{"paper_id":"e77b66fc-a1f2-4905-896b-85f002ad3067","body_text":"ECR 2020 / C-04812\nPelvic endometriosis: An MRI guide for practicing radiologist\nCongress:\nECR 2020\nPoster Number:\nC-04812\nType:\nEducational Exhibit\nKeywords:\nNot applicable, Inflammation, Diagnostic procedure, MR, Genital / Reproductive system female, Emergency, Genitourinary\nAuthors:\nC. Kakkar1, K. Saggar2, A. Ahluwalia3, K. Mittal3; 1Ludhiana, Punjab/IN, 2LUDHIANA, PU/IN, 3Ludhiana/IN\nDOI:\n10.26044/ecr2020/C-04812\nLearning objectives\nHighlight the role of MR imaging in the assessment of pelvic endometriosis.\nUnderstand the importance of optimal protocols for assessment.\nDiscuss the imaging approach of assessment of pelvic endometriosis and its complications on MRI.\nBackground\nEndometriosis is defined as functional endometrial glands and stroma outside of uterine cavity and myometrium, these ectopic glands respond to hormonal stimuli and depending on the location have varying symptomatology.\nClassification\nSuperficial endometriosis:Asymptomatic and occult on imaging, usually less than 5 mm in size, diagnosed on laparoscopy (Fig 1)\nEndometriomas: Ovarian (Chocolate cysts).\nDeep infiltrating: Involves peritoneal attachments, ligaments and pelvic viscera. (Fig.2 and 3).\nClinical symptoms\nThe disease affects approximately 10% of the female population in the reproductive age group and may remain asymptomatic....\nFindings and procedure details\nCompartmental Anatomy (Fig.9)\nVisceral involvementcan vary from adhesions to frank infiltration.\nAdhesions manifest as T2 hypointense spiculated bands which arrange in confluent angles resulting in tethering and angulations of the visceral organs (Fig.10 and 11).\nSigns of adhesions\nPosteriorly displaced and adherent ovaries (Kissing ovaries sign, Fig12,13)\nAngulated and retroflexed uterus (Fig.14,15)\nAngulated Rectosigmoid\nElevation of the posterior fornix (Fig.14,15)\nLoculated ascites\nHydrosalpinx.\nGenitourinary and anterior compartment involvement\nAdhesions (Fig 15) or implants (Fig.16) can lead to anteflexion of the uterus.\nUrinary bladder:Mostcommon location (Fig.16),...\nConclusion\nEndometriosis should be looked for in all females presenting with chronic pelvic pain and infertility as the changes can be very subtle leading to delayed diagnosis.\nUltrasound remains the first line of investigation, however, deep pelvic endometriosis may not be optimally assessed\nMRI is an excellent modality for assessment of deep pelvic endometriosis especially the fibrotic disease.\nMRI serves as a road map for management.\nThe compartmental approach should be used and sites like cul de sac, torus uterinus, pelvic ligaments should be seen when...\nPersonal information and conflict of interest\nC. Kakkar; Ludhiana, Punjab/IN - nothing to disclose K. Saggar; Ludhiana, PU/IN - nothing to disclose A. Ahluwalia; Ludhiana/IN - nothing to disclose K. Mittal; Ludhiana/IN - nothing to disclose\nReferences\nBourgioti C, Preza O, Panourgias E, Chatoupis K, et al. MRimagingofendometriosis:Spectrumofdisease.Diagn Interv Imaging. 2017 Nov;98(11):751-767\nSchneider C, Oehmke F, Tinneberg HR, Krombach GA. MRI technique for the preoperative evaluation of deep infiltrating endometriosis: current status and protocol recommendation. Clin Radiol. 2016 Mar;71(3):179-94.\nFoti PV, Farina R, Palmucci S, Vizzini IAA, etal. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging. 2018 Apr;9(2):149-172.\nCoutinho A Jr, Bittencourt LK, Pires CE, Junqueira F, et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics....","source_license":"CC0","license_restricted":false}