Role of Pelvic MRI in the Evaluation of Endometriosis and its Association with Infertility and Chronic Pelvic Pain in Reproductive-Aged Women

Abstract

Background: Endometriosis is a chronic inflammatory gynecological condition that can be a leading cause of infertility and chronic pelvic pain in women of reproductive age. The diagnosis is still difficult and often done late due to the variable clinical presentation. Non-invasive imaging techniques for the detection and characterisation of endometriosis are now available, and Pelvic Magnetic Resonance Imaging (MRI) has proved to be useful.

Objective: To analyze the effect of pelvic MRI in the diagnosis and its correlation with chronic pelvic pain and infertility in women of reproductive age with endometriosis.

Methods: This cross-sectional clinical study was conducted at a tertiary care teaching hospital in Lahore from May 2024 to May 2025. Non-probability consecutive sampling was used, and a total of 120 women aged 18-45 years who had suspected endometriosis were included. Each participant had a pelvic MRI, and a subset (n = 70) had laparoscopy confirmation. Details of infertility and chronic pelvic pain were included. Chi-square test was used to determine the diagnostic accuracy of MRI and associations with clinical variables.

Results: MRI identified endometriosis in 78 (65.0%) patients. Chronic pelvic pain was significantly higher in MRI-positive patients (68/78, 87.2%) compared to MRI-negative patients (14/42, 33.3%) (p < 0.001). Twenty-eight (35.2%) MRI-positive patients had infertility compared to 14 (33.3%) MRI-negative patients (p = 0.02). MRI demonstrated a sensitivity of 88.5%, specificity of 82.4%, positive predictive value of 85.9%, negative predictive value of 85.1%, and overall diagnostic accuracy of 85.8%. S. epidermidys was significantly associated with severe pelvic pain in the case group of deep infiltrating endometriosis and significantly associated with infertility in the case group of ovarian endometriomas.

Conclusion: Pelvic MRI is a very useful non-invasive tool in the diagnosis and characterization of endometriosis. It demonstrates strong associations with infertility and chronic pelvic pain and plays a crucial role in disease evaluation and clinical decision-making.