Structured MRI reporting for deep pelvic endometriosis: objective report quality and surgeon-perceived clinical utility in a randomized comparative study

OBJECTIVES: To compare structured and free-text MRI reporting in terms of objective report quality and surgeon ratings of perceived clinical utility in suspected deep pelvic endometriosis. MATERIALS AND METHODS: In this single-center randomized reader study, 20 radiology residents were assigned to free-text or structured reporting. Five residents became unavailable before report generation and provided no outcome data. The remaining 15 readers completed the same 22 pelvic MRI examinations, generating 330 reports: 154 free-text and 176 structured reports. Reports were compared with an imaging reference standard established by two pelvic radiologists through independent review and consensus adjudication. The primary endpoint was clinically weighted completeness. Secondary endpoints included unweighted completeness, explicit negative discrepancies relative to the expert imaging reference, positive findings unsupported by the expert imaging reference, and reporting time. Objective outcomes were analyzed using mixed-effects models or Poisson generalized estimating equations. In an exploratory paired assessment, two expert gynecologic surgeons evaluated 44 reports, comprising one free-text and one structured report for each MRI examination. RESULTS: Structured reporting was associated with an 8.1%-point increase in completeness compared with free-text reporting (95% CI, 4.1-12.1; p < 0.001) and a 5.6%-point increase in clinically weighted completeness (95% CI, 1.3-10.0; p = 0.011). Reporting time was 4.52 min longer with structured reporting (95% CI, 3.05-5.99; p < 0.001). Structured reporting was also associated with more explicit negative discrepancies relative to the expert imaging reference (rate ratio, 2.94; 95% CI, 1.73-4.98; p < 0.001). These discrepancies were mainly explicit compartment-based negative statements. In the exploratory surgeon assessment, structured reports received higher ratings for perceived completeness, usefulness for clinical decision-making, and adequacy to clinical needs, whereas clarity ratings were similar between formats. CONCLUSION: Structured MRI reporting was associated with higher objective completeness and, in an exploratory assessment, higher surgeon ratings for several dimensions of perceived clinical utility. These findings should be balanced against longer reporting time and more explicit negative discrepancies relative to the expert imaging reference.