From ports to pixels: Reimagining the AAGL Endometriosis Classification through Imaging

Anatomy, Genital / Reproductive system female, Pelvis, MR, Diagnostic procedure, Education, Structured reporting, Education and training Authors: J. E. Mourao Santos, D. D. C. Martins, A. Melloni, G. Vianna, A. Morganti, F. Braga, B. J. A. Wood, B. Muszkat, F. Muszkat DOI: 10.26044/ecr2026/C-24747 Learning objectives To review and illustrate the anatomical compartments defined in the American Association of Gynecologic Laparoscopists (AAGL) 2021 endometriosis classification. To propose an MRI-based scoring system equivalent to the surgical classification, adapting surgical compartments to imaging-based compartments. To demonstrate how applying this MRI-adapted AAGL score can reduce descriptive variability and enhance communication between radiologists and multidisciplinary surgical teams. To present a structured reporting model incorporating the main sites of endometriotic involvement and the proposed score, aiming to facilitate diagnosis and preoperative staging.

Endometriosis is a chronic inflammatory gynecological disease that affects approximately 10% of women of reproductive age, frequently associated with chronic pelvic pain, dysmenorrhea, dyspareunia, bowel or bladder dysfunction, and infertility, causing a significant impact on quality of life. [1]Magnetic resonance imaging (MRI) is the leading imaging modality for preoperative mapping, enabling accurate assessment of lesion site, depth, and extent, and serving as a valuable tool to estimate surgical complexity. [1] Findings and procedure details MRI PREPARATION AND PROTOCOLA model MRI protocol is presented in Figure 1. [Fig 1]“TYPES OF ENDOMETRIOSIS”1. OVARIAN ENDOMETRIOSISMRI findings: unilocular or multilocular cysts containing hemoglobin degradation products at variable stages, demonstrating hyperintensity on T1-weighted images and hypointensity on T2-weighted images (T2 shading). [2] [Fig 10]2. SUPERFICIAL ENDOMETRIOSISThese are small lesions on the peritoneal surface, better visualized during laparoscopy. On MRI, they appear as foci of hyperintensity on T1-weighted images with fat suppression, generally without corresponding signal on T2-weighted sequences. [5]3. DEEP ENDOMETRIOSISDeep endometriosis is defined...

Implementing an MRI-based score aligned with the AAGL 2021 classification and integrated into a structured report could standardize multidisciplinary communication, improve surgical planning, and enhance preoperative staging of endometriosis, fostering advances in both clinical practice and education in pelvic radiology. Personal information and conflict of interest J. E. Mourao Santos: Nothing to disclose D. D. C. Martins: Nothing to disclose A. Melloni: Nothing to disclose G. Vianna: Nothing to disclose A. Morganti: Nothing to disclose F. Braga: Nothing to disclose B. J. A. Wood: Nothing to disclose B. Muszkat: Nothing to disclose F. Muszkat: Nothing to disclose

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