{"paper_id":"8541bd1e-a209-40b7-bcfb-7d1229888575","body_text":"Abstract\nEndometriosis, defined as the presence of endometrial glands and stroma outside the endometrium, is a common gynecological disorder affecting women in reproductive age, associated with chronic pelvic pain and infertility.\nIts pathogenesis is complex and still unclear, probably multifactorial. The ovaries are the most common sites affected, but endometriosis can involve the gastrointestinal tract, urinary system, thorax, and soft tissue.\nWe consider the anatomic subdivision of pelvic endometriosis into three forms: the adenomyosis, the tubo-ovarian lesions, and the deep pelvic endometriosis (DPE), defined by the invasion of endometrial tissue at least 5 mm beneath the peritoneal surface.\nThe diagnosis and the accurate evaluation of the endometriosis extension are very important to avoid mutilating surgery and enhance fertility, but are often difficult only with physical examination and laparoscopy.\nThe laparoscopy with histological confirmation remains the reference standard for diagnosis and staging, but it has limitations in detecting deep locations hidden by adhesions or located in the subperitoneal space.\nUltrasound (transabdominal or transvaginal) is usually the first-line imaging modality in women with pelvic pain, but it has poor accuracy for deep pelvic endometriosic lesions. We would highlight the role of magnetic resonance (MR) imaging in the diagnosis of endometriosis that has already emerged as a high reproducible method to explore ovarian endometriosis; it demonstrates high accuracy also in the evaluation of DPE, allowing a complete survey of the anterior and posterior compartments of the pelvis, with high spatial resolution and good tissue characterization.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nRevised American Fertility Society classification of endometriosis: 1985 (1985) Fertil Steril 43(3):351–352\nBrosens I et al (2004) Diagnosis of endometriosis: pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol 18(2):285–303\nWoodward PJ, Sohaey R, Mezzetti TP Jr (2001) Endometriosis: radiologic-pathologic correlation. Radiographics 21(1):193–216; questionnaire 288–294\nSpaczynski RZ, Duleba AJ (2003) Diagnosis of endometriosis. Semin Reprod Med 21(2):193–208\nVigano P et al (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 18(2):177–200\nOlive DL, Henderson DY (1987) Endometriosis and mullerian anomalies. Obstet Gynecol 69(3 Pt 1):412–415\nClement PB (1990) Pathology of endometriosis. Pathol Annu 25(Pt 1):245–295\nHalme J et al (1984) Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol 64(2):151–154\nLiu DT, Hitchcock A (1986) Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. Br J Obstet Gynaecol 93(8):859–862\nJenkins S, Olive DL, Haney AF (1986) Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 67(3):335–338\nDunselman GA, Groothuis PG (2004) Etiology of endometriosis: hypotheses and facts. Gynecol Obstet Invest 57(1):42–43\nKurman RJ (2011) Diseases of the peritoneum. In: Blaustein’s pathology of the female genital tract, 6th edn. Springer, New York/London\nKashima K et al (2004) Familial risk among Japanese patients with endometriosis. Int J Gynaecol Obstet 84(1):61–64\nRogers PA et al (2013) Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis in Montpellier, France. Reprod Sci 20(5):483–499\nCarvalho LF et al (2013) From conception to birth – how endometriosis affects the development of each stage of reproductive life. Minerva Ginecol 65(2):181–198\nChapron C et al (2012) Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod 27(3):702–711\nGauche Cazalis C et al (2012) Preoperative imaging of deeply infiltrating endometriosis in: transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging. Gynecol Obstet Fertil 40(11):634–641\nSaba L et al (2012) MRI and “tenderness guided” transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis. J Magn Reson Imaging 35(2):352–360\nBazot M et al (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232(2):379–389\nSiegler AM, Camilien L (1994) Adenomyosis. J Reprod Med 39(11):841–853\nLevy G et al (2013) An update on adenomyosis. Diagn Interv Imaging 94(1):3–25\nKishi Y et al (2012) Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 207(2):114 e1-7\nBazot M et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16(11):2427–2433\nReinhold C