Obstetrics & Gynecology · 1 h ago
Selective MRI May Improve Mapping of Complex Deep Endometriosis
A prospective observational cohort assessed whether second-line MRI adds diagnostic information after expert transvaginal ultrasound in women with suspected deep endometriosis scheduled for surgery. Combined imaging improved sensitivity for some lesions but reduced specificity for several findings, supporting selective rather than routine MRI use in this population.
- Combined imaging increased sensitivity for rectosigmoid lesions.
- Specificity declined for several lesion types.
- Findings support selective, not routine, second-line MRI.
- Prior-surgery subgroup result was exploratory.
This prospective observational cohort included 221 women with suspected deep endometriosis scheduled for surgery after expert transvaginal ultrasound (TVS); 189 underwent surgery, and 112 had both TVS and MRI. MRI was selectively added for suspected advanced disease, inconclusive ultrasound, or persistent symptoms despite negative ultrasound. Surgical visualization was the primary reference standard.
Defining combined imaging as positive when either test was positive increased sensitivity for rectosigmoid disease by 10.3% (six additional true positives and three false positives) and uterosacral ligament involvement by 29.2% (14 additional true positives and 12 false positives). However, specificity fell for endometriomas, pouch of Douglas obliteration, and uterosacral ligament involvement. Accuracy for bladder and ureter disease also decreased, from 82.2% to 75.7%. Most lesions missed by TVS were in the mid or upper rectum.
The results suggest MRI may add value when expert ultrasound leaves concern about complex disease, particularly rectosigmoid involvement, but may also increase false-positive findings. The higher rectosigmoid sensitivity among women with prior abdominal surgery was exploratory. The selected surgical cohort limits generalizability; the findings do not support routine MRI after expert TVS.
In practice
For patients with suspected complex deep endometriosis being considered for surgery, second-line MRI after expert transvaginal ultrasound may improve detection of rectosigmoid and uterosacral ligament lesions, but the combined approach also reduced specificity for several findings. The study supports selective use when ultrasound is inconclusive or concern for advanced disease persists, rather than routine MRI for all patients. Applicability is limited by the selected surgical cohort, and the apparent greater rectosigmoid sensitivity in patients with prior abdominal surgery was exploratory.
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Acta Obstetricia et Gynecologica Scandinavica: Second‐line MRI after expert transvaginal ultrasound in selected patients with suspected complex deep endometriosis: A prospective cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.