Radiologists often misreport common adenomyosis when not briefed beforehand

Radiologists not specifically directed to assess images for a common gynecologic finding known as adenomyosis often underreport the condition, potentially hurting follow-up care strategies, new research suggests.

Pelvic ultrasound and MRI (the current gold standard) are both key to diagnosing adenomyosis, a condition that may negatively impact quality of life. But relying on imaging reports alone decreases providers’ accuracy for spotting adenomyosis, experts reported Thursday in Clinical Imaging.

However, when radiologists were told to analyze images for adenomyosis, MRI accuracy jumped from 30% to more than 85%. Doctors should take note of these differences when assessing potential cases.

Awareness of this decreased accuracy is especially important for non-radiology providers who may rely heavily on the imaging report,” Nicole C. Zanolli, with Duke University School of Medicine’s Division of Interventional Radiology, and co-authors noted. “The improvement seen when radiologists were specifically asked to evaluate for adenomyosis highlights the importance of communication of the clinical concern for adenomyosis.”

The group set out to compare the accuracy of reporting adenomyosis on pelvic ultrasound and MRI against histopathological findings. Zanolli et al. gathered findings from radiology and pathology reports taken from women who underwent US, MRI and a follow-up hysterectomy. In total, 180 imaging pairs were included.

MRI scans yielded higher sensitivity than ultrasound (29.7% vs. 10.9%) but scored worse during specificity testing (85.3% vs. 98.3%, respectively).

At the same time, when two rads were directed to assess images for adenomyosis, MRI sensitivity jumped to 86.7%. 

The overall findings are crucial for non-radiology providers who use reports to guide treatment decisions. Interventional rads also require accurate diagnoses, as uterine embolization procedures are less effective in those with adenomyosis and fibroids compared to fibroids alone, the authors noted.

“In clinical practice, accurate reporting of adenomyosis on pelvic ultrasound and MRI may be much lower than expected,” the researchers added. “The improvement seen when radiologists were specifically asked to evaluate for adenomyosis highlights the importance of communication of the clinical concern for adenomyosis.”

Read more here.

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