Bowel Endometriosis: Systematic Approach to Diagnosis with US and MRI

Haatal B Dave, Luciana Pardini Chamié, Scott W. Young, Michelle D. Sakala, Wendaline M. VanBuren, Priyanka Jha, Luyao Shen, Melina Pectasides, Peter Movilla, Sherelle Laifer‐Narin, Phyllis Glanc, Anuradha S. Shenoy‐Bhangle
Radiographics : a review publication of the Radiological Society of North America, Inc · 2025 · vol. 45(4) , pp. e240102 · doi:10.1148/rg.240102 · PMID:40111900
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This paper outlines a systematic diagnostic approach for bowel endometriosis using ultrasound and MRI, detailing imaging protocols, normal anatomy, and features of bowel wall infiltration to guide surgical treatment.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper reviews a systematic diagnostic approach for bowel endometriosis using transvaginal ultrasound with bowel preparation and endometriosis protocol MRI, describing lesion appearance, measurement, anatomic mapping, and surgical implications. It outlines eTVUS with bowel preparation protocols and an eMRI protocol including MR enterography, covering extrapelvic bowel involvement such as small bowel, appendiceal, cecal/ileo-cecal junction, and gastric endometriosis. The article also enumerates imaging pitfalls and measurement pitfalls, and notes a concern about endometriosis-related gastrointestinal malignancy as part of the diagnostic context. This paper is centrally about endometriosis — it focuses specifically on systematic diagnosis of bowel endometriosis using US and MRI.

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Abstract

Endometriosis involving the bowel is a severe form of the disease, and the bowel is the most common site of extragenital endometriosis. Surface lesions of the bowel are considered peritoneal disease. Bowel endometriosis (BE) is defined as endometriotic tissue infiltrating the muscularis propria layer of the bowel wall. BE is estimated to affect up to 37% of patients with known deep endometriosis, highlighting its coexistence with genital endometriosis. The rectosigmoid colon is the most common segment of the bowel involved, followed by the distal small bowel. US and MRI are the most common imaging modalities used to detect BE. Depending on which bowel segment is imaged, endometriosis protocols for transvaginal US after bowel preparation with a transabdominal component and MRI and MR enterography are most commonly used. The authors provide a systematic approach to the diagnosis of BE using these imaging modalities. Imaging protocols and techniques for optimization of visualization of the bowel are discussed, the normal bowel wall anatomy with both imaging modalities is described, and the varying degrees of bowel wall involvement in endometriosis are illustrated. The imaging features of infiltration of endometriosis in the bowel muscularis propria are described in detail, along with key imaging findings to be conveyed to surgical colleagues to optimize surgical treatment and decrease complications, thereby improving overall patient outcomes. ©RSNA, 2025 Supplemental material is available for this article.
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Introduction

Disease Distribution and Pathogenesis Imaging Techniques Transvaginal US with Bowel Preparation Bowel Preparation Protocol and Scanning Technique Anatomy Appearance, Measurement, and Surgical Implications of the Lesion Magnetic Resonance Imaging eMRI Protocol Anatomy Appearance, Measurement, and Surgical Implications of the Lesion MR Enterography Extrapelvic Bowel Involvement Small Bowel Endometriosis Appendiceal Endometriosis Cecal and Ileocecal Junction Endometriosis Gastric Endometriosis Pitfalls at Imaging Ultrasonography MR Imaging Pitfalls in Measurement Endometriosis-related Gastrointestinal Malignancy Treatment Medical Management Surgical Treatment Implications on Pain and Fertility Reporting Choice of US versus MRI for BE

Conclusion

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Information & Authors Information Published In Abbreviations - BE - bowel endometriosis - DE - deep endometriosis - eMRI - endometriosis protocol MRI - eTVUS - endometriosis protocol transvaginal US - eTVUS-BP - eTVUS with bowel preparation - MRE - MR enterography - RVS - rectovaginal septum Copyright History Authors Disclosures of conflicts of interest.— Metrics & Citations Metrics Article Usage Altmetrics Citations Export citation Select the format you want to export the citation of this publication. Cited by View Options To read the full-text, please use one of the options below to sign in or purchase access. RSNA members have free access to all RadioGraphics content. However, complimentary journal-based CME activities are only included for members with the Standard or Full Access packages. RSNA Journals participate in the World Health Organization's Research4Life program and the online versions of the journals are either freely available or are available with low-cost access to not-for-profit institutions in eligible countries. Login options Check if you have access through your login credentials or your institution to get full access on this article. Purchase Options Subscribe and get full access to this article. Recommend this journal to your librarian To read the full-text, please use one of the options below to sign in or purchase access. RSNA members have free access to all RadioGraphics content. However, complimentary journal-based CME activities are only included for members with the Standard or Full Access packages. RSNA Journals participate in the World Health Organization's Research4Life program and the online versions of the journals are either freely available or are available with low-cost access to not-for-profit institutions in eligible countries. Recommend to a librarian Recommend this journal to your librarian Redeem Voucher Access tokens allow you to activate and access content online. If you have been issued an access token, please enter it here and click 'Submit':

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Intestinal Diseases Intestinal Diseases Intestinal Diseases

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