{"paper_id":"56637885-88e3-478d-bc60-afc84e1df664","body_text":"Abstract\nBackground\nRectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE.\nPurpose\nWe propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning.\nMaterials and methods\nThe records of patients with bowel endometriosis treated surgically from May 2018 to June 2022 were retrieved. Surgery was classified as partial thickness discoid, full thickness discoid, or segmental resection. Each pre-treatment MRI was scored based on the mutual agreement of two abdominal radiologists (reference score). The MRI score was defined as (1) score 0: no evidence of RSE, (2) score 1: minimal tethering involving the serosal surface without MP involvement, (3) score 2: intermediate soft tissue thickening involving the rectosigmoid colon with indeterminate MP involvement, or (4) score 3: definite mushroom cap sign or definite MP involvement. In the reader study, two radiologists independently scored each exam. The area under the curve (AUC) was evaluated for predicting the need for segmental or full thickness discoid resection.\nResults\nThe cohort consisted of 95 patients (median age: 36 years); 16, 14, 30, and 35 patients had MRI score 0, 1, 2, and 3, respectively. Patients with MRI scores 3 and 2 underwent partial thickness discoid (6% vs. 50%), full thickness discoid (6% vs. 17%), and segmental resection (89% vs. 33%), respectively. All patients with MRI scores 1 or 0 either underwent partial thickness discoid resection or did not undergo rectosigmoid surgery. The AUCs were 92.2%, 84.5% and 93.9% for MRI scores of the reference, reader 1, and 2, respectively.\nConclusion\nOur MRI scoring system based on suspected depth of bowel invasion showed good diagnostic performance to predict the type of surgical intervention needed.\nSimilar content being viewed by others\nData availability\nNo datasets were generated or analysed during the current study.\nAbbreviations\n- RSE:\n-\nRectosigmoid endometriosis\n- AUC:\n-\nArea under the curve\n- MP:\n-\nMuscularis propria\nReferences\nGerges B, Li W, Leonardi M, Mol BW, Condous G. Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;58(2):190–200.\nRousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, et al. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography–initial results. Radiology. 2014;273(1):117–24.\nRousset P, Buisson G, Lega JC, Charlot M, Gallice C, Cotte E, et al. 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Wang M.D. for preparing the medical illustrations in Figure 2, and Desiree Lanzino PhD for assistance with editing the manuscript.\nAuthor information\nAuthors and Affiliations\nContributions\nW.M.V. made the main concept of the scoring system, W.M.V. and H.T. made the study design and served as radiologist readers for the reference, H.T. wrote the main manuscript text, T.L.B. reviewed the surgical history, M.S. reviewed the pathology, S.S.S., L.X., C.C., S.P.S., and C.A.B. served as radiologist readers in the reader studies, H.T. and M.P.J. performed statistical analysis, S.S.S. prepared figure 2. All authors reviewed the manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nElectronic supplementary material\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nTakahashi, H., Burnett, T., Shahi, M. et al. Proposed new MRI scoring system of rectosigmoid endometriosis to guide operative planning. Abdom Radiol 50, 6064–6075 (2025). https://doi.org/10.1007/s00261-025-05021-8\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00261-025-05021-8","source_license":"CC0","license_restricted":false}