Bazot 2013.

Study characteristics
Patient sampling	Primary objectives: to compare overall image quality and diagnostic accuracy of multi‐planar 2‐dimensional (2D) fast spin‐echo (FSE) T2‐w and 3‐dimensional (3D) coronal single‐slab FSE T2‐w magnetic resonance imaging (MRI) sequence for evaluation of deep infiltrating endometriosis (DIE) Study population: patients referred for pelvic MRI because of clinical suspicion of endometriosis Selection criteria: not specified Study design: prospective, observational, consecutive enrolment of patients presented to imaging department
Patient characteristics and setting	Clinical presentation: dysmenorrhoea, deep dyspareunia, dyschezia, dysuria or infertility Age: median age 34 years, range 24 to 46 years Number enrolled: 110 women Number available for analysis: 23 women Setting: tertiary care hospital, Tenon Hospital, referral centre for endometriosis Place of study: Paris, France Period of study: February 2010 to May 2010 Language: English
Index tests	Index test:MRI 2 types: 2‐dimensional fast spin echo T2‐w (2D FSE T2‐w MRI); 3‐dimensional fast spin echo T2‐w MRI (3D FSE T2‐w MRI) Description of positive case definition by index test as reported: diagnostic criteria mentioned and referenced to a primary source (Kinkel et al., 1999; Bazot et al., 2004; Kataoka et al., 2005). Readers asked to determine overall image quality and presence or absence of DIE Examiners: images independently analysed by 2 radiologists with different degrees of experience in female MRI (1 reader with > 20 years' experience; second reader a junior radiologist). Both readers blinded to clinical and ultrasonographic findings Interobserver variability: poor interobserver agreement for assessment of DIE found for USL endometriosis. For all locations of endometriosis, high intraobserver agreement observed for an experienced reader; low intraobserver agreement for USL, rectosigmoid and POD obliteration for junior reader
Target condition and reference standard(s)	Target condition: posterior DIE: overall and separate anatomical sites Prevalence of target condition in the sample: pelvic endometriosis in 20/23 (87%); DIE 18/23 (78%); specific locations of DIE: USL 17/23 (74%), rectosigmoid 13/23 (57%), vaginal 5/23 (22%), bladder 1/23 (4%) Reference standard: laparoscopy (n = 20), laparotomy (n = 3) + histopathology. Description of positive case definition by reference test as reported: all locations of endometriosis recorded in surgical reports; reference to sources for histological criteria; surgical procedure not described Examiners: numbers or level of expertise of surgeons or pathologists not reported; unclear whether blinded to results of index test
Flow and timing	Time interval between index test and reference standard: < 12 months (communication with study authors) Withdrawals: 87/110 (79%) women did not undergo surgery and were excluded from final analysis, reason not explained
Comparative
Key conclusions by the authors	Accuracy of 3D MRI yields accuracy not significantly different from accuracy of 2D FSE T2‐w MRI in diagnosis of DIE locations. However, despite significant time savings, 3D MRI cannot replace routine 2D MRI sequences because poorer imaging quality results from significant intraobserver and interobserver variability
Conflict of interests	Not reported
Notes	Reported accuracy estimates for index tests for diagnosis of overall DIE and different sites of posterior DIE confirmed as accurate Accuracy estimates presented separately by study authors for each reader. Only data from R1 (experienced reader) reader presented in this review Overall image quality for 2 MRI techniques and detailed assessment of interobserver and intraobserver variability presented by study authors ‐ not presented in this review Only 21% of participants underwent surgery, hence high selection bias
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Did the study avoid inappropriate exclusions?	Unclear
Was a 'two‐gate' design avoided?	Yes
		Unclear	Low
DOMAIN 2: Index Test Any test
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
Did the study provide a clear pre‐specified definition of what was considered to be a “positive” result of index test?	Yes
Was the index test performed by a single operator or interpreted by consensus in a joint session?	Yes
Were the same clinical data available when the index test results were interpreted as would be available when the test is used in practice?	Yes
		Low	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
		Unclear	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
		High