Deep Endometriosis: Don’t Forget about Round Ligaments. MRI Features, Clinical and Anatomic Review.

Tissue characterisation, Education, Diagnostic procedure, MR, Pelvis, Genital / Reproductive system female Authors: B. Gui1, A. L. Valentini1, M. C. mingote2, V. Ninivaggi1, M. Miccò1, L. Bonomo3; 1Roma/IT, 2Roma (RM)/IT, 3Rome/IT DOI: 10.1594/ecr2013/C-1100 Learning objectives To help Radiologists in correctly identifying round ligament endometriosis on magnetic resonance images (MRI)

Endometriosis is the presence of functional endometrial glands and stroma outside the uterine cavity and affects approximately 10 to20% of reproductive–age women. The patients may have a variety of symptoms such as progressive dysmenorrehea, menstrual irregolarities, dyspareunia and infertility. Deep infiltrating endometriosis (DIE) is hystologically defined as a lesion that extends more than 5 mm into the subperitoneal space and/or that affects wall of pelvic organs and ligaments. [1] DIE predominantly affects posterior structures such as rectovaginal septum and uterosacral ligaments (69,2%), wall of the... Imaging findings OR Procedure details Embriology RLU derive from the lower part of the female Gubernaculum, an embryonic structure,where the upper part becomes the ovarian ligament. The Gubernaculum forms from the caudal fold and is provoked by the mesonephros elevating to covering the peritoneum. It begins as a cord that extends from the gonadal ridge, the location of undifferentiated gonad, to the future inguinal region. It is composed of coelomic-epithelium covered by mesenchimal , muscular and extracellular matrix precursor cells. It persist as the RLU which penetrates the abdominal wall...

Endometriosis of the RLU is a rare localization to be considered in female patients with suspectedpelvic endometriosis. The knowledge of anatomic details of these ligaments might help radiologists to better recognize and define the pelvic extension of the disease in order to help gynecologists for the patient’s work up.

[1] Novellas S, Chassang M, Bouaziz J, Delotte j, Toullalan O, Chevallier EP. Anterior pelvic endometriosis: MRI features. Abdom Imaging. 2010 Dec;35(6):742-9 [2] Coutinho A Jr, Bittencourt LK, Pires CE, Junqueira F, LimaCM, Coutinho E, Domingues MA, Domingues RC, Marchiori E MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 2011 Mar-Apr;31(2):549-67. Review. [3]Acién P, Sánchez del Campo F, Mayol MJ, Acién M, The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations. Eur... Personal Information Dr. B. Gui, Dipartimento di Bioimmagini, Policlinico "A. Gemelli" - Roma/IT [email protected]