Comparative Analysis of Ultrasound and MRI in Detecting Endometriosis among Pakistani Women

Binish Zaidi, Sara L. Gill, Assad Farooq, Muhammad Imran Akhtar, Muhammad Akhtar, Zeghum Hussain Zeghum, Sajida Majeed
In: Pakistan Journal of Medical and Health Sciences · 2023 · vol. 17(4) · doi:10.53350/pjmhs2023174731 · W4408295002
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This prospective study in Pakistani women found MRI superior to transvaginal ultrasound for detecting endometriosis, particularly deep infiltrative lesions, based on higher sensitivity and specificity compared to laparoscopic confirmation.

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This prospective study evaluated the diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging for detecting endometriosis in 90 premenopausal Pakistani women. Using laparoscopic findings and histopathology as reference standards, the researchers compared sensitivity, specificity, and predictive values between the two imaging modalities. The results indicated that MRI significantly outperformed ultrasound, particularly in identifying deep infiltrating lesions, with higher sensitivity and better interobserver agreement. This paper is centrally about endometriosis — specifically the comparative diagnostic performance of imaging techniques for deep infiltrating disease in a specific demographic.

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Abstract

Background: Endometriosis is a persistent gynecological disease that greatly affects a woman’s quality of life and reproductive health. Diagnosis is increasingly done using such non-invasive imaging modalities as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Nevertheless, data regarding their performance in detecting deep infiltrative lesions in Pakistani women, in particular, are scarce. Objective: To assess the diagnostic accuracy of TVUS compared to MRI in the detection of endometriosis in premenopausal Pakistani women using laparoscopic findings and histopathological confirmation as the reference standard. Methods: This is a prospective study of 12 months (January to December 2021) in 90 premenopausal women (aged 18 to 45 years) with clinical symptoms suggestive of endometriosis. TVUS and MRI evaluations were performed on all the participants before diagnostic laparoscopy. Images were interpreted by independent, experienced radiologists. Each imaging modality's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared to laparoscopic and histopathological diagnosis. The diagnostic performance of DIE in a subset analysis was also performed. Results: Laparoscopy confirmed endometriosis in 70 patients (77.8%). In general, TVUS showed a sensitivity of 77.1%, specificity of 70.0%, PPV of 90.0%, and NPV of 46.7%. However, with significantly higher sensitivity (91.4%) and specificity (85.0%), PPV 95.5%, and NPV 73.9% (p < 0.05), MRI was found to be in contrast to the US. MRI has a sensitivity of 93.3% for deep infiltrating endometriosis as compared to 66.7% for TVUS. Moreover, the interobserver agreement for MRI (κ = 0.85) was greater than for TVUS (κ = 0.70). Conclusion: TVUS is still a cost-effective and accessible first-line diagnostic tool but MRI is superior for detecting deep infiltrative lesions. Therefore, the findings support a stepwise, tailored diagnostic approach in resource-constrained settings that incorporates MRI when TVUS findings are unspecific or deep disease is suspected to best guide patient management and surgical planning. Keywords: Endometriosis, Diagnostic Accuracy, Transvaginal Ultrasound, Magnetic Resonance Imaging, Deep Infiltrating Endometriosis, Pakistani Women, Laparoscopy
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Background

Endometriosis is a persistent gynecological disease that greatly affects a woman’s quality of life and reproductive health. Diagnosis is increasingly done using such non-invasive imaging modalities as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Nevertheless, data regarding their performance in detecting deep infiltrative lesions in Pakistani women, in particular, are scarce.

Objective

To assess the diagnostic accuracy of TVUS compared to MRI in the detection of endometriosis in premenopausal Pakistani women using laparoscopic findings and histopathological confirmation as the reference standard.

Methods

This is a prospective study of 12 months (January to December 2021) in 90 premenopausal women (aged 18 to 45 years) with clinical symptoms suggestive of endometriosis. TVUS and MRI evaluations were performed on all the participants before diagnostic laparoscopy. Images were interpreted by independent, experienced radiologists. Each imaging modality's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared to laparoscopic and histopathological diagnosis. The diagnostic performance of DIE in a subset analysis was also performed.

Results

Laparoscopy confirmed endometriosis in 70 patients (77.8%). In general, TVUS showed a sensitivity of 77.1%, specificity of 70.0%, PPV of 90.0%, and NPV of 46.7%. However, with significantly higher sensitivity (91.4%) and specificity (85.0%), PPV 95.5%, and NPV 73.9% (p < 0.05), MRI was found to be in contrast to the US. MRI has a sensitivity of 93.3% for deep infiltrating endometriosis as compared to 66.7% for TVUS. Moreover, the interobserver agreement for MRI (κ = 0.85) was greater than for TVUS (κ = 0.70).

Conclusion

TVUS is still a cost-effective and accessible first-line diagnostic tool but MRI is superior for detecting deep infiltrative lesions. Therefore, the findings support a stepwise, tailored diagnostic approach in resource-constrained settings that incorporates MRI when TVUS findings are unspecific or deep disease is suspected to best guide patient management and surgical planning.

Keywords

Endometriosis, Diagnostic Accuracy, Transvaginal Ultrasound, Magnetic Resonance Imaging, Deep Infiltrating Endometriosis, Pakistani Women, Laparoscopy Downloads How to Cite Issue Section License Copyright (c) 2023 Binish Zaidi, Sara Gill, Anum Farooq, Muhammad Imran Akhtar, Zeghum Hussain Zeghum, Sajida Majeed This work is licensed under a Creative Commons Attribution 4.0 International License.

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