Overview of pelvic MRI for endometriosis in France

Introduction: In 2017, the European Society of Urogenital Radiology (ESUR) and the French National Authority for Health (HAS) issued recommendations on the optimal MRI protocol and criteria for the diagnosis of pelvic endometriosis. To date, there has been no study evaluating radiological practices in France for screening and diagnosing endometriosis. We conducted a survey to evaluate professional practices recommended by the Société d'imagerie de la femme (Sifem) in order to assess: (i) the type of preparation performed as part of an MRI scan for the screening, diagnosis or follow-up of endometriosis; (ii) the type of sequences performed; and (iii) the use of a standard report and the information mentioned by radiologists. Materials and method: This was a national survey carried out in the form of a professional practice assessment with a 46 questions questionnaire. Results: A total of 180 radiologists responded to the study. The majority of radiologists were specialised in endometriosis (n = 124; 69%) and performed at least one pelvic MRI on a weekly basis for suspected endometriosis (n = 154; 86%). Only 101 radiologists (56%) were aware of the ESUR MRI protocol recommendations and 49% used a standardised report. Digestive preparation was prescribed by 76% (n = 137) and bladder repletion was requested by 55% (n = 100) of radiologists responding to the study. Vaginal opacification was performed in 59% of cases (n = 106) and rectal opacification in 32% (n = 57) of cases. Antiperistalsis medication was administered in 83% (n = 150) of radiologists. All radiologists performed T2 and T1 sequences with and without fat suppression. Sixteen percent (n = 28) of the radiologists performed uterine HASTE or SSFSE type sequences to assess uterine peristalsis. An axial T1 sequence after gadolinium injection was performed in 10% of cases (n = 18). Conclusion: This study provided a nationwide description of the practices of MRI radiologists in France in the context of MRI diagnosis of endometriosis. It revealed certain disparities between the ESUR and HAS recommendations and day-to-day practice, particularly with regards to bladder repletion and uterine peristalsis sequences, but also showed that radiologists are gradually applying these recommendations on certain points, such as digestive preparation of patients.