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This prospective single-center study evaluated how consistently three radiologists could apply the updated #Enzian classification to pelvic MRI for diagnosing deep infiltrating endometriosis and endometriomas, and assessed whether reader experience influenced agreement. Fifty consecutive consenting patients undergoing pelvic MRI for endometriosis assessment (March–July 2023) were reviewed independently, with two radiologists experienced in pelvic MRI/endometriosis imaging and one receiving a one-hour briefing; intraobserver variability was also measured. Interobserver agreement was excellent for deep infiltrating endometriosis (Fleiss’ kappa 0.89) and endometriomas (0.93), and was excellent among experienced readers across #Enzian compartments A–C (κw ~0.84–0.89), with substantial-to-excellent agreement when the unexperienced reader was paired with experienced readers. A key limitation is that the work was conducted in a single center with a small sample, which may affect generalizability. This paper is centrally about endometriosis — it specifically tests inter- and intraobserver agreement for MRI-based application of the updated #Enzian classification, including deep infiltrating endometriosis and endometriomas.
Abstract
Objectives: The purpose of this investigation was to evaluate the inter- and intraobserver variability of the updated #Enzian classification of endometriosis on MRI and to evaluate the influence of reader experience on interobserver concordance. Methods: This was a prospective single-center study. All patients were included who received an MRI of the pelvis for evaluation of endometriosis between March and July 2023 and who have provided written informed consent. Images were reviewed independently for endometriosis by three radiologists, utilizing the MRI-applicable categories of the #Enzian classification. Two radiologists had experience in pelvic MRI and endometriosis imaging. One radiologist had no specific experience in pelvic MRI and received a one-hour briefing beforehand. Results: Fifty consecutive patients (mean age, 34.9 years ±8.6 [standard deviation]) were prospectively evaluated. Interobserver agreement was excellent for diagnosis of deep infiltrating endometriosis (Fleiss’ kappa: 0.89; 95% CI 0.73–1.00; p < 0.001) and endometriomas (Fleiss’ kappa: 0.93; 95% CI 0.77–1.00; p < 0.001). For the experienced readers, interobserver agreement in the assessment of compartments A, B and C was excellent (κw ranging from 0.84; 95% CI 0.71–0.97; p < 0.001 to 0.89; 95% CI 0.82–0.97; p < 0.001). For the pairings of the experienced readers to the reader without specific experience in pelvic MRI, agreement was substantial to excellent (κw ranging from 0.64; 95% CI 0.44–0.85; p < 0.001 to 0.91; 95% CI 0.84–0.98; p < 0.001). Intraobserver variability was excellent for compartments A, B and C (κw ranging from 0.85; 95% CI 0.73–0.96; p < 0.001 to 0.95; 95% CI 0.89–1.00; p < 0.001). Conclusion: With sufficient experience, the #Enzian classification enables the achievement of excellent inter- and intraobserver agreement in MRI-based diagnosis of deep infiltrating endometriosis and endometriomas.
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Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement
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https://doi.org/10.22029/jlupub-18917Abstract
Objectives: The purpose of this investigation was to evaluate the inter- and intraobserver variability of the updated #Enzian classification of endometriosis on MRI and to evaluate the influence of reader experience on interobserver concordance. Methods: This was a prospective single-center study. All patients were included who received an MRI of the pelvis for evaluation of endometriosis between March and July 2023 and who have provided written informed consent. Images were reviewed independently for endometriosis by three radiologists, utilizing the MRI-applicable categories of the #Enzian classification. Two radiologists had experience in pelvic MRI and endometriosis imaging. One radiologist had no specific experience in pelvic MRI and received a one-hour briefing beforehand. Results: Fifty consecutive patients (mean age, 34.9 years ±8.6 [standard deviation]) were prospectively evaluated. Interobserver agreement was excellent for diagnosis of deep infiltrating endometriosis (Fleiss’ kappa: 0.89; 95% CI 0.73–1.00; p < 0.001) and endometriomas (Fleiss’ kappa: 0.93; 95% CI 0.77–1.00; p < 0.001). For the experienced readers, interobserver agreement in the assessment of compartments A, B and C was excellent (κw ranging from 0.84; 95% CI 0.71–0.97; p < 0.001 to 0.89; 95% CI 0.82–0.97; p < 0.001). For the pairings of the experienced readers to the reader without specific experience in pelvic MRI, agreement was substantial to excellent (κw ranging from 0.64; 95% CI 0.44–0.85; p < 0.001 to 0.91; 95% CI 0.84–0.98; p < 0.001). Intraobserver variability was excellent for compartments A, B and C (κw ranging from 0.85; 95% CI 0.73–0.96; p < 0.001 to 0.95; 95% CI 0.89–1.00; p < 0.001). Conclusion: With sufficient experience, the #Enzian classification enables the achievement of excellent inter- and intraobserver agreement in MRI-based diagnosis of deep infiltrating endometriosis and endometriomas.Link to publications or other datasets
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Frontiers in medicine 10 (2023), 1 - 9, 1303593
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