MR imaging of deep pelvic endometriosis: Spectrum of findings

Pasquale Paolantonio
2010 · doi:10.1594/ecr2010/c-1271 · W2522230168
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This educational exhibit reviews the pathological and clinical features of endometriosis while detailing the magnetic resonance imaging characteristics, appearances, and anatomical locations of pelvic disease. The authors present cases involving ovarian endometriomas, peritoneal adhesions, severe Pouch of Douglas involvement, and extraperitoneal manifestations such as rectovaginal septal or uterosacral ligament invasion. MRI is highlighted as a valuable non-invasive adjunct for pre-operative planning, particularly for identifying fibrotic tissue in laparoscopic blind spots like retroperitoneal areas or deep dense adhesions where it appears hypointense on T2-weighted images. This paper is centrally about endometriosis — specifically the role of MR imaging in diagnosing and staging deep pelvic lesions to aid surgical planning.

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Abstract

Poster: ECR 2010 / C-1271 / MR imaging of deep pelvic endometriosis: Spectrum of findings by: Paolantonio, R. Ferrari, M. Rengo, F. Vecchietti, P. Lucchesi, A. Laghi; Latina/IT
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Keywords

Genital / Reproductive system female, Obstetrics (Pregnancy / birth / postnatal period), Pelvis Authors: P. Paolantonio, R. Ferrari, M. Rengo, F. Vecchietti, P. Lucchesi, A. Laghi; Latina/IT DOI: 10.1594/ecr2010/C-1271 Learning objectives The Purpose of this Exhibit is to review the pathological and clinical features of endometriosis and to show the MRI characteristics, appearances and location of pelvic endometriosis providing laparoscopic correlation.

Background

We will discuss the rationale of an MR protocol suited for the identification of deep pelvic endometriosis. Imaging findings OR Procedure details We will show the MR appearance of both ovaric endometriomas and pelvic endometriosis. We will show cases of periteoneal endometriosis with pelvic adhesion, severe Pouch of Douglas endometriosis and extraperitoneal endometriosis (rectovaginal septal, retroforniceal involvement, uterosacral ligament Rectal invasion).

Conclusion

MRI is a useful adjunct to clinical, sonographic and laparoscopic assessment of patients with endometriosis. It is particularly useful for assessment of laparoscopic "blind areas" such as retroperitoneal disease and endometriosis deep to dense adhesions. The goal in identification of deep pelvic endometriosis is the identification of fibrotic tissue usually hypointense on T2W images. MRI provides useful information for pre-operative planning and is a non-invasive technique for disease diagnosis, staging and treatment follow-up.

References

APGO Educational Series on Women’s Health Issues. Chronic pelvic pain: an integrated approach. Crofton, Md: APGO, January 2000.Harris RD, Holtzman SR, Poppe AM. Clinical outcome in female patients with pelvic pain and normal pelvic US findings. Radiology 2000; 216: 440– 443.Kuligowska E, Deeds L, Lu K. Pelvic Pain: Overlooked and Undiagnosed gynecologic conditions. Radiographics 2005; 25: 3-20.Hottat N, Larrouse C, Anaf V, Noel JC, Matos C, Absil J, Metens T. Endometriosis: contribution of 3.0T Pelvic MR imaging I preoperative assessmentinitial results. Radiology 2009; 253: 126-134.Francica...

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endometriosis

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