Imaging of endometriosis: what the radiologist needs to know.

Genital / Reproductive system female, Pelvis, Abdomen, MR, Ultrasound, Ablation procedures, Biopsy, Image verification Authors: H. Jaafar1, Z. Houneida2, W. Elouaer2, S. Majdoub2, D. Bakir2, F. bouzayene2, N. Chouchene3; 1MONASTIR/TN, 2Sousse/TN, 3Mahdia/TN DOI: 10.26044/ecr2019/C-2943 Learning objectives • Discuss the pertinent MRI findings for both pelvic and distant anatomical endometrial implants. • Correlate the radiologic findings with pathologic specimens from the selected cases. • Describe the complications associated with pelvic and extra-pelvic endometriosis as well as current therapy recommendations.

Endometriosis is a well-known and pervasive cause of pelvic pain and infertility. Itis defined byan ectopic endometrial tissue outside the uterine cavityexcept formyometrium where the ectopic tissueis calledadenomyosis.As imaging protocols become more precise and experience increases with MRI, better clinical information can be gained with less invasive methods. Appropriate clinical management of the patient depends on accurate diagnosis and thorough evaluation of the involved anatomical sites. Findings and procedure details Endometriosis is defined as the presence of endometrial tissue outside the uterus. This condition manifests in as many as 10% of women of reproductive age (1). It manifests as dyspareunia, dysmenorrhea and infertility, although it may be asymptomatic. Three different forms of endometriosis exist: ovarian endometriosis (endometrioma), peritoneal endometriosis and adhesions, and deep endometriosis [2]. ETIOLOGY AND PATHOGENESIS: The etiology is multifactorial, several theories exist. -Retrograde menstruation is the most accepted, with transportion of endometrial tissue from the uterine cavity into the peritoneum through the...

The lesions of endometriosis are widely polymorphic in terms of signal, with a great many possible locations which are more often than not associated, hence the importance of precise knowledge of the various typical appearances. MRI is the best imaging examination for a complete and detailed pre-surgical or pre-therapeutic assessment of deep endometriosis.

[1] Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J,et al. Incidence of endometriosis by study population and diagnostic method:the ENDO study. Fertility and Sterility 2011;96(August (2):360-5. [2]Caterina Exacoustos , Lucia Manganaro , Errico Zupi: Imaging for the evaluation of endometriosis and adénomyoses: Best Practice & Research Clinical Obstetrics and Gynaecology 28 (2014) 655-681. [3] Jensen JR, Coddington CC 3rd. Evolving spectrum: the pathogenesis of endometriosis. Clin Obstet Gynecol 2010;53(2):379-88. [4] Coutinho A Jr., Bittencourt LK, Pires CE, et al. MR...