Design: Retrospective cross-sectional study

Setting: Tertiary healthcare center

Patients or Participants: Patients who underwent endometriosis surgery at the center, with clear operative reports regarding the status of DE and OE

Interventions: Pelvic MRI, and endometriosis surgery. Data of pelvic MRI, done within 6 months of surgery, was extracted from the radiologic reports. Either 1.5T or 3T MRI machines were used, following a protocol implemented for benign gynecological conditions. A symptom severity score (SSS) ranging from 0 to 3 was employed to estimate the severity of symptoms, specifically focusing on pain symptoms that significantly impact patients' daily lives, such as chronic pelvic pain (CPP), dyspareunia, and neuropathic pain. The decision to utilize this non-validated score was driven by the absence of an alternative validated scoring system in the EPIC EMR database.

Measurements and Main Results: The mean duration of follow-up was 4.74 years. Pelvic MRI exhibited a low sensitivity (75.6%) and high specificity (100%) for DE (n = 96). Conversely, OE was diagnosed with high sensitivity (100%) and specificity (93.9%) via pelvic MRI (n = 122). In a multivariable logistic regression analysis model controlling for endometrioma size, a higher SSS value was significantly associated with a higher risk of DE detection during surgery (p ≤ 0.001), yet no significant association was found with the presence and size of endometrioma (p > 0.05; n = 287).

Conclusion: While pelvic MRI effectively identified DE in our population, caution is advised regarding negative DE MRI results in non-specialized settings. Based on our findings, high suspicion for DE should be maintained in patients with severe symptoms.