MR diagnosis of diaphragmatic endometriosis

Pascal Rousset, Rousset P, Jules Gregory, Jules Grégory, Christine Rousset-Jablonski, Christine Rousset‐Jablonski, Justine Hugon-Rodin, Hugon-Rodin J, Justine Hugon‐Rodin, Jean‐François Régnard, Regnard JF, Jean-François Regnard, Chapron C, Charles Chapron, Coste J, Joël Coste, Jöel Coste, François Golfier, Golfier F, Marie‐Pierre Revel, Marie-Pierre Revel
European radiology · 2016 · vol. 26(11) , pp. 3968–3977 · doi:10.1007/s00330-016-4226-5 · PMID:26868500 · W2281430586
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

Magnetic resonance imaging (MRI) demonstrates 78% to 83% sensitivity in diagnosing diaphragmatic endometriosis, with excellent interobserver agreement for lesion detection.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The paper retrospectively reviewed all diaphragmatic MRI studies performed in the context of diaphragmatic endometriosis over a 2-year period, with two independent readers assessing fat-suppressed axial and coronal T1- and T2-weighted sequences for specific lesion patterns (nodules, plaque lesions, micronodule clustering, and focal liver herniation). MRI findings were correlated with surgical findings in surgically treated women, and interobserver agreement was quantified with kappa statistics. MRI sensitivity was 78–83% depending on reader (83% for reader 1; 78% for reader 2) with excellent interobserver agreement (kappa 0.86), and lesions were mostly right-sided posterior nodules hyperintense on T1; MRI was negative in two surgically treated patients with small nodules or isolated diaphragmatic holes. The limitation is that the dataset was relatively small and includes cases with diagnostic confirmation either by surgery or by symptom relief on hormonal treatment rather than uniform surgical verification. This paper is centrally about endometriosis — it evaluates MRI diagnostic performance for diaphragmatic endometriosis.

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Abstract

PurposeTo evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis.Materials and methodsOver a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics.ResultsTwenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes.ConclusionMRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement.Key points• MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity. • Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences. • Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior. • MRI can help in timely diagnosis of diaphragmatic endometriosis.
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Abstract

Purpose To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis.

Materials and methods

Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics.

Results

Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes.

Conclusion

MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. Key Points • MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity. • Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences. • Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior. • MRI can help in timely diagnosis of diaphragmatic endometriosis. Similar content being viewed by others Abbreviations - CT: - Computed tomography - MRI: - Magnetic resonance imaging

References

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J Minim Invasive Gynecol 16:573–580 Ciriaco P, Negri G, Libretti L et al (2009) Surgical treatment of catamenial pneumothorax: a single centre experience. Interact Cardiovasc Thorac Surg 8:349–352 Fedele L, Bianchi S, Zanconato G, Berlanda N, Borruto F, Frontino G (2005) Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol 193:114–117 Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG 107:44–54 Sibiude J, Santulli P, Marcellin L, Borghese B, Dousset B, Chapron C (2014) Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis. Obstet Gynecol 124:709–717 Kinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298 Acknowledgments The scientific guarantor of this publication is Pascal Rousset. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Joël Coste, is one of the authors, and is from Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic study / observational, multicenter study. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Rousset, P., Gregory, J., Rousset-Jablonski, C. et al. MR diagnosis of diaphragmatic endometriosis. Eur Radiol 26, 3968–3977 (2016). https://doi.org/10.1007/s00330-016-4226-5 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-016-4226-5

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Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Endometriosis Muscular Diseases Adult Endometriosis Female Hernia, Diaphragmatic Hernia, Diaphragmatic Humans Liver Diseases Liver Diseases Magnetic Resonance Imaging Magnetic Resonance Imaging Middle Aged Muscular Diseases Patient Positioning Retrospective Studies Young Adult

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