ArticleAbdominal radiology (New York)2024
MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes.
Article in Abdominal radiology (New York), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Navigating complexity: review and updates of endometriosis and adenomyosis imaging.The British journal of radiology · 2026Review
- Mind the gap: underreporting of key compartments in endometriosis MRI with free-text and non-disease-specific templates.Insights into imaging · 2026Article
- Diagnostic Accuracy of MRI Using the #Enzian Classification in Endometriosis: A Single-Center Retrospective Cohort Study.Gynecologic and obstetric investigation · 2026Observational
- Endometriosis MDC: role of the radiologist.Abdominal radiology (New York) · 2025Review
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Authors and funding
5 authors.
Funding
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Abstract
purposeThis study aimed to investigate the utility of the #Enzian classification in magnetic resonance imaging (MRI) for endometriosis assessment, focusing on inter-reader agreement, diagnostic accuracy, and the correlation of adenomyosis with deep endometriosis (DE).
methodsThis IRB- approved retrospective single-center study included 412 women who underwent MRI evaluation for endometriosis between February 2017 and June 2022. Two experienced radiologists independently analyzed MRI images using the #Enzian classification and assessed the type of adenomyosis, if any. The surgical #Enzian classification served as the gold standard for evaluating preoperative MRI results of 45 patients. Statistical analysis was performed to assess inter-reader agreement and diagnostic accuracy.
resultsInter-reader agreement was substantial to excellent (Cohen's kappa 0.75-0.96) for most compartments except peritoneal involvement (0.39). The preoperative MRI showed mostly substantial to excellent accuracy (0.84-0.98), sensitivity (0.62-1.00), specificity (0.87-1.00), positive (0.58-1.00) and negative predictive values (0.86-1.00) for most compartments, except for peritoneal lesions (0.36, 0.17, 1.00, 1.00, 0.26 respectively). A trend with a higher prevalence of concordant DE in women with MR features of external adenomyosis compared to those with internal adenomyosis was visible (p = 0.067).
conclusionsThe mr#Enzian showed mostly high inter-reader agreement and good diagnostic accuracy for various endometriosis compartments. MRI's role is particularly significant in the context of the current paradigm shift towards medical endometriosis treatment. The inclusion of information about the type of adenomyosis in the mr#Enzian classification could enhance diagnostic accuracy and inform treatment planning.
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