Staging of pelvic endometriosis using magnetic resonance imaging compared with the laparoscopic classification of the American Fertility Society: a prospective study

Zanardi R, Romeo Zanardi, Del Frate C, Chiara Del Frate, Chiara Zuiani, Zuiani C, Giovanni Del Frate, Del Frate G, Massimo Bazzocchi, Bazzocchi M
La Radiologia medica · 2003 · vol. 105(4) , pp. 326–38 · PMID:12835626 · W178919958
Diagnostic accuracy OA: closed CC0 ⤵ 18 in-corpus citations
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This study compared MRI staging of pelvic endometriosis to the laparoscopic AFS classification, finding high agreement (96.6%) and demonstrating MRI's usefulness for preoperative staging despite limitations with small implants.

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Abstract

PURPOSE: To introduce a staging of pelvic endometriosis based on Magnetic Resonance Imaging (MRI) features, compared with the American Fertility Society (AFS) laparoscopic classification. MATERIALS AND METHODS: Thirty-five consecutive females with clinically suspected endometriosis underwent MRI examination using TSE T1, T2W, and SE FAT-SAT T1W sequences, to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within two weeks (mean 8 days) of the examination. A radiologist experienced in pelvic pathology evaluated the presence of endometriomas and implants and calculated a score to classify endometriosis in four classes, comparable with those of AFS laparoscopic staging. The MRI score was based on size, edges, wall thickness, septations, signal intensity on T2-weighted images of endometriomas and presence of pelvic implants. The concordance between MRI and laparoscopic classification was evaluated using k-statistics. RESULTS: Laparoscopy confirmed 47/48 endometriomas, ranging in size from 10 to 62 mm, detected by MRI, with only one false positive due to an hemorrhagic corpus luteum. Nevertheless, 2 intra-ovarian endometriomas were detected by laparoscopy only thanks MRI guidance. Implants were discovered in 17/30 patients with MRI, laparoscopically in 18/30. MRI detected 46 endometrial implants out of 57 detected by laparoscopy (80.7%): 17/46 implants were directly confirmed by laparoscopy, 29/46 were indirectly confirmed by the presence of adhesions. As regards staging, there was agreement between the MRI and AFS classification in 33/35 patients with only two case of discordance (K= 0,892). CONCLUSIONS: Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful for guiding laparoscopy. Moreover, the high level of agreement (96.6%) between the MRI staging proposed in this paper and laparoscopic classification demonstrates a further advantage of the use of MRI in the preoperative staging of endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Magnetic Resonance Imaging Adult Adult Diagnosis, Differential Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Female Humans Humans Laparoscopy Laparoscopy Prospective Studies Prospective Studies

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

Cited by (18)

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