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. 2024 Feb;121(2):189-211.
doi: 10.1016/j.fertnstert.2023.12.017. Epub 2023 Dec 16.

Noninvasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography

Jodie C Avery  1 , Steven Knox  2 , Alison Deslandes  3 , Mathew Leonardi  4 , Glen Lo  5 , Hu Wang  6 , Yuan Zhang  6 , Sarah Jane Holdsworth-Carson  7 , Tran Tuyet Thi Nguyen  8 , George Stanley Condous  9 , Gustavo Carneiro  10 , Mary Louise Hull  8 ; Imagendo Study Group  3
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Free article

Noninvasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography

Jodie C Avery et al. Fertil Steril. 2024 Feb.
Free article

Abstract

Endometriosis affects 1 in 9 women, taking 6.4 years to diagnose using conventional laparoscopy. Non-invasive imaging enables timelier diagnosis, reducing diagnostic delay, risk and expense of surgery. This review updates literature exploring the diagnostic value of specialist endometriosis magnetic resonance imaging (eMRI), nuclear medicine (NM) and computed tomography (CT). Searching after the 2016 IDEA consensus, 6192 publications were identified, with 27 studies focused on imaging for endometriosis. eMRI was the subject of 14 papers, NM and CT, 11, and artificial intelligence (AI) utilizing eMRI, 2. eMRI papers describe diagnostic accuracy for endometriosis, methodologies, and innovations. Advantages of eMRI include its: ability to diagnose endometriosis in those unable to tolerate transvaginal endometriosis ultrasound (eTVUS); a panoramic pelvic view, easy translation to surgical fields; identification of hyperintense iron in endometriotic lesions; and ability to identify super-pelvic lesions. Sequence standardization means eMRI is less operator-dependent than eTVUS, but higher costs limit its role to a secondary diagnostic modality. eMRI for deep and ovarian endometriosis has sensitivities of 91-93.5% and specificities of 86-87.5% making it reliable for surgical mapping and diagnosis. Superficial lesions too small for detection in larger capture sequences, means a negative eMRI doesn't exclude endometriosis. Combined with thin sequence capture and improved reader expertise, eMRI is poised for rapid adoption into clinical practice. NM labeling is diagnostically limited in absence of suitable unique marker for endometrial-like tissue. CT studies expose the reproductively aged to radiation. AI diagnostic tools, combining independent eMRI and eTVUS endometriosis markers, may result in powerful capability. Broader eMRI use, will optimize standards and protocols. Reporting systems correlating to surgical anatomy will facilitate interdisciplinary preoperative dialogues. eMRI endometriosis diagnosis should reduce repeat surgeries with mental and physical health benefits for patients. There is potential for early eMRI diagnoses to prevent chronic pain syndromes and protect fertility outcomes.

Keywords: Endometriosis; computed tomography; diagnosis; magnetic resonance imaging; nuclear medicine.

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Conflict of interest statement

Declaration of interests J.C.A. reports grants from the Australian MRFF, Endometriosis Australia, the Australasian Society of Ultrasound in Medicine, and the Robinson Research Institute. S.K. has nothing to disclose. A.D. reports funding from the Australian Government Research Training Program fee offset scholarship and the University of Adelaide higher degree research stipend scholarship, honoraria from Philips Healthcare, as an expert witness opinion provided through experts direct, and is President of the Australasian Society for Ultrasound in Medicine. M.L. reports grants from Australian MRFF, AbbVie, CanSAGE, Hamilton Health Sciences, Hyivy, and Pfizer; honoraria for lectures and writing from AIUM, GE Healthcare, Bayer, AbbVie, and TerSera. G.L. reports honorarium for the Abdominal Radiology Group of Australia and New Zealand (ARGANZ) online endometriosis pelvic MRI workshop/course to present an online endometriosis workshop. H.W. has nothing to disclose. Y.Z. reports funding from the Australian Government Research Training Program fee offset scholarship and the University of Adelaide higher degree research stipend scholarship. S.J.H-C. reports grants from the Australian MRFF, Endometriosis Australia, and the Epworth Medical Foundation. T.T.T.N. has nothing to disclose. G.S.C. reports grants from Australian MRFF, Australasian Society of Ultrasound in Medicine, Honoraria from Samsung, and sponsorship from Stryker, Applied Medical and Medtronic, and is ISUOG Scientific Committee Vice Chair and WFUMB President elect. He is director of Omni Ultrasound and Gynecological Care in Sydney, Australia. G.C. reports grants from Australian ARC and MRFF, and British UKRI NIHR and EPSRC. M.L.H. reports grants from the Australian MRFF, Endometriosis Australia, the Australasian Society of Ultrasound in Medicine, the Robinson Research Institute, the Australian Gynecological Endoscopy Society, the Jean Hails Development Fund, and the Australian Department of Health. She is paid honoraria from Merck, MSD, Ferring, Guerber, Myovant, Bayer, and Gideon Richter. She is a member of the ASPIRE Scientific Committee and the Jean Hailes Governance Committee. She is Director of Embrace Fertility, Adelaide, Australia.

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