STUDY OBJECTIVE: To evaluate the diagnostic contribution of the computed 
tomography (CT) enema and magnetic resonance imaging (MRI) for multifocal 
(multiple lesions affecting the same segment) and multicentric (multiple lesions 
affecting several digestive segments) bowel endometriosis.
DESIGN: Prospective cohort study (Canadian Task Force classification II-2).
PATIENTS: Eighty-five patients.
SETTING: Tenon University Hospital, Paris, France.
INTERVENTION: All patients received a preoperative CT enema and underwent MRI 
interpreted by 2 radiologists.
MEASUREMENTS AND MAIN RESULTS: Patients underwent colorectal resection for 
colorectal endometriosis from February 2009 to November 2012. Nineteen patients 
(22%) had multifocal lesions, and 11 patients (13%) had multicentric lesions. 
Six patients (7%) had both multifocal and multicentric lesions. The sensitivity, 
specificity, and positive and negative likelihood ratios (LRs) of MRI for the 
diagnosis of multifocal lesions were 0.58, 0.84, 3.55, and 0.5, respectively. 
The sensitivity, specificity, and positive and negative LRs of the CT enema for 
the diagnosis of multifocal lesions were 0.64, 0.86, 4.56, and 0.4, 
respectively. The sensitivity, specificity, and positive LR of MRI for the 
diagnosis of multicentric lesions were 1, 0.88, and 8.4, respectively. The 
sensitivity, specificity, and positive and negative LRs of MRI for the diagnosis 
of multicentric lesions were 0.46, 0.92, 5.6, and 0.59, respectively. No 
difference was observed between MRI and the CT enema for the diagnosis of 
multifocal and multicentric colorectal endometriosis. The interobserver 
agreement was good for MRI and the CT enema (κ = 0.45 and 0.45) for 
multifocality, and it was poor for both MRI and the CT enema (κ = 0.32 and 0.34) 
for multicentricity.
CONCLUSIONS: Both MRI and the CT enema were able to diagnose multifocal and 
multicentric bowel endometriosis with similar accuracy.