et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199(1):151–158\nNovellas S et al (2011) MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol 196(5):1206–1213\nTakeuchi M, Matsuzaki K, Nishitani H (2010) Manifestations of the female reproductive organs on MR images: changes induced by various physiologic states. Radiographics 30(4):1147\nUtsunomiya D et al (2004) Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images. AJR Am J Roentgenol 182(2):399–404\nPatel MD et al (1999) Endometriomas: diagnostic performance of US. Radiology 210(3):739–745\nTogashi K et al (1991) Endometrial cysts: diagnosis with MR imaging. Radiology 180(1):73–78\nWu TT et al (2004) Magnetic resonance imaging of ovarian cancer arising in endometriomas. J Comput Assist Tomogr 28(6):836–838\nCoutinho AC Jr et al (2011) Pelvic applications of diffusion magnetic resonance images. Magn Reson Imaging Clin N Am 19(1):133–157\nSiegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32(6):1675–1691\nMcDermott S et al (2012) MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics 32(3):845–863\nTakeuchi M, Matsuzaki K, Nishitani H (2008) Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr 32(3):353–355\nTakeuchi M et al (2006) Malignant transformation of pelvic endometriosis: MR imaging findings and pathologic correlation. Radiographics 26(2):407–417\nKim MY et al (2009) MR Imaging findings of hydrosalpinx: a comprehensive review. Radiographics 29(2):495–507\nRezvani M, Shaaban AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31(2):527–548\nDel Frate C et al (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26(6):1705–1718\nRedwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76(2):358–365\nDarai E et al (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192(2):394–400\nDarai E et al (2005) Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril 84(4):945–950\nAbrao MS et al (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22(12):3092–3097\nKinkel K et al (1999) Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod 14(4):1080–1086\nChapron C et al (1998) Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis. Hum Reprod 13(8):2266–2270\nFedele L et al (1998) Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol 91(3):444–448\nChapron C et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18(1):157–161\nFaccioli N et al (2008) Barium enema evaluation of colonic involvement in endometriosis. AJR Am J Roentgenol 190(4):1050–1054\nRock JA (1995) The revised American Fertility Society classification of endometriosis: reproducibility of scoring. ZOLADEX Endometriosis Study Group. Fertil Steril 63(5):1108–1110\nPrystowsky JB et al (1988) Gastrointestinal endometriosis. Incidence and indications for resection. Arch Surg 123(7):855–858\nLandi S et al (2004) Preoperative double-contrast barium enema in patients with suspected intestinal endometriosis. J Am Assoc Gynecol Laparosc 11(2):223–228\nSiegelman ES, Outwater EK (1999) Tissue characterization in the female pelvis by means of MR imaging. Radiology 212(1):5–18\nLoubeyre P et al (2009) Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification. AJR Am J Roentgenol 192(6):1625–1631\nCoutinho A Jr et al (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31(2):549–567\nSavelli L et al (2009) Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis. Ultrasound Obstet Gynecol 34(5):595–600\nKinkel K et al (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16(2):285–298\nFrachet O et al (2006) Ureteral obstruction from endometriosis: a case report and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 35(5 Pt 1):500–503\nPerez-Utrilla Perez M et al (2009) Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urology 73(1):47–51\nKataoka ML et al (2005) Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology 234(3):815–823\nKinkel K. (2005) Management of endometriosis. Informa Healthcare, Philadelphia, pp 448–451\nBazot M et al (2011) Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod 26(2):346–353\nErcoli A et al (2005) Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: a dissection-based comparative study. Am J Obstet Gynecol 193(4):1565–1573\nTouboul C et al (2008) The lateral infraureteral parametrium: myth or reality? Am J Obstet Gynecol 199(3):242 e1-6\nBazot M et al (2012) The value of MRI in assessing parametrial involvement in endometriosis. Hum Reprod 27(8):2352–2358\nFaccioli N et al (2010) Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging. Abdom Imaging 35(4):414–421\nOlive DL, Schwartz LB (1993) Endometriosis. N Engl J Med 328(24):1759–1769\nBazot M et al (2007) Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod 22(5):1457–1463\nChapron C et al (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol 24(2):175–179\nAscher SM et al (1995) Endometriosis: appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques. J Magn Reson Imaging 5(3):251–257\nZanardi R et al (2003) Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging 28(5):733–742\nBazot M et al (2011) Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images. Eur J Radiol 80(3):e331–e339\nScardapane A et al (2013) Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography. Radiol Med 118(2):323–338\nBis KG et al (1997) Pelvic endometriosis: MR imaging spectrum with laparoscopic correlation and diagnostic pitfalls. Radiographics 17(3):639–655\nSonavane SK, Kantawala KP, Menias CO (2011) Beyond the boundaries-endometriosis: typical and atypical locations. Curr Probl Diagn Radiol 40(6):219–232\nTokue H, Tsushima Y, Endo K (2009) Magnetic resonance imaging findings of extrapelvic endometriosis of the round ligament. Jpn J Radiol 27(1):45–47\nNovellas S et al (2010) Anterior pelvic endometriosis: MRI features. Abdom Imaging 35(6):742–749\nIdeyi SC et al (2003) Spontaneous endometriosis of the abdominal wall. Dig Surg 20(3):246–248\nCrespo R, Puig F, Marquina I (2005) Pyramidalis muscle endometriosis in absence of previous surgery. Int J Gynaecol Obstet 89(2):148–149\nHassanin-Negila A et al (2006) Endometriomas of the abdominal wall: imaging findings. J Radiol 87(11 Pt 1):1691–1695\nZhao X et al (2005) Abdominal wall endometriomas. Int J Gynaecol Obstet 90(3):218–222\nGougoutas CA et al (2000) Pelvic endometriosis: various manifestations and MR imaging findings. AJR Am J Roentgenol 175(2):353–358\nGunes M et al (2005) Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. J Obstet Gynaecol Res 31(5):471–475\nChoudhary S et al (2009) Unusual imaging appearances of endometriosis. AJR Am J Roentgenol 192(6):1632–1644\nKirkpatrick A et al (2006) Radiologic-pathologic conference of Brooke Army Medical Center: endometriosis of the canal of Nuck. AJR Am J Roentgenol 186(1):56–57\nCervini P, Mahoney J, Wu L (2005) Endometriosis in the canal of Nuck: atypical manifestations in an unusual location. AJR Am J Roentgenol 185(1):284–285\nStrasser EJ, Davis RM (1977) Extraperitoneal inguinal endometriosis. Am Surg 43(6):421–422\nMashfiqul MA, Tan YM, Chintana CW (2007) Endometriosis of the inguinal canal mimicking a hernia. Singapore Med J 48(6):e157–e159\nWadhwa V et al (2012) Sciatic nerve tumor and tumor-like lesions – uncommon pathologies. Skeletal Radiol 41(7):763–774\nGoldsmith PJ et al (2009) Case hepatic endometriosis: a continuing diagnostic dilemma. HPB Surg 2009:407206\nKeichel S et al (2011) Lymphangiogenesis in deep infiltrating endometriosis. Hum Reprod 26(10):2713–2720\nInal M et al (2000) Hepatic endometrioma: a case report and review of the literature. Eur Radiol 10(3):431–434\nFluegen G et al (2013) Intrahepatic endometriosis as differential diagnosis: case report and literature review. World J Gastroenterol 19(29):4818–4822\nAsran M, Rashid A, Szklaruk J (2010) Hepatic endometriosis mimicking metastatic disease: a case report and review of the literature. J Radiol Case Rep 4(11):26–31\nRousset-Jablonski C et al (2011) Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod 26(9):2322–2329\nLaghzaoui O, Laghzaoui M (2001) Nasal endometriosis: apropos of 1 case. J Gynecol Obstet Biol Reprod (Paris) 30(8):786–788\nMignemi G et al (2012) A case report of nasal endometriosis in a patient affected by Behcet’s disease. J Minim Invasive Gynecol 19(4):514–516\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2015 Springer International Publishing Switzerland\nAbout this chapter\nCite this chapter\nMautone, S. et al. (2015). Endometriosis. In: Manfredi, R., Pozzi Mucelli, R. (eds) MRI of the Female and Male Pelvis. Springer, Cham. https://doi.org/10.1007/978-3-319-09659-9_4\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-09659-9_4\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-09658-2\nOnline ISBN: 978-3-319-09659-9\neBook Packages: MedicineMedicine (R0)\nKeywords\nThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.","source_license":"CC0","license_restricted":false}