MEDL Score: A Novel MRI Protocol That Can Predict Endometriosis With High Accuracy

Study Objective

In a previous research, we established a novel MRI protocol for evaluating the severity of endometriosis called MEDL. In the present study, we revised the protocol to evaluate the severity of endometriosis using MRI in comparison to laparoscopy.

Design

An observational retrospective study.

Setting

A tertiary hospital.

Patients or Participants

71 patients diagnosed with endometriosis were enrolled in this study. All patients underwent clinical evaluation, pre-operative MRI, and laparoscopic surgery.

Interventions

The MEDL score is a novel MRI scoring system developed using a two (Absent/Present) or three-category (None/Mild/Severe) system to measure the disease severity and level of adhesions between organs due to endometriosis. All pre-operative MRIs were evaluated by three independent radiologists using MEDL score to assess disease severity and the anatomical location of the adhesions. All recorded surgeries were evaluated by two independent surgeons to map the lesions and their adhesion severity. All results were submitted for statistical analysis to determine the agreement rate between MRI and laparoscopic mapping.

Measurements and Main Results

For adhesion between organs and lesion severity on the uterine wall, the agreement rate (kappa) between MRI and laparoscopy finding was calculated. The results of adhesion between organs were 0.80∼0.97 for Present/Absent and 0.72∼0.97 for None/Mild/Severe (n=67∼69). The results of lesion severity on the uterine wall were 0.70∼0.96 for Present /Absent and 0.64∼0.96 for None/Mild/Severe (n=65∼69). For the three-category evaluation of all items, the total score was calculated for each patient, with None=0, Mild=1, Severe=2, and the Spearman's rank correlation coefficient between laparoscopy and MRI total scores was 0.81(n=61).

Conclusion

The results showed that pre operative MRI under the MEDL score had a high agreement compared to laparoscopy and can be used to accurately map endometriotic lesions. This is a promising method applicable not only to assess disease severity but in the near future might be used to measure drug therapy response before and after treatment.