Bermot Cécile, Labauge Pénélope, Limot Olivier, Louboutin Anne, Fauconnier Arnaud, Huchon Cyrille
Service de Radiologie, CHI Poissy-St-Germain, 10, rue du Champ Gaillard BP 3082, 78303 Poissy CEDEX, France.
Service de Radiologie, CHI Poissy-St-Germain, 10, rue du Champ Gaillard BP 3082, 78303 Poissy CEDEX, France.
J Gynecol Obstet Hum Reprod. 2018 Dec;47(10):499-503. doi: 10.1016/j.jogoh.2018.09.011. Epub 2018 Sep 28.
To study the performance of MRI for the detection of anterior pelvic endometriotic lesions.
We carried out a retrospective, single site, case-controlled study of patients who underwent surgery for endometriosis between March 2005 and December 2013. Laparoscopy was used to obtain the reference diagnosis of the endometriotic lesions. We age-matched patients with anterior endometriosis with those with isolated posterior endometriosis for reference. All of the pre-therapeutic MRI data were anonymized and blindly reread by two radiologists (junior and senior) twice. They assessed the overall presence of anterior lesions, those of the inter-vesicouterine space, the detrusor, the uterus, and posterior lesions. For each site, we calculated the sensitivity (Se) and specificity (Sp) for each reading compared to the reference, as well as the inter- and intra-operator variability using the Kappa coefficient (K) with its 95% confidence interval (95% CI).
During the study period, 256 patients underwent surgery for endometriosis: 22 presented with anterior endometriosis at surgery, and had had pre-preoperative imagery. We included 22 controls who had an isolated posterior lesion. For the overall detection of anterior lesions, the two radiologists had an identical Se of 77.3% (95% CI; 54.6-92.2). The Sp was 100% (95% CI; 82.4-100) for the junior, and 89.5% (95% CI; 66.9-98.7) for the senior radiologist. The area under the ROC curve was 0.89 (95% CI; 0.80-0.98) for the junior and 0.81 (95% CI; 0.68-0.93) for the senior radiologist. The intra-operator variability was low with almost perfect reproducibility for the overall detection of anterior lesions; k=0.90 (95% CI; 0.77-1) for the junior and k=0.85 (95% CI; 0.70-1) for the senior radiologist. For the various anterior sites, the junior radiologist had k values between 0.60 and 1, whereas those of the senior radiologist were between 0.87 and 1. For inter-operator reproducibility, there was modest agreement between the two radiologists, k=0.46 (95% CI; 0.19-0.73), for the overall detection of anterior lesions; k varied between 0.43 and 0.61, depending on the site.
Our results show that the characterization of anterior lesions by MRI is specific, but not very sensitive, with only moderate inter-operator reproducibility depending on the site. MRI can be used to diagnose anterior lesions, but cannot replace laparoscopy.
研究MRI检测盆腔前部子宫内膜异位病变的性能。
我们对2005年3月至2013年12月间接受子宫内膜异位症手术的患者进行了一项回顾性、单中心、病例对照研究。采用腹腔镜检查以获得子宫内膜异位病变的参考诊断。我们将盆腔前部子宫内膜异位症患者与孤立性盆腔后部子宫内膜异位症患者按年龄匹配作为对照。所有治疗前的MRI数据均进行了匿名处理，并由两位放射科医生（初级和高级）进行两次盲法重新解读。他们评估了前部病变、膀胱子宫间隙、逼尿肌、子宫以及后部病变的总体存在情况。对于每个部位，我们计算了每次解读相对于参考诊断的敏感性（Se）和特异性（Sp），以及使用Kappa系数（K）及其95%置信区间（95%CI）计算的阅片者间和阅片者内变异性。
在研究期间，256例患者接受了子宫内膜异位症手术：22例在手术中表现为盆腔前部子宫内膜异位症，且术前有影像学检查。我们纳入了22例有孤立性盆腔后部病变的对照患者。对于前部病变的总体检测，两位放射科医生的Se均为77.3%（95%CI；54.6 - 92.2）。初级放射科医生的Sp为100%（95%CI；82.4 - 100），高级放射科医生的Sp为89.5%（95%CI；66.9 - 98.7）。初级放射科医生的ROC曲线下面积为0.89（95%CI；0.80 - 0.98），高级放射科医生的为0.81（95%CI；0.68 - 0.93）。阅片者内变异性较低，对于前部病变的总体检测几乎具有完美的可重复性；初级放射科医生的k = 0.90（95%CI；0.77 - 1），高级放射科医生的k = 0.85（95%CI；0.70 - 1）。对于各个前部部位，初级放射科医生的k值在0.60至1之间，而高级放射科医生的k值在0.87至1之间。对于阅片者间的可重复性，两位放射科医生对于前部病变的总体检测一致性一般，k = 0.46（95%CI；0.19 - 0.73）；根据部位不同，k值在0.43至0.61之间变化。
我们的结果表明，MRI对前部病变的特征描述具有特异性，但不太敏感，且阅片者间的可重复性取决于部位，仅为中等程度。MRI可用于诊断前部病变，但不能替代腹腔镜检查。
