Bronovo Hospital, Bronovolaan, the Netherlands.
Leiden University Medical Center, Leiden, the Netherlands.
J Ultrasound Med. 2019 Apr;38(4):989-996. doi: 10.1002/jum.14783. Epub 2018 Sep 23.
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.
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.
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.
There is no significant added value of routine MRI after dynamic TVUS for the preoperative staging of endometriosis.
评估磁共振成像（MRI）在经阴道超声（TVUS）动态检查后对盆腔子宫内膜异位症术前分期诊断路径的附加价值。
这是一项前瞻性观察性研究，于 2014 年 4 月 22 日至 2015 年 5 月 1 日进行。在此期间，纳入了 363 例临床疑似患有子宫内膜异位症的患者。所有患者均接受了病史、临床检查和 TVUS 动态检查。大多数患者（n=274）根据欧洲人类生殖与胚胎学会指南接受了保守治疗。有 89 名患者选择手术治疗，其中 72 名患者接受了完整的诊断路径：即病史、临床检查、TVUS 和 MRI。所有数据均通过非参数 McNemar 检验进行分析，用于比较诊断算法的每个步骤。
病史、盆腔检查和 TVUS 的敏感性和特异性分别为 93.7%和 55.6%（P<0.001）；当包括 MRI 结果时，敏感性和特异性分别为 85.9%和 62.5%。在诊断程序中常规添加 MRI 并不能显著提高敏感性或特异性。
对于子宫内膜异位症的术前分期，TVUS 动态检查后常规 MRI 没有明显的附加价值。
