Learning curve in the detection of ovarian and deep endometriosis by using Magnetic Resonance

Luca Saba, Saba L, S. Guerriero, Stefano Guerriero, Rosa Sulis, Sulis R, R. Sulis, Pilloni M, Monica Pilloni, Ajossa S, S. Ajossa, Silvia Ajossa, Gianbenedetto Melis, G. B. Melis, Melis G, G. Mallarini, Giorgio Mallarini, Mallarini G
European journal of radiology · 2010 · vol. 79(2) , pp. 237–244 · doi:10.1016/j.ejrad.2010.01.019 · PMID:20171820 · W70924599
article OA: closed CC0 ⤵ 32 in-corpus citations
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This study evaluated the learning curve for detecting ovarian and deep endometriosis using magnetic resonance imaging, assessing radiologist performance over time.

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Abstract

PurposeDetermining if Magnetic Resonance Imaging (MRI) accuracy in diagnosing endometriosis is related to radiologist's expertise.Methods and materialsWritten informed consent was obtained from all patients. This study is compliant to STARD method. Thirty patients (mean age 34; range 21-45 years) who had undergone MRI study for suspected endometriosis underwent surgery were retrospectively evaluated. MRI at 1.5T was performed with SE and TSE sequences, T1 and T2-weighted with and without fat suppression. Four localizations were analyzed: ovary, uterosacral ligaments (USL), vaginal fornix and Rectum\Sigma\Douglas (R.S.D.). One radiologist evaluated each dataset; sensitivity, specificity, PPV and NPV, accuracy, LR+ and LR- were calculated according to the surgical results (first analysis). Dataset were then re-analyzed 12 months (second analysis) and 24 months (third analysis) later. McNemar test was applied to determine differences between the three analysis.ResultsSensitivity, specificity and accuracy for the ovary at the first analysis were 88.9%, 87% and 88%, at the second 92.6%, 87% and 90% whereas at the third 92.6%, 91.3% and 92%. Sensitivity, specificity and accuracy for the USLs at the first analysis were 62.5%, 76.9% and 70%, at the second 72%, 80.8% and 76% whereas at the third 80%, 84.6% and 82%. Sensitivity, specificity and accuracy for the vaginal fornix at the first analysis were 63.2%, 64.5% and 64%, at the second 73.7%, 77.4% and 76% whereas at the third 73.7%, 83.9% and 80%. Sensitivity, specificity and accuracy for the R.S.D. at the first analysis were 39.1%, 81.5% and 62%, at the second 62.5%, 85.2% and 76% whereas at the third 73.9%, 88.9% and 82%. McNemar test indicated a significant statistical difference in sensitivity in detecting nodules of endometriosis in R.S.D. between first and third analysis (p=0.0215). The mean review time decreased (p=0.0001).ConclusionsAccuracy of MRI in diagnosing endometriosis increased with radiologist's expertise and the improvement was statistically significant in determining RSD involvement.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Adult Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Middle Aged Predictive Value of Tests Retrospective Studies Sensitivity and Specificity Statistics, Nonparametric

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