Role of MRI in detection of deep infiltrating endometriosis

Genital / Reproductive system female, MR, Contrast agent-intravenous, Diagnostic procedure, Pelvic floor dysfunction, Tissue characterisation Authors: E. Puchkova, E. A. Mershina, V. Sinitsyn, T. Pustovitiva; Moscow/RU DOI: 10.1594/ecr2015/C-0337 Learning objectives To illustrate the typical MR imaging findings of deep infiltrating endometriosis, describe the different locations of solid endometriosis and review MR imaging protocol in affected patients.

Endometriosis is a severe gynecologic disorder that affects women of reproductive age[1,2,3]. It is defined as the presence of functional endometrial glands and stroma outside the uterus[6,8]. There are three forms of pelvic endometriosis - superficial peritoneal lesions, ovarian endometrioma and deep infiltrating endometriosis. The superficial peritoneal lesions are noninvasive implants that can be easily diagnosed at laparoscopy[12,13]. Ovarian endometrioma is a widely known disorder that can be easily detected with US, MRI and laparoscopy[5,14,15,16]. The deep infiltrating endometriosis is defined as subperitoneal endometrial lesions... Findings and procedure details The presentation is based on analysis of 65 cases of deep pelvic endometriosis. Examinations were performed with 1.5 T MR scanner. Standard imaging protocol includes sagittal, axial and oblique coronal turbo spin-echo T2-weighted images (T2-WI), coronal T2-WI with fat suppression, axial and coronal turbo spin-echo T1-WI with fat suppression before and after intravenous administration of gadolinium chelates (0.2 mmol/kg). Sagittal sequences were acquired with saturation bands placed anteriorly to eliminate the high signal of subcutaneous fat and breath artifacts. Standard protocol is detailed in the...

Deep infiltrating endometriosis is a severe gynecologic disorder for which surgery remains the best medical procedure. Adequate treatment requires radical removing of all endometriotic lesions therefore an accurate preoperative assessment of the endometriosis extension is extremely important. MRI is a non-invasive preoperative examination with a high diagnostic accuracy that helps to identify endometriotic lesions to define the surgical strategy. MRI allows to diagnose endometriosis of the bladder, ureters, vesicouterine pouch, round, broad and uterosacral ligaments, rectovaginal pouch, and small implants on the serosal surface of...

Choudhary S., Fasih N., Paradatos D., Surabhi VR. Unusual imaging appearances of endometriosis. AJR Am J Roentgenol 2009;192(6):1632-1644. Available at: http://www.ajronline.org/doi/full/10.2214/AJR.08.1560 Woodward PJ., Sohaey R., Mezzetti TP Jr. Endometriosis: radiologic-pathologic correlation. RadioGraphics 2001;21(1):193-216. Available at:http://pubs.rsna.org/doi/full/10.1148/radiographics.21.1.g01ja14193 Trufanov G.E. Radiologic guidelines in gynaecology. – 2008. - Jelbi-Spb. – 592s. (inRussian) Giudice LC., Kao LC. Endometriosis. Lancet 2004;364(9447):1789-1799. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17403-5/fulltext Adamjan L.V., Kulakov V.I., Andreeva E.N. Endometriosis (Guidelines for radiologist). – 2006. – M.:Medicina. – 480s. (inRussian) Matalliotakis IM., Arici A., Cakmak H., Goumenou AG., Koumantakis G.,...