ArticleInsights into imaging2026
Mind the gap: underreporting of key compartments in endometriosis MRI with free-text and non-disease-specific templates.
Article in Insights into imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the impact of different reporting approaches on the completeness of endometriosis documentation in pelvic MRI reports. MATERIALS AND
methodsRetrospective single-center analysis of 186 pelvic MRI reports categorized as free-text (n = 102), general template (n = 24), or endometriosis-specific template (n = 60). Completeness was assessed for ten anatomical compartments based on the #Enzian classification. Rates were compared with Kruskal-Wallis test; compartment-level documentation was modeled with Firth's penalized logistic regression adjusted for reporting bias from pathological findings; temporal trends were analyzed with multinomial logistic regression.
resultsReport completeness differed significantly between report types (median 80.0% [IQR 22.5] for endometriosis-specific templates; 60.0% [20.0] for general templates; and 50.0% [20.0] for free-text; p < 0.0001). Compartment-level documentation for free-text was low for ureter (25.5%), peritoneum (25.5%), uterosacral ligaments (25.5%), fallopian tubes (33.3%) and vagina/rectovaginal space (45.1%); corresponding rates were 70.8%, 33.3%, 16.7%, 37.5%, 33.3% for general templates and 71.7%, 50.0%, 71.7%, 65.0%, 81.7% for endometriosis-specific templates. Endometriosis-specific templates yielded higher adjusted odds ratios (aOR) of documenting critical compartments than free-text, including bladder (aOR 12.8 [95% CI: 5.7-34.3]), rectum (6.5 [3.1-15.4]), uterus (5.9 [2.6-13.5]), vagina/rectovaginal space (5.4 [2.4-14.1]), uterosacral ligaments (3.1 [1.5-6.9]), and fallopian tubes (2.5 [1.2-5.2]). General templates showed inconsistent benefits, with deficiencies for key compartments (uterosacral ligaments: 0.2 [0.03-0.6]; fallopian tubes: 1.0 [0.4-2.6]; vagina/rectovaginal space: 0.6 [0.1-1.7]). Free-text reporting predominated throughout the 37-month observation period (58.5% at study end).
conclusionsEndometriosis-specific structured templates markedly improve documentation completeness versus general templates and free-text, with key compartments underreported in unstructured and generic structured formats. CRITICAL RELEVANCE STATEMENT: By quantifying documentation gains of disease-specific MRI templates over generic structured and narrative formats, this study provides actionable evidence to implement targeted structured reporting to improve surgical planning and multidisciplinary communication in endometriosis. KEY POINTS: Endometriosis-specific MRI templates achieve higher documentation completeness compared to non-disease-specific templates and free-text reports. Disease-specific templates achieved 80% completeness versus 60% for general templates and 50% for free-text. Free-text reports underreport critical anatomical compartments, such as uterosacral ligaments, fallopian tubes and vagina/rectovaginal space. Endometriosis-specific templates showed up to 13-fold higher odds of documenting critical compartments versus free-text. Template specificity, not mere structure, drives comprehensive endometriosis reporting.
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