Ha 1994.

Study characteristics
Patient sampling	Primary objectives: to compare fat‐suppressed T1‐w MRI with conventional MR images for diagnosis of endometriosis, focusing on detectability of peritoneal implants Study population: patients with suspected endometriosis Selection criteria: not specified Study design: prospective, observational; non‐consecutive enrolment
Patient characteristics and setting	Clinical presentation: not specified Age: mean 35 years, range 20 to 52 years Number enrolled: 31 women Number available for analysis: 31 women Setting: University Hospital, Catholic University Medical College Place of study: Seoul, Korea Period of study: 12‐month period, dates not specified Language: English
Index tests	Index test:MRI 2 types (T1/T2‐w MRI; fat‐suppressed T1‐w MRI) Description of positive case definition by index test as reported: diagnostic criteria as previously published (referenced to Arrive et al.,1989; Togashi et al., 1991; Nishimura ey al., 1987; Zawin et al., 1989) and described; pelvic adhesions excluded from analysis because fat‐suppressed images were not useful in detecting fibrotic lesions; conventional and fat‐suppressed images evaluated separately in random order Examiners: images reviewed independently by 2 radiologists; level of expertise not reported. Observer knew only that patients had suspected endometriosis Interobserver variability: not provided; consensus findings used if interpretations differed
Target condition and reference standard(s)	Target condition: pelvic endometriosis Prevalence of target condition in the sample: pelvic endometriosis 29/31 (94%): rASRM stage I 7/29 (24%), stage II 7/29 (24%), stage Ill 4/29 (14%), stage IV 11/29 (38%) Reference standard: laparoscopy 31/31 (100%) Description of positive case definition by reference test as reported: endometriosis diagnosed on the basis of visualisation of pelvic cavity at laparoscopy as endometrial cysts or peritoneal implants (rASRM classification); anatomical sites of involvement divided into 6 categories: right or left ovary, right or left uterine surface or uterosacral ligament, cul‐de sac and other anatomic sites (most often, rectum) Examiners: numbers or level of expertise of surgeons not reported; unclear whether blinded to results of the index test
Flow and timing	Time interval between index test and reference standard: within 2 weeks Withdrawals: none reported
Comparative
Key conclusions by the authors	Results show fat‐suppressed MR imaging as more accurate in the diagnosis of pelvic endometriosis and better than conventional MR imaging for predicting severity of disease
Conflict of interests	Not reported
Notes	Reported accuracy estimates for MRI, both conventional and fat‐suppressed, for diagnosis of pelvic endometriosis not confirmed Accuracy estimates for specific sites of endometriosis as well as for peritoneal and ovarian disease not included in this review as calculated per number of lesions rather than number of patients Data on accuracy of MRI in predicting severity of disease also presented – not included in this review
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Did the study avoid inappropriate exclusions?	Unclear
Was a 'two‐gate' design avoided?	Yes
		High	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?	Unclear
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?	Yes
		Low