ENDOMETRIOSIS-SPECIFIC MRI templates significantly improve the documentation and completeness of pelvic reporting, a 2026 observational study has found.
They produce a completeness at least 20% higher, on average, than general templates or free-text reporting.
MRI Techniques in Endometriosis
Endometriosis affects approximately 10% of women of reproductive age. Clinical practice has evolved toward non-invasive triage for deep endometriosis.
Imaging is increasingly used for diagnosis and surgical planning, signalling a movement away from laparoscopy. MRI offers a comprehensive pelvic assessment and precise lesion mapping. The retrospective single-centre study categorised MRI reports into three structural types.
Free-text reports are unstructured narrative reports without predefined sections or standardised terminology. General structures templates are reports that use institutional templates designed for pelvic MRI studies on women. Endometriosis-specific MRI templates are reports that incorporate standardised terminology and dedicated sections for individual anatomical compartments relevant to endometriosis assessment.
Impact of Endometriosis-Specific MRI Templates
The study analysed 186 pelvic MRI reports in a 37-month observation period: 102 free-text reports, 24 general templates, and 60 endometriosis-specific template approaches.
There were 10 anatomical compartments used to assess completeness based on the #Enzian classification. Compartment-level documentation was modelled with Firth’s penalised logistic regression, which was also adjusted for reporting bias from pathological findings.
Report completeness varied significantly between report types, with medians of 80%, 60%, and 50%, for endometriosis-specific templates, general templates, and free-text reporting respectively.
Endometriosis-specific MRI templates documented critical compartments with an up to 13 times higher adjusted odds ratio than free-text, including bladder, rectum, uterus, vagina/rectovaginal space, uterosacral ligaments, and fallopian tubes. Free-text reports underreported compartments including uterosacral ligaments, fallopian tubes, and vagina/rectovaginal space.
Documentation Completeness Versus Diagnostic Accuracy
The study analysed documentation above diagnostic accuracy. It cannot be said that improved completeness translates to higher diagnostic accuracy.
The radiologist was also not blinded to the report types, although a large language model was used for initial text screening to mitigate potential observer bias.
Future of Endometriosis Reporting
Template specificity, rather than structure alone, drives comprehensive endometriosis reporting. Endometriosis-specific MRI templates decisively outperformed both general templates and free-text reports in documentation completeness and the monitoring of critical components in endometriosis assessment.
Researchers emphasised a resulting justification for the institutional adoption of disease-specific structured reporting, to close documentation gaps and closer align radiology and surgery departments.
Reference
Deniffel C et al. Mind the gap: underreporting of key compartments in endometriosis MRI with free-text and non-disease-specific templates. Insights Imaging. 2026;17(34):DOI:10.1186/s13244-026-02210-x.
