Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification
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GENERAL GYNECOLOGY
Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification Laurin Burla1 · David Scheiner1 · Andreas M. Hötker2 · Andreas Meier2 · Daniel Fink1 · Andreas Boss2 · Patrick Imesch1 Received: 28 April 2020 / Accepted: 7 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Proposal of a systematic approach to assess Deep infiltrating endometriosis (DIE) through pelvic Magnetic resonance imaging (MRI) using the Enzian classification and examination of inter-rater agreement. Methods Three radiologists reviewed 23 MRI of patients with pelvic DIE at one tertiary referral center retrospectively and independently. Inclusion criteria were intraoperative confirmation of DIE and MR imaging according to ESUR (European Society of Urogenital Radiology) guidelines. Assessment of the anatomical pelvic compartments was performed using a manual based on the Enzian classification with step-by-step instructions using recommended planes and sequences presented here. Interrater agreement was measured using kappa statistics. Results According to the intraoperative site lesions in 53 anatomical compartments were present. Interrater agreement was best for compartments A (0.255) and FB (0.642). For FI (0.204) and B (0.146) it was slight, there was poor agreement for C (− 0.263), FA (− 0.022), and FO (− 0.030), respectively, and as for FU, no ureter infiltration was described. Conclusion MRI as a noninvasive diagnostic tool offers essential advantages regarding classification and therapy planning for patients with DIE. However, its assessment is difficult and a more systematic approach is needed. Our proposed manual based on the Enzian classification is reproducible and could support radiologists and gynecologists. Keywords Endometriosis · Deep infiltrating endometriosis · Enzian classification · MRI assessment of deep infiltrating endometriosis · Interrater agreement MRI endometriosis · Interobserver agreement MRI endometriosis
Introduction Endometriosis shows a prevalence of 6–10%, making it a common gynecological disease in women of reproductive age. It is defined as the presence of endometrial glandular and stromal cells outside the physiological site in the uterine cavity. The severity of symptoms such as dysmenorrhea, dyspareunia, infertility and pelvic pain does not correlate adequately with the severity of the disease [1, 2]. Despite its frequent occurence and its usually severe symptoms, the Andreas Boss and Patrick Imesch shared last authorship. * Laurin Burla [email protected] 1
Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
2
latency period from onset of symptoms to diagnosis may last up to 10 years. As a result, long periods of suffering together with pronounced psychological and somatic stress are frequent. Despair and high costs for the health and social systems due to “doctor
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