Observational studyUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology2026
Head-to-head prospective comparison of diagnostic accuracy of preoperative ultrasonography and MRI in patients undergoing surgery for deep endometriosis using #Enzian classification.
Observational study in Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 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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Abstract
objectiveTo perform a head-to-head comparison of the diagnostic performance of ultrasonography (US) vs magnetic resonance imaging (MRI) for the preoperative detection of endometriosis using the #Enzian classification system.
methodsThis was a prospective observational study of postmenarchal premenopausal women who underwent laparoscopy between 1 April 2021 and 31 May 2024 in a tertiary referral center for clinical suspicion of endometriosis. All women underwent both transvaginal and transabdominal US imaging, according to the International Deep Endometriosis Analysis (IDEA) protocol, as well as MRI evaluation. The sonologist and the radiologist were blinded to each other's results. The diagnostic performance of US and MRI were determined for the following #Enzian compartments: O (ovarian endometriosis), T (adhesions at the level of the tubo-ovarian unit), A (deep endometriosis (DE) in the vagina, rectovaginal septum and torus uterinus), B (DE in the uterosacral ligament, cardinal ligament, parametrium and pelvic sidewall), C (DE in the rectosigmoid bowel), FI (lesions in other intestinal locations), FB (urinary bladder involvement), FU (ureteric involvement) and FO (lesions in other extragenital locations). The sensitivity and specificity were compared between imaging modalities using McNemar's test. Concordance between preoperative imaging and surgical assessment of #Enzian severity grade for endometriotic lesions/adhesions in #Enzian compartments O, T, A, B and C was assessed.
resultsIn total, 463 women who underwent laposcopy for diagnosis and excisional treatment of endometriosis were enrolled in the study. For the detection of endometriotic lesions/adhesions in #Enzian compartments O
conclusionsUS evaluation following the IDEA protocol has significantly higher specificity compared with that of MRI for pelvic adhesions in #Enzian compartment T. However, US and MRI have similarly high sensitivity and specificity for diagnosing DE in all relevant #Enzian compartments. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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