Beyond shading: a comprehensive review of the MR features of pelvic endometriosis with laparoscopic correlation

Pathology, Diagnostic procedure, MR, Genital / Reproductive system female Authors: N. Yang1, D. Kurda2, S. Esler1, T. Ma3, L. Ellet 3, P. J. Maher 3; 1Heidelberg/AU, 2Amman/JO, 3Melbourne /AU DOI: 10.1594/ecr2016/C-0454 Learning objectives After completion of this educational exhibit, readers will be able to: Recognisethe key magnetic resonance (MR) featuresof pelvic endometriosis. Befamiliar with imaging “pearls” that facilitate disease recognition and evaluation. Consolidate understanding of the disease process, aided by laparoscopic correlation.

Endometriosis is a common and important disorder affecting women of childbearing age. It is the 3rd leading cause for gynaecologic hospitilisation and is a common cause of hysterectomy [1]. Laparoscopy is the gold standard for diagnosis and staging of endometriosis. However, it is an invasive technique with potential to miss “blind spots” such as sub-peritoneal disease and lesions deep to adhesions. Additionally, it can bedifficult for laparoscopists to assess the depth of bowel wall invasion. MRI can be used for the diagnosis of endometriomas and... Findings and procedure details OVARIAN ENDOMETRIOMA(Figs. 2, 3 and 4) Endometriomas demonstrate homogenous high T1 signal intensity (Fig. 2) with no loss of signal on T1 fat saturated (T1FS) imaging (Fig. 3). The presence of multiple T1FS hyperintense adnexal cysts is highlyspecific for ovarian endometriomas [11]. T2 signal intensity may be varied, but a common and important feature is “shading”, (Fig. 4). Shading is defined as T2 shortening in an adnexal cyst that is hyperintense on T1. The loss of T2 signal may be complete or layered in appearance...

Endometriosis is a common condition with important sequelae in women of reproductive age. The detection of deep infiltrating endometriosis (DIE) can be difficult and easily under-diagnosedon MRI, as these lesions are low on T2 weighted sequences and are less likely to contain T1 hyperintense foci within. A good knoweldge of pelvic anatomy and the MR findings of pelvic endometriosis is important for DIE diagnosis, evaluation of disease extent and aidingsurgical planning.

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