MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report
Authors:
Open Access
- 5 July 2023
- journal article
- review article
- Published by Springer Nature in Insights into Imaging
- Vol. 14 (1) , 1-12
Abstract
Endometriosis represents one of the most common causes of life-impacting chronic pelvic pain and female infertility. Magnetic resonance imaging (MRI) plays an increasing role in the diagnosis and mapping of endometriosis, while diagnostic laparoscopy currently tends to be reserved for the patients with negative imaging results. The #Enzian, published in 2021, proposes a new comprehensive classification system of endometriosis, combining a complete staging of deep infiltrative endometriosis with the evaluation of peritoneal/ovarian/tubal localizations and the presence of adenomyosis. This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis. Overall, there is a significant matching between MRI features and the #Enzian classification criteria, two different perspectives of endometriosis mapping, with different goals and levels of detail. The main discrepancy lies in the evaluation of tubo-ovarian condition, which is not fully assessable by MRI. Furthermore, as endometriosis is a complex disease, usually multifocal, that can present with a myriad of imaging findings, MRI reporting should be clear and well organized. The authors group, both radiologists and gynecologists, propose a structured MRI report of endometriosis in correlation with the #Enzian classification, merging the detailed anatomical and pre-operative information provided by the MRI with the benefits of a comprehensive classification system of endometriosis in the clinical practice and research field.Critical relevance statement This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis and proposes a #Enzian-based structured MRI report. Graphical abstractKeywords
This publication has 46 references indexed in Scilit:
- Thoracic endometriosis syndrome: CT and MRI featuresClinical Radiology, 2014
- Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging featuresAbdominal Radiology, 2014
- Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosisEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2013
- Good practice for radiological reporting. Guidelines from the European Society of Radiology (ESR)Insights into Imaging, 2011
- Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracyActa Obstetricia et Gynecologica Scandinavica, 2010
- ENZIAN-Score, eine Klassifikation der tief infiltrierenden EndometrioseZentralblatt Fur Gynakologie, 2005
- ESHRE guideline for the diagnosis and treatment of endometriosisHuman Reproduction, 2005
- Posterior Cul-de-Sac Obliteration Associated with Endometriosis: MR Imaging EvaluationRadiology, 2005
- Deep Pelvic Endometriosis: MR Imaging for Diagnosis and Prediction of Extension of DiseaseRadiology, 2004
- Revised American Society for Reproductive Medicine classification of endometriosis: 1996Fertility and Sterility, 1997