Evidence map›Paper›PMID 41937990›Full record

ArticleWorld journal of radiology2026

Characterization of endometriosis in patients with Mullerian anomalies using the Enzian classification: A retrospective cohort study.

Ishan Kumar, Shweta Kumari, Ritu Ojha, Rupam Kumari, Kajal Kushwaha, Pramod Kumar Singh, Ashish Verma

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Article in World journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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7 authors.

Ishan KumarDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India. ishanjd@gmail.com.
Shweta KumariDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Ritu OjhaDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Rupam KumariDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Kajal KushwahaDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Pramod Kumar SinghDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
Ashish VermaDepartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMullerian anomalies are frequently associated with endometriosis, particularly in the presence of genital tract obstruction; however, the anatomical distribution and determinants of disease in this population remain incompletely characterized. Most existing data are derived from surgical series, with limited use of standardized imaging-based classification systems.

aimTo characterize the prevalence and distribution of endometriosis in patients with Mullerian anomalies using pelvic magnetic resonance imaging (MRI) and the Enzian classification.

methodsThis retrospective observational study included pelvic MRI examinations performed over a 15-month period. Patients whose MRI reports described Mullerian anomalies were identified, and imaging datasets were re-evaluated. Mullerian anomalies were classified using the Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy system. Endometriosis was assessed on MRI and mapped using the Enzian classification, including ovarian (O), peritoneal (P), and deep infiltrating tissue (T) involvement across pelvic compartments. The presence of genital tract obstruction was determined based on MRI evidence of hemorrhagic collections.

resultsSeventy-five patients with Mullerian anomalies were included. MRI findings consistent with endometriosis were identified in 22 patients (29.3%). Ovarian endometriomas were the most common manifestation, present in 16 patients (21.3%), while tubo-ovarian involvement corresponding to Enzian T2-T3 disease was seen in 11 patients (14.7%). Endometriosis was more frequently observed in complex uterine configurations, particularly bicorporeal septate uterus (U3c), aplastic uterus with a functional rudimentary cavity (U5a), and in patients classified as U0 with associated cervicovaginal anomalies. Vaginal aplasia (V4) was associated with a significantly lower prevalence of endometriosis compared with normal vaginal anatomy (

conclusionEndometriosis in patients with Mullerian anomalies demonstrates variable distribution on MRI, with higher prevalence in complex and obstructive uterine configurations. MRI combined with standardized Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy and Enzian classifications provides a structured, anatomy-driven approach for evaluating disease patterns in this heterogeneous population.

Indexed as

EndometriosisEnzian classificationGenital tract obstructionMagnetic resonance imagingMullerian duct anomalies

Identifiers

PMID41937990
PMCPMC13047641

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