What are the diagnostic performances of MRIs when used to identify mild endometriosis of the uterosacral ligaments (USL)?
This study was a monocentric retrospective study of patients who underwent a pelvic MRI followed by laparoscopy for determination of endometriosis between January 2016 and December 2020. Patients were included whether endometriosis of USLs was suspected or not, but patients presenting large lesions that left no doubt as to their endometriotic nature on the MRI were excluded. Six criteria for the description of USLs on MRIs were studied to determine their diagnostic performances in predicting the presence of endometriosis in laparoscopy as follows: asymmetry, thickening, irregularity, straightness, the presence of a nodule, or a hypersignal-T1-spot.
Seventy-seven patients were included. Among the criteria, ‘asymmetry’ and ‘thickening’ had the highest sensitivities [0.69 (95% confidence interval 0.54–0.80) and 0.51 (0.40–0.63), respectively] but moderate specificities [0.52 (0.31–0.73) and 0.62 (0.50–0.72)]. Conversely, ‘irregularity,’ ‘nodule,’ ‘straightness’ and ‘hypersignal-T1-spot’ were associated with high specificities [0.81 (0.70–0.89), 0.96 (0.89–0.99), 0.95 (0.87–0.99), and 0.99 (0.93–1.00), respectively] but poor sensitivities [0.22 (0.14–0.33), 0.12 (0.06–0.21), 0.08 (0.03–0.16), and 0.08 (0.03–0.16), respectively]. The presence of at least one criterion for the description of the USL was associated with good sensitivity [0.80 (0.66–0.89)] but poor specificity [0.35 (0.16–0.57)].
Our results suggest that the identification of minimal changes in the normal appearance of USL should not automatically lead to a conclusion of mild endometriosis at this location.
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Dr Margaux Stoppa is a radiologist graduated from Aix-Marseille university. She works in the women's imaging department in La Timone Hospital, Marseille. Her main scientific interests are endometriosis and female infertility imaging.
Accepted: March 2, 2023
Received: December 23, 2022
Publication stageIn Press Journal Pre-Proof
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