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Agreement improved when BPP was used, while diagnostic metrics increased in sensitivity, specificity, and predictive values after 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transvaginal ultrasonography  \nCemil Gürses1, Alpaslan Yavuz1, Nevfel Kahvecioğlu1, Mustafa Yalçın1, Gizem Ünal1, Burak Karadağ2, Hüseyin Çiyiltepe3  \n1Department of Radiology, 2Department of Obstetrics and Gynecology, 3Department of Gastrointestinal Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey  \nAbstract  \nAims: The study aims to assess the impact of bowel preparation on MRI scans in diagnosing rectosigmoid endometriosis (RSE) and to examine the level of agreement among investigators, including radiologists and clinicians with varying levels of MRI experience. Material and methods: Fifty-eight patients underwent MRI scans, with 34 showing RSE and 24 without involvement, according to TVUS as the reference standard. The scans were conducted both with and without a bowel preparatory protocol (BPP) . Results: The highest concordance was observed in the group 4, which included patients with RSEand BPP, with a Kappa value of 0.47-0.52. In contrast, for groups with MRI scans without the BPP, there was no consistency among the investigators (Kappa \u003C0.20) . The sensitivity, specificity, positive predictive value, and negative predictive value were 0.72, 0.47, 0.72, and 0.47 without BPP, and increased to 0.82, 0.74, 0.85, and 0.74, respectively, after BPP. Conclusions: The results reveal that the concordance between investigators in detecting RSE via MRI scan improves with the use of BPP. Additionally, the success rate of MRI and TVUS for detecting RSE can be comparable, but only if bowel preparatory techniques are utilized during MRI scans.  \nKeywords: deeply infiltrating endometriosis; MRI; transvaginal ultrasonography  \nIntroduction  \nThe prevalence of endometriosis varies widely, ranging from 0.8% to 28.6%, with an overall estimated prevalence of 4.4% in the general population. Among patients undergoing surgery for benign pathologies, the prevalence is reported to be 33.5% . For infertile individuals, the prevalence is approximately 23.8%, while in women experiencing chronic pelvic pain, it reaches up to 49.7% . Rectosigmoid endometriosis affects around 12-37% of  \nReceived 12.06.2024 Accepted 21.09.2024 Med Ultrason  \n2025, Vol. 27, No 1, 38-43  \nCorresponding author: Cemil Gürses  \nUniversity of Health Sciences, Antalya Training and Research Hospital, Department of Radiology,  \nVarlık Mh., Kazım Karabekir,  \n07100 Muratpaşa, Antalya, Turkey  \nE-mail: [cemilgurses@hotmail.com](cemilgurses@hotmail.com)  \nPhone: +905066014545  \npatients diagnosed with endometriosis. Intestinal endometriosis predominantly impacts the rectosigmoid colon in 70% of cases, making it the most frequently affected bowel segment [1,2] .  \nTransvaginal ultrasonography (TVUS) is the firstline imaging technique for assessing deep infiltrating endometriosis (DIE) [3] . Magnetic resonance imaging (MRI) has been shown to have generally higher sensitivity and specificity than TVUS for evaluating DIE [1-6] . Hence, it is expected that the detectability of DIE by MRI should be at least equal to that of TVUS. However, it has been observed that MRI scans frequently fail to confirm rectosigmoid endometriosis (RSE) diagnoses made by TVUS in routine practice, which can be disappointing.  \nThe study aims to assess how bowel preparation affects MRI scans in confirming RSE and to explore the level of agreement among radiologists and clinicians when interpreting MRI scans, comparing those with and without bowel preparation, using TVUS as the reference standard.  \nMaterial and methods  \nThe study was conducted following the acquisition of written informed consent from the patients and approval from the hospital’s ethics committee (2022-237) .  \nThe study included 58 patients aged 20 to 45, prospectively selected from a cohort of 148 patients who exhibited indications of endometriosis on TVUS since 2017. The inclusion criteria c","cbCair7Hb0U3IM2E","https://ap.wps.com/l/cbCair7Hb0U3IM2E","pdf",775881,"English","# Abstract\n## Aims\n## Material and methods\n## Results\n## Conclusions\n# Introduction\n# Material and methods","[{\"question\":\"What was the study’s main aim?\",\"answer\":\"To assess how bowel preparation influences MRI scans for confirming rectosigmoid endometriosis (RSE) and to evaluate agreement among investigators with different MRI experience levels.\"},{\"question\":\"How were patients selected and grouped for MRI interpretation?\",\"answer\":\"Fifty-eight patients underwent MRI either with or without a bowel preparatory protocol (BPP), forming four groups based on TVUS-confirmed RSE status and whether BPP was used.\"},{\"question\":\"How did bowel preparation affect diagnostic agreement and accuracy?\",\"answer\":\"Concordance between investigators improved with BPP, and sensitivity, specificity, and predictive values increased after bowel preparation compared with scans without BPP.\"}]","The impact of bowel preparation on MRI scans for confirming rectosigmoid endometriosis detected by transvaginal ultrasonography | PDF",1790540660,15]