{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:24:03Z","timestamp":1760059443912,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: Endometriosis is a common gynecologic condition characterized by the presence of endometrial-like tissue outside the uterus, often leading to pelvic pain and infertility. Diagnosis is frequently delayed, with prolonged diagnostic wandering that could be improved through enhanced first-line radiologic assessment. The uterosacral ligament (USL) is the most frequent site of deep infiltrating endometriosis (DIE). The H\u00f4tel-Dieu (HTD) MRI classification, published in 2024, offers a structured framework for evaluating USL involvement by correlating MRI findings with the diagnostic certainty of endometriosis. Key Findings: This pictorial essay provides a practical guide for applying the HTD MRI classification, presenting key imaging criteria with illustrative examples for each USL type. The classification distinguishes between \u201clinear\u201d and \u201cnodular\u201d USL lesions, with implications for diagnostic confidence. \u201cNodular\u201c types demonstrate a 100% positive predictive value (PPV), while \u201clinear\u201c types may yield higher false positive rates (FPR). The HTD MRI classification may also be complemented by innovative biomarker testing, such as microRNA signatures, especially in cases with \u201clinear\u201c USL involvement. Conclusions: By standardizing the assessment of USL lesions, the HTD MRI classification enhances diagnostic accuracy, improves MRI reproducibility, and supports earlier identification of endometriosis in first-line settings. Its integration into radiologic workflows can contribute to reduced diagnostic delays. Implications for practice: The HTD MRI classification is a valuable screening tool for first-line radiologists and clinicians. Incorporating it into routine pelvic MRI interpretations may streamline diagnostic pathways, promote consistency across readers, and guide additional testing strategies, such as microRNA assays, for cases where MRI alone is less definitive.<\/jats:p>","DOI":"10.3390\/diagnostics15121508","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T09:51:24Z","timestamp":1749808284000},"page":"1508","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The H\u00f4tel-Dieu MRI Classification of Uterosacral Ligament Involvement in Endometriosis: A Pictorial Guide to Clinical Use"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9876-2633","authenticated-orcid":false,"given":"Siegfried","family":"H\u00e9lage","sequence":"first","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Laponche","sequence":"additional","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaux","family":"Homps","sequence":"additional","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Dong","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Group, \u00c9cole Polytechnique F\u00e9d\u00e9rale de Lausanne (EPFL), 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Rivi\u00e8re","sequence":"additional","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Pr\u00e9aux","sequence":"additional","affiliation":[{"name":"L\u00e9onard de Vinci Medical Imaging, 43 rue Cortambert, 75016 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre-Alexandre","family":"Just","sequence":"additional","affiliation":[{"name":"Department of Pathology, H\u00f4pital Cochin (AP-HP), 27 rue du Faubourg Saint-Jacques, 75014 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nizar","family":"Aflak","sequence":"additional","affiliation":[{"name":"Department of Gynecological Surgery, H\u00f4pital Beaujon (AP-HP), 100 boulevard du G\u00e9n\u00e9ral Leclerc, 92110 Clichy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-No\u00ebl","family":"Buy","sequence":"additional","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c9lisabeth","family":"Dion","sequence":"additional","affiliation":[{"name":"Department of Radiology, H\u00f4tel-Dieu de Paris (AP-HP), 1 place du Parvis Notre-Dame, 75004 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"ref_1","unstructured":"Kurman, R.J. 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