{"paper_id":"e36c5260-4f9a-466c-9af2-cef4b40e88fe","body_text":"Abstract\nDeep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.\nSimilar content being viewed by others\nReferences\nNovellas S, Chassang M, Bouaziz J, et al. (2010) Anterior pelvic endometriosis: MRI features. Abdom Imaging 35:742–749. doi:10.1007/s00261-010-9600-1\nSiegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691. doi:10.1148/rg.326125518\nKinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298.\nRedwine DB (1999) Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril 72:310–315.\nCrispi CP, de Souza CA, Oliveira MA, et al. (2012) Endometriosis of the round ligament of the uterus. J Minim Invasive Gynecol 19:46–51. doi:10.1016/j.jmig.2011.09.006\nAcién P, Sánchez del Campo F, Mayol MJ, Acién M (2011) The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations. Eur J Obstet Gynecol Reprod Biol 159:426–432. doi:10.1016/j.ejogrb.2011.07.040\nTokue H, Tsushima Y, Endo K (2009) Magnetic resonance imaging findings of extra-pelvic endometriosis of the round ligament. Jpn J Radiol 27:45–47. doi:10.1007/s11604-008-0293-0\nBalboni GC, Bastianini A, et al. (1990) Apparato genitale femminile. Anatomia Umana, 3rd edn. Milano: Edi Ermes s.r.l, pp 516–517\nGray H (1995) Female organs of generation. Anatomy descriptive and surgical, 15th edn. New York: Barnes & Noble Books, pp 1008–1023.\nJimenez M, Miles RM (1960) Inguinal endometriosis. Ann Surg 151:903–911.\nMashfiqul MA, Tan YM, Chintana CW (2007) Endometriosis of the inguinal canal mimicking a hernia. Singapore Med J 48:157–159.\nSilberman EA, Quildrian SD, Vigovich FA, Porto EA (2011) Inguinal endometriosis of the round ligament: endometriosis del ligamento redondo inguinal. Cir Esp 89:469–470. doi:10.1016/j.ciresp.2010.07.020\nTerada S, Miyata Y, Nakazawa H, et al. (2006) Immunohistochemical analysis of an ectopic endometriosis in the uterine round ligament. Diagn Pathol 9:1–27.\nWoodward PF, Sohaey R, Mezzetti TP (2001) Endometriosis: radiologic–pathologic correlation. Radiographics 21:193–216.\nCoutinho A Jr, Bittencourt LK, Pires CE, et al. (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31:549–567. doi:10.1148/rg.312105144\nBazot M, Darai E, Hourani R, et al. (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389.\nBusard MP, Mijatovic V, van Kuijk C, Hompes PG, van Waesberghe JH (2010) Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol 20:1267–1276. doi:10.1007/s00330-009-1658-1\nEuropean Society of Human Reproduction and Embryology (2008) The ESHRE Guideline on Endometriosis. http://guidelines.endometriosis.org/The%20ESHRE%20Guideline%20on%20endometriosis%202008.pdf. Accessed 30 Mar 2010\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nGui, B., Valentini, A.L., Ninivaggi, V. et al. Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features. Abdom Imaging 39, 622–632 (2014). https://doi.org/10.1007/s00261-014-0091-3\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00261-014-0091-3","source_license":"CC0","license_restricted":false}