Spot the Difference: MRI Pearls and Pitfalls in Endometriosis and Overlapping Conditions

Genital / Reproductive system female, MR, Diagnostic procedure, Education and training Authors: F. Dinkó, I. L. L. Kui, A. Lakatos DOI: 10.26044/ecr2026/C-14461 Learning objectives To review the MRI anatomy of the female pelvis focusing on the predilection sites of endometriosis. To provide a practical MR imaging guide based on the 2025 ESUR consensus, focusing on detection strategies and structured reporting in endometriosis. To provide an image based pictorial guidance for the recognition of endometriosis and its frequently associated conditions

Endometriosis is a prevalent chronic gynaecological disorder in which endometrial-like tissue is found outside the uterine cavity, most commonly affecting the ovaries, peritoneum, and pelvic organs. This ectopic tissue undergoes cyclical hormonal changes similar to the eutopic endometrium, leading to inflammation, scarring, and adhesions. Clinically, the condition is strongly associated with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, and it often has a significant impact on the quality of life. (1).Current guidelines from the European Society of Urogenital Radiology (ESUR) and the European Society of... Findings and procedure details Forms of endometriosis:Endometriosis is generally classified into three principal forms, which may occur independently or coexist within the same patient: Superficial Peritoneal Endometriosis (SPE), involving small implants on the peritoneal surface. Ovarian Endometrioma (OMA), characterized by cystic lesions within the ovary. Deep Infiltrating Endometriosis (DIE), defined by lesions penetrating more than 5 mm beneath the peritoneum and frequently affecting adjacent pelvic organs (1-4). Role of MRI in endometriosis:Magnetic Resonance Imaging plays a pivotal role in the evaluation of ovarian endometriomas (OMA) and in accurately determining...

To achieve optimal diagnostic accuracy in endometriosis, both the examination protocol and image interpretation must be carefully tailored to the individual clinical circumstances of each patient. Radiologists should adopt a systematic approach, provide structured reports, and pay particular attention to critical anatomical regions—such as the ileocecal area—in order to identify coexistent Crohn’s disease or differentiate it. This review offers comprehensive guidance on optimizing MRI examinations, ensuring high-quality imaging, and delivering accurate interpretation with standardized reporting, ultimately facilitating more effective patient care and surgical planning. Personal information and conflict of interest F. Dinkó: Nothing to disclose I. L. Kui: Nothing to disclose A. Lakatos: Nothing to disclose

Thomassin-Naggara I, Dolciami M, Chamie LP, Guerra A, Bharwani N, Freeman S, Rousset P, Manganaro L; ESUR Endometriosis Working Group. ESUR consensus MRI for endometriosis: indications, reporting, and classifications. Eur Radiol. 2025. doi:10.1007/s00330-025-11579-0 Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, et al. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27(7):2765–2775. doi:10.1007/s00330-016-4673-z Foulon A, Pichois R, Sabbagh C, Fumery M. Bowel endometriosis mimicking Crohn disease. Inflamm Bowel Dis. 2021;27(3):e26–e27. doi:10.1093/ibd/izaa259 Quesada J, Härmä K,...