Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care

Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted. Similar content being viewed by others

Shafrir AL et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Practice and Research Clinical Obstetrics and Gynaecology. 2018; 51:1-15. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertility and Sterility. 1997; 68:585–596. Hogg S and Vyas S. Endometriosis update. Obstetrics, Gynaecology and Reproductive Medicine. 2018;28(3): 61-69. Bulun S. Endometriosis. The New England Journal of Medicine. 2009; 360:268-279. Dunselman GAJ et al. ESHRE guideline: management of women with endometriosis. Human reproduction 2014; 29(3): 400-412. Johnson NP and Hommelshoj L. For the World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Human Reproduction. 2013; 28(6):1552-2568. Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A and Abrao MS. Surgical treatment of different types of endometriosis: comparison of major society guidelines and preferred clinical algotirhms. Best Practice and Research Clinical Obstetrics and Gynaecology. 2018; 51:102-110. D’Hooghe T and Hummelshoy L. Multi-disciplinary centres /networks of excellence for endometriosis management and research: a proposal. Human Reproduction. 2006; 21:2743-2748. Ebert AD et al. Implementation of certified endometriosis centers: 5-year experience in German-speaking Europe. Gynecologic and Obstetric Investigation. 2013; 76:4-9. Menakaya UA, Rombauts L, Johnson NP. Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: Is it still relevant? The Australian and New Zealand Journal of Obstetrics and Gynaecolgy. 2016; 56(5):518-22. Medeiros LR et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. General Gynecology. 2015; 291: 611-621. Noventa M et al. Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertility Sterility 2015; 104(2): 366-83. Kinkel K, Chapron C, Balleyguier C, Fritel X, Dubuisson JB, Moreau JF. Magnetic resonance imaging characteristics of deep endometriosis. Human Reproduction 14(4):1080–1086. Bazot et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 2004; 232:379-389. Chamie LP, Blasbalg R, Goncalves MO, Carvalho FM, Abrao MS, de Oliveira IS. Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis. International Journal of Gynaecolgy and Obstetetrics. 106(3):198–201. Hottat N, Larrousse C, Anaf V et al (2009) Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment– initial results. Radiology 253(1):126–134. Grasso RF, Di Giacomo V, Sedati P et al. Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography. Abdominal Imaging. 2010; 35(6):716–725. Di Paola V, Manfredi R, Castelli F, Negrelli R, Mehrabi S, Pozzi Mucelli R. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. European Journal of Radiology. 2015; 84(4):568–574. Bazot et al. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. European Radiology (2017) 27:2765-2775. Sahni VA, Silveira PC, Sainai NI and Khorasani R. Impact of a structured report template on the quality of MRI reports for rectal cancer staging. American Journal of Roentgenology. 2015; 205:584-588. Magnetta MJ, Donovan AL, Jacobs BL, Davies BJ and Alessandro Furlan. Evidence-based reporting: a method to optimize prostate MRI communications with referring physicians. American Journal of Roentgenology. 2018;210:108-112. Brook OR et al. Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology 2014; 274(2):464-472. Franconeri A et al. Structured vs narrative reporting of pelvic MRI for fibroids: clarity and impact on treatment planning. European Radiology 2018; 28(7):3009-3017. Mattos L.A., Goncalves M.O., Andres M.P., Young S.W., Feldman M, Abrao M.S., and Kho R.M. Structured ultrasound and magnetic resonance imaging reports for patients with suspected endometriosis: Guide for imagers and clinicians. The Journal of Minimally Invasive Gynecology. Available online March 16, 2019. Novellas S, Chassand M, bouaziz J, Delotte J, Toullalan Oand Chevallier P. Anterior pelvic endometriosis. Abdominal imaging. 2010; 35(6):742-749 Foti PV et al. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights into Imaging (2018) 9:149-172. Chamié LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics 2011; 31(4):E77–100. Coutinho A et al. MR Imaging in deep pelvic endometriosis: A pictoral essay. Radiographics. 2011; 31:549-567. Thotakura P, Dyer RB. The T2 shading sign. Abdominal Radiology (2016) 41:2401-2403 Corwin MT, Gerscovich EO, Lamba R, Wilson M and McGahan JP. Differentiation of Ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology April 2014 (271:1) 126-132 McDermott S, Oei TN, Iyer VR and Lee SI. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics 2012; 32:845-863. Bennett GL, Slywotzky CM, Cantera M and Hecht EM. Unusual manifestations and complications of endometriosis—Spectrum of imaging findings: pictorial review. American Journal of Roentgenology 2010; 194:WS34-WS46. Rocha TP, Andres MP, Borrelli GM, Abrão MS. Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options. Reproductive Sciences. 2018; 25(4):480-6. Gui B, Valentini AL, Ninivaggi V, Marino M, Lacobucci M and Bonoma L. Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features. Abdominal Imaging (2014) 39:622-632. Kaniewska M, Golofit P, Heubner M, Maake C nd Kubik-Huch RA. Suspensory ligaments of the female genital organs: MRI evaluation with intraoperative correlation. Radiographics 2018; 38(7):2195-2211. Kruger K, behrendt K, Niedobietek-Kreuter G, Kolterman K and Ebert AD. Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2013; 169:93-98. Chasang M, Novellas S, Bloch-Marcotte C, Delotte J, Toullalan O, Bongain A, Chevallier P. Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis. European Radiology. 2010; 20(4):1003-1010. Audebert A, Petousis S. Margioula-Siarkou C, Ravanos K, Prapas N and Prapas Y. Anatomic distribution of endometriosis: a reappraisal based on series of 1101 patients. European Journal of Obstetrics and Gynecology and Reprodutive Biology. 2018; 230:36-40 Bazot M, Gasner A, Ballester M and Darai E. Value of thin-section oblique axial t2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Human Reproduction. 2011;26(2):346-353. Abrao MS, Petraglia F, Falcone T, Keckstein J, Osuga Y and Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Human reproduction update. 2015; 21(3):329-339 Yoon JH, Choi D, Jang KT, et al. Deep rectosigmoid endometriosis: “mushroom cap” sign on T2-weighted MR imaging. Abdominal Imaging. 2010;35(6):726–731 Chamie LP, Ribeiro DMFR, Tiferes DA, Macedo Neto AC and Serafini PC. Atypical sites of deeply infiltrative endometriosis: clinical characteristics and imaging findings. Radiographics. 2018; 38:309-328. Filho et al. What abdominal radiologists should know about extragenital endometriosis-associated neuropathy. Abdominal Radiology. 2018 E pub ahead of print Author information Authors and Affiliations Corresponding author Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Feldman, M.K., VanBuren, W.M., Barnard, H. et al. Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care. Abdom Radiol 45, 1608–1622 (2020). https://doi.org/10.1007/s00261-019-02182-1 Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-019-02182-1