Deep rectosigmoid endometriosis: “mushroom cap” sign on T2-weighted MR imaging

Jung‐Hwan Yoon, Jung Hwan Yoon, Dongil Choi, Kee‐Taek Jang, Kee-Taek Jang, Chan Kyo Kim, Heejung Kim, Soon Jin Lee, Ho-Kyung Chun, Woo Yong Lee, Seong Hyeon Yun
Abdominal imaging · 2010 · vol. 35(6) , pp. 726–731 · doi:10.1007/s00261-010-9643-3 · PMID:20820774 · W1995507637
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This study evaluated the T2-weighted MRI "mushroom cap" sign, finding it characteristic of deep rectosigmoid endometriosis and absent in other submucosal tumors.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This study assessed the “mushroom cap” sign on T2-weighted MR imaging in 12 patients who underwent colonic resection for rectosigmoid lesions presenting or mimicking submucosal tumors, including six cases of deep endometriosis and other tumors (gastrointestinal stromal tumor, ovarian cancer metastasis, and carcinoid). MRI findings were compared with macroscopic and microscopic features from resected specimens, and the authors report that all six deep endometriosis cases showed a characteristic “mushroom cap” pattern with heterogeneous low signal in hypertrophic muscularis propria covered by high-signal mucosa and submucosa, while this sign was absent in the other six tumors; histology indicated deep endometriosis involved the submucosa or mucosa. The main limitation is the small sample size (only six endometriosis cases) and the mixture of multiple diseases, which restricts generalizability. This paper is centrally about endometriosis — it evaluates MRI features (“mushroom cap” sign) for diagnosing deep rectosigmoid endometriosis.

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Abstract

Purpose The purpose of this study is to evaluate the “mushroom cap” sign on T2-weighted MR imaging in patients with submucosal tumors in the rectosigmoid colon.

Methods

From January 2001 to August 2009, 12 patients with four different diseases presenting or mimicking submucosal tumors in the rectosigmoid colon underwent colonic resection. All patients with deep endometriosis (n = 6), gastrointestinal stromal tumor (n = 4), metastasis from ovary cancer (n = 1), and carcinoid tumor (n = 1) had either an MRI of the rectum or pelvis before surgery. We evaluated the MRI findings and compared them with the macroscopic and microscopic observations in the resected specimens.

Results

In all six cases of deep endometriosis, a characteristic “mushroom cap” shaped appearance was found on T2-weighted MR imaging. Heterogeneous low signal intensity of the hypertrophic muscularis propria, covered with high signal intensity of the mucosa and submucosa on T2-weighted MR images, looked like a “mushroom cap” with the pattern of intraluminal endophytic growth. In histological findings, deep endometriosis involved the submucosa (n = 4) or mucosa (n = 2). The “mushroom cap” sign was not present in any of the six other tumors.

Conclusion

The “mushroom cap” sign on T2-weighted MR imaging may be a characteristic sign for diagnosing deep rectosigmoid endometriosis. Similar content being viewed by others

References

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Acknowledgement

This study was supported by the Samsung Biomedical Research Institute grant, #SBRI C-A7-425. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Yoon, J.H., Choi, D., Jang, KT. et al. Deep rectosigmoid endometriosis: “mushroom cap” sign on T2-weighted MR imaging. Abdom Imaging 35, 726–731 (2010). https://doi.org/10.1007/s00261-010-9643-3 Published: Issue date: DOI: https://doi.org/10.1007/s00261-010-9643-3

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Colon, Sigmoid Endometriosis Magnetic Resonance Imaging Rectum Adult Colon, Sigmoid Colon, Sigmoid Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Middle Aged Rectum Rectum

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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