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Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria

Several current guidelines recommend imaging in the diagnostic work-up of deep infiltrating endometriosis (DIE). The purpose of this retrospective diagnostic test study was to evaluate the diagnostic accuracy of MRI compared to laparoscopy for the identification of pelvic DIE, considering lesion mor...

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Autores principales: Harth, Sebastian, Roller, Fritz C., Zeppernick, Felix, Meinhold-Heerlein, Ivo, Krombach, Gabriele A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217213/
https://www.ncbi.nlm.nih.gov/pubmed/37238278
http://dx.doi.org/10.3390/diagnostics13101794
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author Harth, Sebastian
Roller, Fritz C.
Zeppernick, Felix
Meinhold-Heerlein, Ivo
Krombach, Gabriele A.
author_facet Harth, Sebastian
Roller, Fritz C.
Zeppernick, Felix
Meinhold-Heerlein, Ivo
Krombach, Gabriele A.
author_sort Harth, Sebastian
collection PubMed
description Several current guidelines recommend imaging in the diagnostic work-up of deep infiltrating endometriosis (DIE). The purpose of this retrospective diagnostic test study was to evaluate the diagnostic accuracy of MRI compared to laparoscopy for the identification of pelvic DIE, considering lesion morphology using MRI. In all, 160 consecutive patients were included who received pelvic MRI for evaluation of endometriosis between October 2018 and December 2020 and underwent subsequent laparoscopy within 12 months of the MRI examination. MRI findings were categorized for suspected DIE using the Enzian classification and were additionally graded using a newly suggested deep infiltrating endometriosis morphology score (DEMS). Endometriosis was diagnosed in 108 patients (all types, i.e., purely superficial and DIE), of which 88 cases were diagnosed with DIE and 20 with solely superficial peritoneal endometriosis (i.e., not deep infiltrating endometriosis/DIE). The overall positive and negative predictive values of MRI for the diagnosis of DIE, including lesions with assumed low and medium certainty of DIE on MRI (DEMS 1–3), were 84.3% (95% CI: 75.3–90.4) and 67.8% (95% CI: 60.6–74.2), respectively, and 100.0% and 59.0% (95% CI: 54.6–63.3) when strict MRI diagnostic criteria were applied (DEMS 3). Overall sensitivity of MRI was 67.0% (95% CI: 56.2–76.7), specificity was 84.7% (95% CI: 74.3–92.1), accuracy was 75.0% (95% CI: 67.6–81.5), positive likelihood ratio (LR+) was 4.39 (95% CI: 2.50–7.71), negative likelihood ratio (LR-) was 0.39 (95% CI: 0.28–0.53), and Cohen’s kappa was 0.51 (95% CI: 0.38–0.64). When strict reporting criteria are applied, MRI can serve as a method to confirm clinically suspected DIE.
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spelling pubmed-102172132023-05-27 Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria Harth, Sebastian Roller, Fritz C. Zeppernick, Felix Meinhold-Heerlein, Ivo Krombach, Gabriele A. Diagnostics (Basel) Article Several current guidelines recommend imaging in the diagnostic work-up of deep infiltrating endometriosis (DIE). The purpose of this retrospective diagnostic test study was to evaluate the diagnostic accuracy of MRI compared to laparoscopy for the identification of pelvic DIE, considering lesion morphology using MRI. In all, 160 consecutive patients were included who received pelvic MRI for evaluation of endometriosis between October 2018 and December 2020 and underwent subsequent laparoscopy within 12 months of the MRI examination. MRI findings were categorized for suspected DIE using the Enzian classification and were additionally graded using a newly suggested deep infiltrating endometriosis morphology score (DEMS). Endometriosis was diagnosed in 108 patients (all types, i.e., purely superficial and DIE), of which 88 cases were diagnosed with DIE and 20 with solely superficial peritoneal endometriosis (i.e., not deep infiltrating endometriosis/DIE). The overall positive and negative predictive values of MRI for the diagnosis of DIE, including lesions with assumed low and medium certainty of DIE on MRI (DEMS 1–3), were 84.3% (95% CI: 75.3–90.4) and 67.8% (95% CI: 60.6–74.2), respectively, and 100.0% and 59.0% (95% CI: 54.6–63.3) when strict MRI diagnostic criteria were applied (DEMS 3). Overall sensitivity of MRI was 67.0% (95% CI: 56.2–76.7), specificity was 84.7% (95% CI: 74.3–92.1), accuracy was 75.0% (95% CI: 67.6–81.5), positive likelihood ratio (LR+) was 4.39 (95% CI: 2.50–7.71), negative likelihood ratio (LR-) was 0.39 (95% CI: 0.28–0.53), and Cohen’s kappa was 0.51 (95% CI: 0.38–0.64). When strict reporting criteria are applied, MRI can serve as a method to confirm clinically suspected DIE. MDPI 2023-05-19 /pmc/articles/PMC10217213/ /pubmed/37238278 http://dx.doi.org/10.3390/diagnostics13101794 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Harth, Sebastian
Roller, Fritz C.
Zeppernick, Felix
Meinhold-Heerlein, Ivo
Krombach, Gabriele A.
Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title_full Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title_fullStr Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title_full_unstemmed Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title_short Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria
title_sort deep infiltrating endometriosis: diagnostic accuracy of preoperative magnetic resonance imaging with respect to morphological criteria
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217213/
https://www.ncbi.nlm.nih.gov/pubmed/37238278
http://dx.doi.org/10.3390/diagnostics13101794
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