MRI as a promising tool for adhesion assessment in endometriosis: a feasibility study with laparoscopic correlation

STUDY OBJECTIVE: To investigate the feasibility of magnetic resonance imaging (MRI) in detecting and classifying adhesions between pelvic organs caused by endometriosis, comparing MRI findings to those obtained by laparoscopy. DESIGN: Prospective observational study conducted at two medical centres in Japan. SETTING: Tertiary referral centres for endometriosis and gynaecologic imaging. PATIENTS: Sixty-five women with suspected endometriosis scheduled for laparoscopic surgery were enrolled. A total of 55 were included in the final analysis following protocol compliance and image quality review. INTERVENTIONS: MRI and laparoscopic assessments were independently performed to identify adhesions between the uterus, bladder, rectum, and ovaries. Adhesions were classified using a two-category scale (none vs. present) and a semi-quantitative three-category scale (none, mild, severe). MAIN OUTCOME MEASURES: Agreement rates and Cohen's κ coefficients between MRI and laparoscopic findings for each adhesion site were assessed. RESULTS: Each adhesion was identified in 1.8-67.3 % of 55 patients by MRI and 1.8-58.2 % by laparoscopy. In the two-category evaluation, overall agreement between MRI and laparoscopy was high (mean agreement rate: 77 %), though κ values ranged from - 0.02 to 0.50, indicating modest reliability. The three-category evaluation showed more variable agreement (mean agreement rate: 66 %; κ range: -0.02 to 0.41), with notable discrepancies in interpreting adhesions between the uterus and rectum, and between the ovary and rectum. CONCLUSIONS: MRI could demonstrate potential to detect pelvic adhesions due to endometriosis, with moderate agreement compared to laparoscopically diagnosed results. While not yet a substitute for surgical diagnosis, MRI may serve as a non-invasive adjunct in preoperative planning and future therapeutic evaluation.