Radiologists training and qualification importance in the diagnosis of endometriosis through MRI with a specific protocol using vaginal and rectal gel

To assess radiologists’ diagnostic performance following training with five thousand pelvic magnetic resonance imaging with bowel preparation (MRI-BP) exams over 12 months for specialization in imaging-based endometriosis diagnosis. Additionally, to examine the diagnostic accuracy of vaginal and rectal gel application in MRI-BP for detecting endometriotic lesions and evaluate whether this protocol enhances lesion mapping. Methods: This educational, multicenter study employed an active learning model with real-case clinical scenarios. The team included three trainees and two experienced Japanese specialists, each provided with a lexicon for standardized reporting of imaging findings. Twenty-nine MRI-BP cases, with and without the vaginal and rectal gel protocol and laparoscopic confirmation, were selected. Patients had a mean age of 35.6 ± 6.9 years, and the average interval between MRI-BP exams was 21.8 ± 28.7 days. Cases were anonymized, coded, randomized, and stored in an institutional repository for blinded review. Trainees conducted three blind readings: a baseline assessment (pre-test), a second at training completion (protocol without gel), and a third six months post-training (post-test), re-evaluating initial cases (protocol with gel). Japanese specialists completed two blinded readings in a single session (protocol with and without gel). Pre- and post-test accuracy and precision, as well as readings for protocols with and without rectal and vaginal gel, were analyzed. Results: The most frequently identified endometriotic sites were the uterosacral ligaments (89.7%), retrocervical space (86.2%), and paracervical space (82.8%). The largest improvement in trainees’ diagnostic accuracy occurred in bowel evaluation, particularly in the rectosigmoid segment (35.5%, 37.3%, p<0.001). The use of vaginal and rectal gel improved mapping in the retrocervical (16.4%, p=0.013) and retrovaginal spaces (26.1%, p<0.001), endometriomas (18.7%, p=0.001), and the rectum (12.4%, p=0.037) and sigmoid colon (16.6%, p=0.008) for trainees, as well as mapping of the bladder (21.5%, p=0.009), paracervical space (18.9%, p=0.042), and uterine serosa (23.1%, p=0.011) for specialists. The protocol incorporating vaginal and rectal gel enhanced both diagnostic accuracy and precision for trainees and specialists. Post-test reading accuracy improved by 27.0%, 11.1%, and 15.1% for trainees 1, 2, and 3, respectively, with precision gains of 60.7%, 24.0%, and 26.2%. Conclusion: Radiologists’ diagnostic accuracy improved significantly following training with five thousand MRI-BP exams over 12 months, with gains of up to 15% for experienced radiologists and 27% for recent graduates. The MRI-BP protocol with vaginal and rectal gel enhances lesion mapping for endometriosis, particularly in the paracervical, retrocervical, and retrovaginal spaces, bowel (rectum and sigmoid colon), bladder, posterior uterine wall, and endometriomas.

To assess radiologists’ diagnostic performance following training with five thousand pelvic magnetic resonance imaging with bowel preparation (MRI-BP) exams over 12 months for specialization in imaging-based endometriosis diagnosis. Additionally, to examine the diagnostic accuracy of vaginal and rectal gel application in MRI-BP for detecting endometriotic lesions and evaluate whether this protocol enhances lesion mapping. Methods: This educational, multicenter study employed an active learning model with real-case clinical scenarios. The team included three trainees and two experienced Japanese specialists, each provided with a lexicon for standardized reporting of imaging findings. Twenty-nine MRI-BP cases, with and without the vaginal and rectal gel protocol and laparoscopic confirmation, were selected. Patients had a mean age of 35.6 ± 6.9 years, and the average interval between MRI-BP exams was 21.8 ± 28.7 days. Cases were anonymized, coded, randomized, and stored in an institutional repository for blinded review. Trainees conducted three blind readings: a baseline assessment (pre-test), a second at training completion (protocol without gel), and a third six months post-training (post-test), re-evaluating initial cases (protocol with gel). Japanese specialists completed two blinded readings in a single session (protocol with and without gel). Pre- and post-test accuracy and precision, as well as readings for protocols with and without rectal and vaginal gel, were analyzed. Results: The most frequently identified endometriotic sites were the uterosacral ligaments (89.7%), retrocervical space (86.2%), and paracervical space (82.8%). The largest improvement in trainees’ diagnostic accuracy occurred in bowel evaluation, particularly in the rectosigmoid segment (35.5%, 37.3%, p<0.001). The use of vaginal and rectal gel improved mapping in the retrocervical (16.4%, p=0.013) and retrovaginal spaces (26.1%, p<0.001), endometriomas (18.7%, p=0.001), and the rectum (12.4%, p=0.037) and sigmoid colon (16.6%, p=0.008) for trainees, as well as mapping of the bladder (21.5%, p=0.009), paracervical space (18.9%, p=0.042), and uterine serosa (23.1%, p=0.011) for specialists. The protocol incorporating vaginal and rectal gel enhanced both diagnostic accuracy and precision for trainees and specialists. Post-test reading accuracy improved by 27.0%, 11.1%, and 15.1% for trainees 1, 2, and 3, respectively, with precision gains of 60.7%, 24.0%, and 26.2%. Conclusion: Radiologists’ diagnostic accuracy improved significantly following training with five thousand MRI-BP exams over 12 months, with gains of up to 15% for experienced radiologists and 27% for recent graduates. The MRI-BP protocol with vaginal and rectal gel enhances lesion mapping for endometriosis, particularly in the paracervical, retrocervical, and retrovaginal spaces, bowel (rectum and sigmoid colon), bladder, posterior uterine wall, and endometriomas. Descrição Citação PAIVA, Lara Sá de. Importância do treinamento e capacitação de radiologistas no mapeamento de endometriose por RM com protocolo específico e melhora do desempenho com uso de gel vaginal e retal. 2024. 52 f. Tese (Doutorado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo. 2024.