declare no competing interests.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\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\nBuckley, B., Elias, Z., Khatri, G. et al. Endometriosis MDC: role of the radiologist. Abdom Radiol 50, 4914–4926 (2025). https://doi.org/10.1007/s00261-025-04920-0\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00261-025-04920-0","source_license":"public-domain-us","license_restricted":false}