Objectives <p>To evaluate the impact of different reporting approaches on the completeness of endometriosis documentation in pelvic MRI reports.</p> Materials and methods <p>Retrospective single-center analysis of 186 pelvic MRI reports categorized as free-text (<i>n</i> = 102), general template (<i>n</i> = 24), or endometriosis-specific template (<i>n</i> = 60). Completeness was assessed for ten anatomical compartments based on the #Enzian classification. Rates were compared with Kruskal–Wallis test; compartment-level documentation was modeled with Firth’s penalized logistic regression adjusted for reporting bias from pathological findings; temporal trends were analyzed with multinomial logistic regression.</p> Results <p>Report completeness differed significantly between report types (median 80.0% [IQR 22.5] for endometriosis-specific templates; 60.0% [20.0] for general templates; and 50.0% [20.0] for free-text; <i>p</i> &lt; 0.0001). Compartment-level documentation for free-text was low for ureter (25.5%), peritoneum (25.5%), uterosacral ligaments (25.5%), fallopian tubes (33.3%) and vagina/rectovaginal space (45.1%); corresponding rates were 70.8%, 33.3%, 16.7%, 37.5%, 33.3% for general templates and 71.7%, 50.0%, 71.7%, 65.0%, 81.7% for endometriosis-specific templates. Endometriosis-specific templates yielded higher adjusted odds ratios (aOR) of documenting critical compartments than free-text, including bladder (aOR 12.8 [95% CI: 5.7–34.3]), rectum (6.5 [3.1–15.4]), uterus (5.9 [2.6–13.5]), vagina/rectovaginal space (5.4 [2.4–14.1]), uterosacral ligaments (3.1 [1.5–6.9]), and fallopian tubes (2.5 [1.2–5.2]). General templates showed inconsistent benefits, with deficiencies for key compartments (uterosacral ligaments: 0.2 [0.03–0.6]; fallopian tubes: 1.0 [0.4–2.6]; vagina/rectovaginal space: 0.6 [0.1–1.7]). Free-text reporting predominated throughout the 37-month observation period (58.5% at study end).</p> Conclusions <p>Endometriosis-specific structured templates markedly improve documentation completeness versus general templates and free-text, with key compartments underreported in unstructured and generic structured formats.</p> Critical relevance statement <p>By quantifying documentation gains of disease-specific MRI templates over generic structured and narrative formats, this study provides actionable evidence to implement targeted structured reporting to improve surgical planning and multidisciplinary communication in endometriosis.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Endometriosis-specific MRI templates achieve higher documentation completeness compared to non-disease-specific templates and free-text reports.</p> </ItemContent> <ItemContent> <p>Disease-specific templates achieved 80% completeness versus 60% for general templates and 50% for free-text.</p> </ItemContent> <ItemContent> <p>Free-text reports underreport critical anatomical compartments, such as uterosacral ligaments, fallopian tubes and vagina/rectovaginal space.</p> </ItemContent> <ItemContent> <p>Endometriosis-specific templates showed up to 13-fold higher odds of documenting critical compartments versus free-text.</p> </ItemContent> <ItemContent> <p>Template specificity, not mere structure, drives comprehensive endometriosis reporting.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>