T2*-Weighted Imaging Performance in the Detection of Deep Endometriosis among Readers with Different Experience: Comparison with Conventional MRI Sequences

Magnetic resonance imaging (MRI) is an effective technique for the diagnosis and preoperative staging of deep infiltrative endometriosis (DIE). The usefulness of MRI sequences susceptible to chronic blood degradation products, such as T2*-weighted imaging, remains uncertain. The present study aims to evaluate the diagnostic performance of these sequences in addition to the conventional protocol for DIE assessment. Forty-four MRI examinations performed for clinical and/or ultrasound DIE suspicion were evaluated by three readers with variable experience in female imaging. The inter-observer agreement between the reader who analysed only the conventional protocol and the one who also considered T2*-weighted sequences was excellent. The less experienced reader diagnosed a significantly higher number of endometriosis foci on the T2*-weighted sequences compared with the most experienced observer. T2*-weighted sequences do not seem to provide significant added value in the evaluation of DIE, especially in less experienced readers. Furthermore, artifacts caused by undesirable sources of magnetic inhomogeneity may lead to overdiagnosis.

Automated summary

Magnetic resonance imaging (MRI) is effective for diagnosing and staging deep infiltrative endometriosis (DIE). The diagnostic performance of MRI sequences susceptible to chronic blood degradation products, such as T2*-weighted imaging, is still uncertain. This study evaluated the usefulness of these sequences in addition to the conventional protocol for DIE assessment. The results showed that T2*-weighted sequences do not provide significant added value in the evaluation of DIE, especially for less experienced readers. Additionally, artifacts caused by undesirable sources of magnetic inhomogeneity may lead to overdiagnosis.