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Limited Added Value of Magnetic Resonance Imaging After Dynamic Transvaginal Ultrasound for Preoperative Staging of Endometriosis in Daily Practice: A Prospective Cohort Study
Author(s) -
Berger Judith P.,
Rhemrev Johann,
Smeets Maddy,
Henneman Onno,
English James,
Jansen Frank W.
Publication year - 2019
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14783
Subject(s) - medicine , endometriosis , magnetic resonance imaging , mcnemar's test , physical examination , prospective cohort study , radiology , dynamic contrast enhanced mri , ultrasound , cohort , surgery , gynecology , statistics , mathematics
Objectives To assess the added value of magnetic resonance imaging (MRI) after dynamic transvaginal ultrasound (TVUS) in the diagnostic pathway for preoperative staging of pelvic endometriosis. Methods A prospective observational study was conducted between April 22, 2014, and May 1, 2015. During that period, 363 patients with a clinical suspicion of endometriosis were included. All patients underwent a history, clinical examination, and dynamic TVUS examination. Most of the patients (n = 274) underwent conservative treatment according to the European Society of Human Reproduction and Embryology guidelines. Eighty‐nine patients were selected for surgery, of whom 72 patients underwent the complete diagnostic pathway: ie, history, clinical examination, dynamic TVUS, and MRI. All data were analyzed by the nonparametric McNemar test for comparing each step in the diagnostic algorithm. Results The sensitivity and specificity for the history, pelvic examination, and dynamic TVUS were 93.7% and 55.6% ( P < .001), respectively; when MRI findings were included, the sensitivity and specificity were 85.9% and 62.5%. Adding MRI routinely to the diagnostic procedure of endometriosis did not significantly improve the sensitivity or specificity. Conclusions There is no significant added value of routine MRI after dynamic TVUS for the preoperative staging of endometriosis.