Mapping Deep Pelvic Endometriosis: Why Precise Lesion Localization Matters for Therapy Planning

Abdomen, CT, MR, Comparative studies, Image verification, Outcomes Authors: G. Drakotos, J. Buric DOI: 10.26044/ecr2026/C-26727 Purpose Deep pelvic endometriosis (DPE) is a complex, infiltrative disease associated with chronic pelvic pain, infertility, and significant surgical morbidity. Accurate preoperative characterisation is essential, as surgical management often requires multidisciplinary involvement and tailored operative strategies. This poster aims to describe the key magnetic resonance imaging (MRI) features of DPE and to demonstrate how structured, compartment-based lesion mapping enhances surgical planning. In particular, it highlights how standardised MRI reporting can move beyond confirmation of diagnosis to actively informing operative complexity, the need for bowel or urinary...

and materials A literature-based narrative review was conducted, focusing on contemporary evidence and expert consensus surrounding MRI evaluation of deep pelvic endometriosis. Established European Society of Urogenital Radiology (ESUR) and International Deep Endometriosis Analysis (IDEA) group recommendations were integrated to define optimal imaging protocols and reporting standards. MRI techniques emphasised include high-resolution T2-weighted multiplanar imaging for anatomical delineation, T1-weighted fat-suppressed sequences for identification of haemorrhagic foci, and optional diffusion-weighted or cine sequences to assist with tissue characterisation and assessment of organ mobility. Lesions were mapped using a...

Deep pelvic endometriosis typically manifests on MRI as irregular, fibromuscular nodules or plaques that are hypointense on T2-weighted sequences, reflecting dense fibrosis and smooth muscle proliferation. Small foci of T1 hyperintensity may be present, corresponding to ectopic haemorrhagic implants. Posterior compartment involvement was most frequently associated with increased operative complexity, particularly when lesions demonstrated bowel wall invasion. A bowel lesion thickness of ≥14 mm or circumferential involvement exceeding 35–40% was associated with a higher likelihood of requiring segmental resection rather than superficial shaving. Parametrial, ureteric,...

Precise MRI mapping of deep pelvic endometriosis using a structured, compartment-based reporting approach significantly enhances preoperative planning and multidisciplinary coordination. By accurately defining lesion location, depth of infiltration, and organ involvement, MRI enables more informed surgical decision-making, reduces the risk of incomplete excision, and supports realistic patient counselling regarding operative risks and outcomes. Integration of standardised MRI protocols into multidisciplinary pathways reinforces radiology’s pivotal role in guiding personalised, evidence-based management of endometriosis, particularly in complex cases requiring advanced surgical expertise.The existing evidence underpinning MRI-based predictive... Personal information and conflict of interest G. Drakotos: Nothing to disclose J. Buric: Nothing to disclose

1. Bazot M, Bharwani N, Huchon C, et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27(7): 2765–2775.2. Harth, S., Roller, F. C., Zeppernick, F., Meinhold-Heerlein, I., & Krombach, G. A. (2023). Deep Infiltrating Endometriosis: Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging with Respect to Morphological Criteria. Diagnostics, 13(10), 1794. https://doi.org/10.3390/diagnostics13101794