Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results

Luca Saba, Rosa Sulcis, Gian Benedetto Melis, Giannina Ibba, Juan Luis Alcázar, Juan Luis Alcazar, Mario Piga, S. Guerriero, Stefano Guerriero
European radiology · 2013 · vol. 24(2) , pp. 335–343 · doi:10.1007/s00330-013-3013-9 · PMID:24026621 · W2158685317
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

This study assessed reader confidence in MRI diagnosis of endometriosis across five pelvic regions, finding variation and challenges in specific areas and for less experienced readers.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This retrospective study evaluated diagnostic confidence across five MRI-analyzed pelvic regions for detecting endometriosis in 65 patients, comparing multiple readers’ five-point confidence scores against surgical results. For ovarian endometrioma and several deep sites, performance varied by region, with reported AUC values ranging from high discrimination in rectum/sigma/pouch of Douglas (around 0.94 for one reader) to more modest discrimination in the vaginal fornix (down to about 0.69 for one reader) and lower accuracy for less experienced readers in some areas such as anterior compartment and rectum/sigma/pouch of Douglas. The authors reported that diagnostic uncertainty for less expert readers could be as high as one third of examinations. This paper is centrally about endometriosis — it analyzes MRI diagnostic confidence for ovarian and deep endometriosis using surgical comparison.

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Abstract

Objective To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis.

Methods

Sixty-five patients (mean age 33; range 19–45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR–).

Results

The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834.

Conclusions

Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations. Key points • Magnetic resonance imaging (MRI) is increasingly used to assess endometriosis • The diagnostic confidence of observers varies according to the location of endometriosis • The diagnosis is more difficult to establish by MRI in some anatomical locations • Specific training should be given concerning those locations that cause difficulty Similar content being viewed by others

References

Giudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362:2389–2398 Bulun SE (2009) Endometriosis. N Engl J Med 360:268–279 Macario S, Chassang M, Novellas S et al (2012) The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis. AJR Am J Roentgenol 199:1410–1415 Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691 Guerriero S, Ajossa S, Garau N, Alcazar JL, Mais V, Melis GB (2010) Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography. Fertil Steril 94:742–746 Saba L, Guerriero S, Sulcis R et al (2012) MRI and "tenderness guided" transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis. J Magn Reson Imaging 35:352–360 Bazot M, Gasner A, Ballester M, Daraï E (2011) Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod 26:346–353 Scardapane A, Bettocchi S, Lorusso F et al (2011) Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography. Eur Radiol 21:1553–1563 Busard MP, Mijatovic V, van Kuijk C, Hompes PG, van Waesberghe JH (2010) Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol 20:1267–1276 Chassang M, Novellas S, Bloch-Marcotte C et al (2010) Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis. Eur Radiol 20:1003–1010 Saba L, Guerriero S, Sulcis R, Ajossa S, Melis G, Mallarini G (2010) Agreement and reproducibility in identification of endometriosis using magnetic resonance imaging. Acta Radiol 51:573–580 Saba L, Guerriero S, Sulis R et al (2011) Learning curve in the detection of ovarian and deep endometriosis by using magnetic resonance: comparison with surgical results. Eur J Radiol 79:237–244 Ng CS, Palmer CR (2007) Analysis of diagnostic confidence and diagnostic accuracy: a unified framework. Br J Radiol 80:152–160 Brealey SD, Scally AJ, Hahn S, Godfrey C (2007) Evidence of reference standard related bias in studies of plain radiograph reading performance: a meta-regression. Br J Radiol 80:406–413 Rennie D (2003) Improving reports of studies of diagnostic tests: the STARD initiative. JAMA 289(1):89–90 Park SH, Goo JM, Jo CH (2004) Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 5:11–18 Zawin M, McCarthy S, Scoutt L (1989) Endometriosis: appearance and detection at MR imaging. Radiology 171:693–696 Zacharia TT, O’Neill MJ (2006) Prevalence and distribution of adnexal findings suggesting endometriosis in patients with MR diagnosis of adenomyosis. Br J Radiol 79:303–307 Bazot M, Darai E, Hourani R et al (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389 Redwine DB (1987) The distribution of endometriosis in the pelvis by age groups and fertility. Fertil Steril 47:173–175 Kinkel K, Chapron C, Balleyguier C (1999) Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod 14:1080–1086 Guerriero S, Alcázar JL, Ajossa S, Pilloni M, Melis GB (2009) Three-dimensional sonographic characteristics of deep endometriosis. J Ultrasound Med 28:1061–1066 Acknowledgments The authors would like to thanks Mrs Diana Caravana, Mr Franco Conti and Mr Paolo Contu for their precious help. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Saba, L., Sulcis, R., Melis, G.B. et al. Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results. Eur Radiol 24, 335–343 (2014). https://doi.org/10.1007/s00330-013-3013-9 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-013-3013-9

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Ovarian Diseases Ovariectomy Ovary Adult Diagnosis, Differential Endometriosis Endometriosis Female Follow-Up Studies Humans Magnetic Resonance Imaging Middle Aged Ovarian Diseases Ovarian Diseases Ovary Ovary Reproducibility of Results Retrospective Studies

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