title: Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results.
abstract: OBJECTIVE
  To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis.
  
  
  METHODS
  Sixty-five patients (mean age 33; range 19-45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR-).
  
  
  RESULTS
  The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834.
  
  
  CONCLUSIONS
  Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations.
  
  
  CONCLUSIONS
  • Magnetic resonance imaging (MRI) is increasingly used to assess endometriosis • The diagnostic confidence of observers varies according to the location of endometriosis • The diagnosis is more difficult to establish by MRI in some anatomical locations • Specific training should be given concerning those locations that cause difficulty.
authors.affiliation: Department of Radiology, Azienda Ospedaliero Universitaria, di Cagliari - Polo di Monserrato s.s. 554, Monserrato, 09045, Italy, lucasaba@tiscali.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.forename: Rosa
authors.initials: R
authors.lastname: Sulcis
authors.forename: Gian Benedetto
authors.initials: GB
authors.lastname: Melis
authors.forename: Giannina
authors.initials: G
authors.lastname: Ibba
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcazar
authors.forename: Mario
authors.initials: M
authors.lastname: Piga
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
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