Sugimura 1993.

Study characteristics
Patient sampling	Primary objectives: to analyse the value of magnetic resonance imaging (MRI) in detection and characterisation of pelvic endometriosis; to assess the usefulness of fat‐saturated MRI for detection of endometrial cysts, with laparoscopy or laparotomy as the standard reference Study population: women with clinically suspected endometriosis Selection criteria: not specified Study design: prospective, observational; consecutive enrolment
Patient characteristics and setting	Clinical presentation: not specified Age: mean 36 years, range 24 to 48 years Number enrolled: 35 women Number available for analysis: 35 women Setting: university hospital, Shimane Medical University Place of study: Izumo, Japan Period of study: March 1991 to August 1992 Language: English
Index tests	Index test:MRI (T1/T2‐w) Description of positive case definition by index test as reported: assessed sites included surface of the uterus, adnexa, POD, peritoneum, ovaries; recorded details included location of lesion, size, shape; thickness, regularity and signal intensity of lesion margins; distinctness of interface of the lesion with adjacent organs; and appearance of the lesion. Criteria provided only for ovarian endometrioma and referenced to a primary source Examiners: MRI images prospectively read by 2 study authors who were aware that patients had a clinical history of suspected endometriosis; level of expertise not reported Interobserver variability: not provided
Target condition and reference standard(s)	Target condition: pelvic endometriosis Prevalence of target condition in the sample: pelvic endometriosis 26/35 (74.3%) Reference standard: laparoscopy 13/35 (37%), laparotomy 22/35 (63%) + histopathology Description of positive case definition by reference test as reported: diagnostic criteria not mentioned; surgical procedure not described Examiners: 'laparoscopy and laparotomy procedure reports and photographs and histologic slides (when available) were reviewed by 2 gynaecologists from our university' ‐ additional information not provided; unclear whether blinded to results of the index test
Flow and timing	Time interval between index test and reference standard: within 2 weeks Withdrawals: no withdrawals reported
Comparative
Key conclusions by the authors	Diagnostic accuracy improved with addition of fat‐saturated images, so their use together with conventional images is recommended in assessment of endometriosis
Conflict of interests	Not reported
Notes	Reported accuracy estimates for conventional MRI for diagnosis of pelvic endometriosis confirmed as accurate Data for endometrioma reported separately for large and small endometriomas; this does not allow construction of 2 × 2 tables ‐ not presented in this review Likely overlap with data for fat‐saturated MRI for another larger study from the same group ‐ Okada 1995 (study period August 1991 to December 1993) ‐ not able to clarify with study authors; therefore these data have been removed from the index study
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?	No
Was the index test performed by a single operator or interpreted by consensus in a joint session?	No
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
		High	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?	Yes
		Low