Eur Radiol. 2025 Nov 29. doi: 10.1007/s00330-025-12154-3. Online ahead of print.
ABSTRACT
OBJECTIVE: To assess the reproducibility and the diagnostic accuracy of MRI for the assessment of (#)ENZIAN classification in patients with deep endometriosis by means of a meta-analysis.
MATERIALS AND METHODS: MEDLINE and EMBASE databases were searched for relevant articles from January 1, 2005, to January 1, 2025. Data on MRI reproducibility (interobserver/intraobserver kappa) were extracted for P (peritoneum), O (ovary), T (tubo-ovarian condition), A (vagina/rectovaginal space), B (utero-sacral ligaments), C (rectum/sigmoid colon), FA (F adenomyosis), FB (F bladder), FU (F ureter), FI (F intestinum), and FO (F other). Pooled sensitivity, specificity, PPV, and NPV were calculated for each compartment.
RESULTS: Twelve articles (1024 patients) were included, of which 7 used ENZIAN and 5 used #ENZIAN. MRI-based (#)ENZIAN showed high reliability for O, A, B, and C, with substantial or excellent agreement in most studies. MRI-based (#)ENZIAN showed high diagnostic values for O, T, A, B, and C. Sensitivity and specificity for O were 97.5% and 96.4% and for T, 94.1% and 89.1%, respectively. Sensitivity values for A, B, and C were slightly lower, but remained high at 76.1%, 83.4%, and 79.1% respectively, and specificity values were high at 92.4%, 87.8%, and 94.8%. Sensitivity values for FA, FB, and FI were low, with values of 64.6%, 56.9%, and 66.8%. Data for P, FU, and FO were insufficient and could not be pooled.
CONCLUSION: MRI-based (#)ENZIAN showed high reliability for compartments O, T, A, B, and C. Data for other compartments were either insufficient or the diagnostic accuracy was low.
KEY POINTS: Question What is the diagnostic value of MRI in the assessment of (#) ENZIAN classification in patients with deep endometriosis? Findings MRI-based(#)ENZIAN showed high diagnostic values for compartments O, T, A, B, and C. Data on the remaining compartments were insufficient, or the diagnostic accuracy was low. Clinical relevance MRI-based (#) ENZIAN can be used for assessing endometriosis located at the ovaries, tubal ovarian condition, vaginal-rectovaginal space, utero-sacral ligaments, and rectosigmoid. For other compartments, more data are needed and clear definitions might also improve the role of MRI.
PMID:41317188 | DOI:10.1007/s00330-025-12154-3
