{"paper_id":"a4d59378-eba6-4123-bcf1-23e44983e988","body_text":"ECR 2026 / C-18642\nBeware of Deep Infiltrating Endometriosis - MRI Multi-Compartment Seeding, a Series of Cases\nCongress:\nECR 2026\nPoster Number:\nC-18642\nType:\nEducational Exhibit\nKeywords:\nGenital / Reproductive system female, Pelvis, Urinary Tract / Bladder, MR, Imaging sequences, Education and training, Obstruction / Occlusion, Pelvic floor dysfunction\nAuthors:\nE. C. Gavrila, L. Stanciulescu, H. Roman\nDOI:\n10.26044/ecr2026/C-18642\nLearning objectives\nThe aim of this educational exhibit is to:\nReview the MRI definition and key imaging characteristics of deep infiltrating endometriosis (DIE).\nIllustrate MRI features of DIE in pelvic and extra-pelvic compartments that are frequently underdiagnosed and carry major prognostic implications.\nEmphasize the value of symptom-oriented MRI interpretation for accurate lesion localization and optimized preoperative planning.\nBackground\nEndometriosis is a chronic inflammatory disease characterized by ectopic endometrial-like tissue, affecting up to 10% of women of reproductive age. Deep infiltrating endometriosis (DIE) represents the most severe form, defined by infiltration exceeding 5 mm beneath the peritoneal surface.DIE is a compartment-based disease that may involve pelvic and extra-pelvic structures, including the bowel, urinary tract, pelvic nerves, and diaphragm. Symptoms are often disproportionate to lesion size and may be misleading or non-specific.Accurate preoperative mapping is crucial, as missed lesions may lead to persistent symptoms, incomplete...\nFindings and procedure details\nMRI Technique and General Imaging PrinciplesMRI enables multiplanar evaluation with excellent soft-tissue contrast, allowing detection of both direct and indirect signs of DIE.A standardized pelvic MRI protocol should include:\nHigh-resolution T2-weighted sequences in axial, sagittal, and oblique or coronal planes\nAxial and sagittal T1-weighted images, with and without fat suppression\nDiffusion-weighted imaging (DWI) (optional)\nCoronal and oblique planes are particularly valuable for assessing structures with oblique or cranio-caudal courses, such as pelvic nerves and diaphragmatic insertions.Routine gadolinium administration is not required but may be useful...\nConclusion\nDeep infiltrating endometriosis is a complex, compartment-based disease in which MRI plays a pivotal role beyond lesion detection. Correlating symptom patterns with anatomical compartments and recognizing indirect imaging signs enables accurate disease mapping, prognostic assessment, and optimized surgical planning. A systematic, symptom-oriented MRI approach across pelvic and extra-pelvic compartments is essential to improve patient outcomes.\nPersonal information and conflict of interest\nE. C. Gavrila:\nNothing to disclose\nL. Stanciulescu:\nNothing to disclose\nH. Roman:\nNothing to disclose\nReferences\nYuruk Y, Ozdemir MS, Simsar M, et al. A review of the MRI features of endometriosis: what should be paid attention to during the reporting process? Abdominal Radiology. 2025;50:6052–6063.\nKaveh, M., Tahermanesh, K., Mehdizadeh Kashi, A., Tajbakhsh, B., Mansouri, G., & Sadegi, K. (2018). Endometriosis of diaphragm: A case report. International Journal of Fertility & Sterility, 12(3), 263–266.\nZamurovic, M., Tomic, A., Djordjevic, K., Simanic, S., Sopta, J., Rasulic, L., Simic, L., Jevtic, J., Nedeljkovic‑Arsenovic, O., & Rovcanin, M. (2023). Isolated deep infiltrating endometriosis of...","source_license":"CC0","license_restricted":false}