Magnetic resonance inter-observer agreement in the analysis of deep pelvic endometriosis

Saba, Luca
2010 · doi:10.1594/ecr2010/c-1232 · W6906181674
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Magnetic resonance imaging inter-observer agreement for deep pelvic endometriosis detection varied by anatomical location, with higher agreement observed in the ovaries and bladder.

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This study evaluated the inter-observer agreement of magnetic resonance imaging in detecting deep pelvic endometriosis among 83 female patients suspected of having the condition. The researchers analyzed MRI scans to identify lesions and calculated kappa values for different anatomical sites, finding high agreement in the ovaries but lower consistency in the bladder and other areas. The results indicate that while MRI is useful for pre-surgical planning, its diagnostic reliability varies significantly depending on the specific location of the endometriotic tissue within the pelvis. This paper is centrally about endometriosis — specifically the radiological assessment and diagnostic accuracy of deep infiltrating disease using MRI.

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Keywords

Genital / Reproductive system female, Obstetrics (Pregnancy / birth / postnatal period), Pelvis Authors: L. Saba, S. Guerriero, R. Sulcis, M. Pilloni, G. Melis, G. Mallarini; Cagliari/IT DOI: 10.1594/ecr2010/C-1232 Purpose Endometriosis is defined as the presence of endometrium-like tissue in sites outside the uterine cavity (ectopic as opposed to normally located or eutopic endometrium). The ectopic endometrium responds to hormonal stimulation with various degrees of cyclic hemorrhage and symptoms. Endometriosis is a common and important clinical problem of women, predominantly those in the reproductive age group and it affects 5 to 10% of women of reproductive age in the United States of America. The mean age at diagnosis is 25-29 years and it is often...

Methods

and Materials 83 consecutive female patients (mean age 39; range 19-49) were studied by using MRI in our Center. Each patient was suspected of having endometriosis at clinical examination (pelvic pain, infertility, nodules or tenderness at physical examination) and prior to MRI, underwent transvaginal sonography (TV-US) performed by an experienced gynecological sonographist.All examinations were performed with a Gyroscan 1.5-T superconducting magnet . In all 83 exams a body coil was used for imaging of the pelvis. Before each exam patients were asked to perform an intestinal toilette...

Results

Of the 83 MRI examinations performed 12 demonstrated no evidence of disease. In the remaining 71 patients, 157 endometriotic lesions ranging in size from 0.4 to 6.2 cm were detected. In 22 patients isolated disease was detected whereas in 49 patients multifocal endometriotic lesions were present.In the ovary, the inter-observer agreement was 92.77% and the kappa value 0.802 (95% CI from 0.695 to 0.91). In the bladder the inter-observer agreement was 96.39% and the kappa value 0.553 (95% CI from 0.056 to 1). In the...

Conclusion

The results of this study suggest that MRI produces different agreements in detecting endometriosis according to the anatomical location. Several imaging techniques have been used to identify endometriosis and to assess its extent in specific locations such as the vaginal fornix, the bladder, the USLs and the pouch of Douglas with varying results. Accurate depiction of the extent of the disease, in particular deep endometriosis, is extremely important for correct pre-surgical planning by helping in the analysis of lesions that are difficult or impossible to...

References

Healy DL, Trounson AO, Andersen AN. Female Infertility: causes and treatment. Lancet 1994;343:1539-44.Goldstein DP, deCholnoky C, Emans SJ, Leventhal JM. Laparoscopy in the diagnosis and management of pelvic pain in adolescents. J Reprod Med 1989;24:251-256.Koninckx PR, Martin D. Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol 1994; 6:231-241.Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K. MR imaging of disorders associated with female infertility: use in diagnosis, treatment ad management. Radiographics 2003;23:1401-21.Guerriero S, Mais V, Ajossa S, Paoletti AM, Angiolucci M,...

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endometriosis

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