深部盆腔子宫内膜异位症的结构化MRI报告：dPEI的性能与临床影响
本研究回顾性纳入100例手术确诊的深部盆腔子宫内膜异位症患者，评估dPEI作为结构化MRI报告工具的可行性、观察者间重复性、报告效率及临床感知影响。结果显示dPEI适用于所有病例，全局评分观察者间一致性低至中等（ICC=0.44），受经验影响，报告时间随经验增加而缩短且存在学习效应；临床医生认为有助于疾病分层和多学科沟通，但外科医生认为对晚期手术规划 usefulness 有限，主要因缺乏定量描述符。
要点
- dPEI结构化报告可行且直观，但全局评分观察者间一致性低至中等（ICC=0.44）。
- 中央区域一致性较高，侧方及盆腔外区域一致性较低。
- 报告时间随经验增加而缩短，所有读者均低于30分钟，存在明显学习效应。
核心结论
- dPEI是一种可行且直观的MRI分期系统，其性能受读者经验影响，但易于应用且学习曲线快。
- 支持其作为常规临床实践中的补充结构化报告工具，并可能作为深部盆腔子宫内膜异位症影像的教育和培训工具。
研究设计与样本
- 回顾性单中心研究，纳入100例连续的手术确诊深部盆腔子宫内膜异位症女性，术前接受3T盆腔MRI。
- 三名经验不同（2年、4年和20年）的放射科医生独立使用基于dPEI的结构化MRI报告评估所有检查。
- 全局评分观察者间一致性采用组内相关系数（ICC），分区一致性采用Cohen和Fleiss κ统计量。
- 记录每位读者的报告时间，并通过结构化问卷评估10名临床医生和10名外科医生的感知临床效用和实际限制。
诊断标准与关键数值
- 全局评分观察者间一致性低至中等（ICC=0.44），受读者经验影响，高级和中级放射科医生之间的一致性高于包含初级读者的配对。
- 中央区域一致性较高，侧方和盆腔外区域一致性较低。
- 报告时间随读者经验增加而减少，所有读者均低于30分钟。
临床应用与阅片要点
- dPEI可作为深部盆腔子宫内膜异位症MRI结构化报告的补充工具，便于疾病分层和多学科沟通。
- 注意侧方和盆腔外区域的一致性较低，阅片时需更加谨慎。
- 初级读者应用dPEI时一致性较低，建议结合培训或复核。
局限性
- 回顾性单中心研究设计。
- 样本量有限（100例）。
- 仅评估了3名放射科医生，可能影响普遍性。
- 外科医生认为dPEI对晚期手术规划 usefulness 有限，主要因缺乏定量描述符。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To evaluate the feasibility, interobserver reproducibility, reporting efficiency, and perceived clinical impact of the Deep Pelvic Endometriosis Index (dPEI) when implemented as part of structured MRI reporting in routine clinical practice.
MATERIALS AND METHODS: This retrospective single-center study included 100 consecutive women with surgically confirmed deep pelvic endometriosis who underwent preoperative 3-Tesla pelvic MRI. Three radiologists with different levels of experience (2, 4, and 20 years) independently reviewed all examinations using a structured MRI report based on the dPEI. Interobserver agreement for the global score was assessed using the intraclass correlation coefficient (ICC), while compartment-specific agreement was evaluated using Cohen's and Fleiss' κ statistics. Reporting time was recorded for each reader. Perceived clinical utility and practical limitations were assessed through a structured questionnaire administered to 10 clinicians and 10 surgeons involved in multidisciplinary endometriosis care.
RESULTS: The dPEI was applicable across all cases and readers. Interobserver agreement for the global score was low-to-moderate (ICC = 0.44) and was influenced by reader experience, with higher concordance between senior and intermediate radiologists than between pairs including the junior reader. Agreement was higher in central compartments and lower in lateral and extrapelvic compartments. Reporting time decreased with increasing reader experience and demonstrated a clear learning effect, remaining below 30 min for all readers. Clinicians rated the dPEI as useful for disease stratification and multidisciplinary communication, whereas surgeons reported limited usefulness for advanced surgical planning, mainly due to the lack of quantitative descriptors.
CONCLUSION: The dPEI is a feasible and intuitive MRI-based staging system whose performance is influenced by reader experience, while remaining easy to apply and associated with a rapid learning curve. These characteristics support its use as a complementary structured reporting tool in routine clinical practice and suggest a potential role as an educational and training instrument in deep pelvic endometriosis imaging.
引用
- Miceli V, Ninkova RV, Gennarini M, et al. Structured MRI reporting in patients with deep pelvic endometriosis: performance and clinical impact of the deep pelvic endometriosis index (dPEI). Eur J Radiol. 2026. PMID: 42142520. doi:10.1016/j.ejrad.2026.112926
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。