Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement

Sebastian Harth, Hasan Emin Kaya, Felix Zeppernick, Ivo Meinhold‐Heerlein, Ivo Meinhold-Heerlein, Jörg Keckstein, J. Keckstein, Selcuk Murat Yildiz, Emina Nurkan, Gabriele Anja Krombach, Gabriele A. Krombach, Fritz Roller, Fritz Christian Roller
Frontiers in medicine · 2023 · vol. 10 , pp. 1303593 · doi:10.3389/fmed.2023.1303593 · PMID:38046415 · W4388764326
article OA: gold CC0 ⤵ 7 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found excellent inter- and intraobserver agreement in diagnosing deep infiltrating endometriosis and endometriomas using the #Enzian classification on MRI.

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Abstract

Objectives The purpose of this investigation was to evaluate the inter- and intraobserver variability of the updated #Enzian classification of endometriosis on MRI and to evaluate the influence of reader experience on interobserver concordance. Methods This was a prospective single-center study. All patients were included who received an MRI of the pelvis for evaluation of endometriosis between March and July 2023 and who have provided written informed consent. Images were reviewed independently for endometriosis by three radiologists, utilizing the MRI-applicable categories of the #Enzian classification. Two radiologists had experience in pelvic MRI and endometriosis imaging. One radiologist had no specific experience in pelvic MRI and received a one-hour briefing beforehand. Results Fifty consecutive patients (mean age, 34.9 years ±8.6 [standard deviation]) were prospectively evaluated. Interobserver agreement was excellent for diagnosis of deep infiltrating endometriosis (Fleiss’ kappa: 0.89; 95% CI 0.73–1.00; p < 0.001) and endometriomas (Fleiss’ kappa: 0.93; 95% CI 0.77–1.00; p < 0.001). For the experienced readers, interobserver agreement in the assessment of compartments A, B and C was excellent (κ w ranging from 0.84; 95% CI 0.71–0.97; p < 0.001 to 0.89; 95% CI 0.82–0.97; p < 0.001). For the pairings of the experienced readers to the reader without specific experience in pelvic MRI, agreement was substantial to excellent (κ w ranging from 0.64; 95% CI 0.44–0.85; p < 0.001 to 0.91; 95% CI 0.84–0.98; p < 0.001). Intraobserver variability was excellent for compartments A, B and C (κ w ranging from 0.85; 95% CI 0.73–0.96; p < 0.001 to 0.95; 95% CI 0.89–1.00; p < 0.001). Conclusion With sufficient experience, the #Enzian classification enables the achievement of excellent inter- and intraobserver agreement in MRI-based diagnosis of deep infiltrating endometriosis and endometriomas.

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Outcome instruments

Enzian

Condition tags

endometriosisdie_deep_infiltrating

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (34)

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