Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation

Jamie C Williams, Tatnai L Burnett, Tiffanny Jones, T.L. Jones, Sudhakar K Venkatesh, Wendaline M VanBuren
Abdominal radiology (New York) · 2019 · vol. 45(6) , pp. 1637–1644 · doi:10.1007/s00261-019-02153-6 · PMID:31385008 · W2964589735
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-10 ⓘ

Kissing or retropositioned ovaries on MR imaging were associated with an eightfold higher odds of stage IV endometriosis compared to normally positioned ovaries.

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This retrospective study evaluated 65 women with suspected endometriosis who underwent pre-operative pelvic MRI followed by intra-operative endometriosis staging using the rASRM (0–IV). Two experienced radiology reviewers assessed ovarian position on MRI (kissing ovaries posterior to the uterus and in contact, retropositioned ovaries posterior but not in contact, or normal) and recorded presence of an endometrioma; a surgeon with expertise provided the surgical stage. Kissing and retropositioned ovarian positioning were associated with significantly higher odds of stage IV disease, independent of endometrioma presence, with an accuracy of 82% for predicting stage IV (86% sensitivity, 79% specificity), and all kissing-ovary cases had stage III/IV disease. The authors note the study’s retrospective design and that ovarian position classifications were based on pre-operative imaging rather than prospective assessment. This paper is centrally about endometriosis — it links MRI ovarian positioning patterns (“kissing” and retropositioned ovaries) to intra-operative rASRM severity.

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Abstract

Purpose To retrospectively investigate the relationship between ovarian positioning on pre-operative MR imaging and intra-operative staging of endometriosis.

Materials and methods

Sixty-five women with suspected endometriosis who underwent pre-operative MRI and subsequent intra-operative staging of endometriosis formed the study group. A trained senior radiology resident and a board-certified staff radiologist experienced in endometriosis reviewed MR images for ovarian positioning and the presence of an endometrioma. The position of the ovaries was classified as (a) kissing when they were posterior to the uterus and in contact, (b) retropositioned when they were posterior to the uterus but not in contact, or (c) normal. Intra-operative staging of endometriosis (stage 0 to IV) was determined using the revised American Society for Reproductive Medicine classification system (rASRM) by a surgeon with expertise in endometriosis surgery. Correlation between ovarian positioning and endometriosis stage was evaluated with a logistical regression analysis. Sensitivity, specificity, and accuracy were calculated.

Results

MR images revealed kissing ovaries in 12 women, retropositioned ovaries in 17 women, and normally positioned ovaries in 36 women. At surgery, endometriosis stages 0, I, II, III, and IV were found in 13, 15, 6, 9, and 22 patients, respectively. The odds of stage IV endometriosis were eight times higher given kissing or retropositioned compared to normal ovaries, regardless of the presence of an endometrioma (p =0.01). Kissing and retropositioned ovaries had an accuracy of 82% for stage IV endometriosis, with 86% sensitivity and 79% specificity. All cases with kissing ovaries had stage III/IV endometriosis.

Conclusions

Kissing and retropositioned ovaries on pre-operative MR images are associated with higher intra-operative rASRM stages of endometriosis. Similar content being viewed by others

References

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Acknowledgements

The authors acknowledge the assistance of Desiree Lanzino, PhD, and Sonia Watson, PhD, in editing and submission of the manuscript. Funding Internal departmental funding was utilized without commercial sponsorship or support. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval The institutional review board approval was obtained with waiver of written consent for this retrospective review. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Williams, J.C., Burnett, T.L., Jones, T. et al. Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation. Abdom Radiol 45, 1637–1644 (2020). https://doi.org/10.1007/s00261-019-02153-6 Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-019-02153-6

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Ovary Ovary Retrospective Studies

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