Endometriosis and Its Myriad Presentations: Magnetic Resonance Imaging-Based Pictorial Review

Seema Sud, Tarvinder Bir Singh Buxi, Swapnil Sheth, Samarjit Singh Ghuman
The Indian journal of radiology & imaging · 2021 · vol. 31(1) , pp. 193–202 · doi:10.1055/s-0041-1729670 · PMID:34316127 · PMC8299511 · W3165848096
article OA: gold CC0 ⤵ 10 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This pictorial review examines the diverse MRI appearances of endometriosis, a condition of ectopic endometrial tissue, emphasizing the need for radiologists to recognize its full spectrum for accurate surgical planning.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This MRI-based pictorial review describes endometriosis as ectopic functional endometrial tissue and outlines high-level approaches to diagnosis, including first-line transvaginal/transrectal sonography, second-line MRI in complex cases, and laparoscopy with histopathological confirmation. It summarizes accepted theories of pathogenesis, categorizes endometriosis into superficial disease, deep infiltrating endometriosis (DIE), and ovarian endometriomas, and provides an MRI protocol (3.0 T, fasting, antispasmodic use, bowel preparation considerations) plus signal and location patterns such as T1 hyperintensity, T2 shading, T2 dark spots, and a hemosiderin rim for endometriomas. A key limitation is that the article is primarily a pictorial/review format rather than presenting original patient outcome data, and it notes imaging can miss DIE due to low signal similar to adjacent low-signal structures. Relevance to endometriosis: the entire paper is centrally about endometriosis imaging findings and reporting, including MRI recognition of deep infiltrating endometriosis and ovarian endometriomas, with emphasis on avoiding missed diagnosis.

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Abstract

Endometriosis is a major cause of infertility and pain in females in the reproductive age group. It is a result of ectopic functional endometrial cells outside the uterus. It consists of a spectrum of findings from superficial to deep implants initiating a fibrotic response and resulting in adhesions. Diagnosis of endometriosis is based on clinical history, noninvasive and invasive techniques. The final diagnosis is based on laparoscopy with histopathological confirmation. Ultrasonography is the first line of investigation, followed by magnetic resonance imaging (MRI) in complex cases. MRI is a noninvasive, multiplanar technique that involves no radiation and provides excellent delineation of the disease process. As deep endometriosis has a similar low signal to adjacent normal organs, it can be easily overlooked by radiologists. They should be aware of the spectrum of diseases so as to provide a roadmap for the surgeons. A structured reporting system helps radiologists organize and standardize their reports.

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endometriosisinfertility

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