MR inter-observer agreement in the analysis of endometriosis

Saba, Luca
2009 · doi:10.1594/ecr2009/c-319 · W6924990440
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This study evaluated MRI inter-observer agreement in diagnosing endometriosis across various locations, finding high agreement in the rectosigmoid and rectovaginal septum, but lower agreement in uterosacral ligaments.

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This study evaluated the inter- and intra-observer agreement of magnetic resonance imaging for diagnosing endometriosis in 83 female patients suspected of having the condition based on clinical symptoms. Researchers analyzed MRI scans at 1.5 Tesla to assess diagnostic consistency across different anatomical locations, including the rectosigmoid, rectovaginal septum, uterosacral ligaments, and pouch of Douglas. The results demonstrated high overall agreement with a kappa value of 0.635, noting particularly strong reliability for lesions in the rectosigmoid and rectovaginal septum but sub-optimal agreement for those in the uterosacral ligaments. This paper is centrally about endometriosis — specifically assessing the reliability of MRI as an imaging modality for identifying and localizing deep infiltrating endometriotic lesions.

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Keywords

Authors: L. Saba1, S. Guerriero1, B. Virgilio1, R. Sulcis2, M. Gerada1, G. Melis1, G. Mallarini1; 1Cagliari/IT, 2Muravera/IT DOI: 10.1594/ecr2009/C-319 DOI-Link: Purpose Endometriosis is defined as the presence of endometrial glands in locations outside the uterus (ectopic as opposed to normally located or eutopic endometrium). The ectopic endometrium responds to hormonal stimulation with various degrees of cyclic hemorrhage and symptoms. Endometriosis is a common and important clinical problem of women, predominantly those in the reproductive age group. Physical examination and the reference standard, laparoscopic exploration, may not always allow diagnosis or prediction of the extension of pelvic endometriosis, especially deep pelvic endometriosis. Imaging techniques currently used to...

Methods

and Materials From July 2006 to February 2008, 83 consecutive female patients (mean age 39; range 19-49) were studied by using MRI in our Center. Each patient was suspected of having endometriosis at clinical examination (pelvic pain, infertility, nodules, or tenderness at physical examination) and underwent transvaginal sonography (TV-US) prior MR. MR at 1.5 Tesla was performed with SE and TSE sequences, T1 and T2 weighted with and without fat suppression. Each exam was completed with of Gadolinium. Each dataset was reviewed for the presence of endometriosis....

Results

We observed an overall inter-observer agreement of 89.36% and the kappa value was 0.635 (95% Confidence Interval [CI] from 0.512 to 0.759). In the USLs the inter-observer agreement was 85.11% and the kappa value 0.571 (95% CI from 0.278 to 0.864). In the pouch of Douglas the inter-observer agreement of 82.98% and a kappa value of 0.552 (95% CI from 0.27 to 0.835). In the vagina the inter-observer agreement was 91.49% and the kappa value was 0.552 (95% CI from 0.133 to 0.972). In the...

Conclusion

The purpose of this study was to evaluate inter- and intra- observer agreement in the evaluation of endometriosis according to different endometriosis localizations by using MR. Results of our study indicate that MR has an high inter and intra-observer agreement in the identification of endometriosis located in the rectosigmoid and in the rectovaginal septum, whereas the agreement is sub-optimal in the endometriosis located in the USLs. Several imaging techniques have been used to identify endometriosis and to assess its extension in specific locations such as...

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endometriosis

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