Endometriosis: Does the menstrual cycle affect magnetic resonance (MR) imaging evaluation?
OBJECTIVE
To determine if the menstrual cycle affects MR interpretation in patients with pelvic endometriosis.


METHODS
Thirty-one patients with either laparoscopically proven endometriosis, or a high clinical suspicion of deep infiltrative endometriosis, were prospectively recruited from May 2008 to October 2009 and January to June 2012. Two pelvic MR scans were performed for pre-operative planning; during menses and the other mid-cycle. Two experienced radiologists independently assessed image quality and disease extent. Both were blinded to patient identity, previous imaging and menstrual status. Interobserver agreement was assessed using the Kappa (k) test. Descriptive statistics were prepared using chi-squared (or Fishers' exact) tests and Mann-Whitney (rank sum) tests to assess for significant differences between menstrual and non-menstrual imaging.


RESULTS
Interobserver agreement for image quality was moderate for T2 weighted imaging (k=0.475, p-value <0.001) and substantial for T1 fat saturated imaging (k=0.733, p-value<0.001), with no significant difference in image quality between menstrual and non-menstrual scans (all p-values>0.255). Readers demonstrated at least moderate interobserver agreement for certainty level of endometriosis at site-specific locations, with median k 0.599 (IQR 0.488-0.807). No significant difference in disease extent was observed between menstruating and non-menstruating scans (all p-values>0.05).


CONCLUSIONS
Findings suggest no significant differences in image quality, disease extent or disease severity between menstruating and non-menstruating MR; thus, timing of pelvic MR for assessment of endometriosis need not be influenced by the menstrual cycle.
Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084,Australia. Electronic address: elissabotterill@gmail.com.
Elissa M
EM
Botterill
Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084,Australia. Electronic address: stephen.esler@gmail.com.
Stephen J
SJ
Esler
Department of Endosurgery, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: katemcilwaine@optusnet.com.au.
Kate T
KT
McIlwaine
Department of Endosurgery, Mater Hospital for Women, Raymond Terrace, South Brisbane, Queensland 4101, Australia. Electronic address: nishajagasia@gmail.com.
Nisha
N
Jagasia
Department of Endosurgery, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: lenore@crosbie.com.au.
Lenore
L
Ellett
Department of Endosurgery, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: gynoscopy@gmail.com.
Peter J
PJ
Maher
Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084,Australia. Electronic address: yang.natalie@gmail.com.
Natalie
N
Yang
D000328:Adult; D004715:Endometriosis / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008597:Menstrual Cycle / Q000502:physiology*; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
Deep infiltrating endometriosis; Endometriosis; Magnetic resonance imaging; Menstrual cycle