European Radiology

, Volume 26, Issue 11, pp 3968–3977 | Cite as

MR diagnosis of diaphragmatic endometriosis

  • Pascal Rousset
  • Jules Gregory
  • Christine Rousset-Jablonski
  • Justine Hugon-Rodin
  • Jean-François Regnard
  • Charles Chapron
  • Joël Coste
  • François Golfier
  • Marie-Pierre Revel
Magnetic Resonance



To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis.

Materials and methods

Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics.


Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes.


MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement.

Key Points

MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity.

Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences.

Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior.

MRI can help in timely diagnosis of diaphragmatic endometriosis.


Endometriosis Magnetic resonance imaging Diaphragm Catamenial pneumothorax Basithoracic pain 



Computed tomography


Magnetic resonance imaging



The scientific guarantor of this publication is Pascal Rousset. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Joël Coste, is one of the authors, and is from Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic study / observational, multicenter study.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Pascal Rousset
    • 1
    • 2
  • Jules Gregory
    • 3
    • 4
  • Christine Rousset-Jablonski
    • 5
  • Justine Hugon-Rodin
    • 3
    • 6
  • Jean-François Regnard
    • 3
    • 7
  • Charles Chapron
    • 3
    • 8
  • Joël Coste
    • 3
    • 4
  • François Golfier
    • 1
    • 5
  • Marie-Pierre Revel
    • 3
    • 9
  1. 1.Lyon 1 Claude Bernard UniversityVilleurbanneFrance
  2. 2.Radiology DepartmentCentre Hospitalier Lyon SudPierre BéniteFrance
  3. 3.Paris Descartes University, Sorbonne Paris CitéParisFrance
  4. 4.Biostatistics and Epidemiology departmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  5. 5.Obstetric and Gynecologic DepartmentCentre Hospitalier Lyon SudPierre BéniteFrance
  6. 6.Gynecology Endocrinology DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  7. 7.Thoracic Surgery DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  8. 8.Obstetric and Gynecologic DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  9. 9.Radiology DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance

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