MRI Features of Malignant Transformation of Pelvic Endometriosis: A Systematic Review

Shirin Yaghoobpoor
2025 · W7048942851
Systematic review / meta-analysis OA: green CC0
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This systematic review of eight studies identifies key MRI features for detecting malignant transformation of pelvic endometriosis, including large lesion size, loss of T2 shading, and enhancing mural nodules protruding at acute angles.

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This systematic review analyzed magnetic resonance imaging features associated with the malignant transformation of pelvic endometriosis. The authors identified eight relevant studies comprising 87 individuals to evaluate diagnostic imaging characteristics published between 1992 and 2021. Key findings indicated that larger lesion size, loss of T2-weighted shading, contrast enhancement of mural nodules, and acute-angle protrusion from the cyst wall were primary indicators of malignancy. This paper is centrally about endometriosis — specifically the identification of MRI markers for its malignant transformation into cancer.

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Abstract

Background: Endometriosis is a benign gynecologic condition that is estrogen-dependent. Malignant transformation is one of the complications of endometriosis; it can affect the woman's ovarian and extra-ovarian regions. Diagnosing endometriosis-associated cancers has an essential role in treatment. Purpose: Our study aimed to review magnetic resonance imaging (MRI) features of malignant transformation of pelvic endometriosis. Material and Methods: We searched three online databases including Web of Science, Scopus, and PubMed, applying relevant keywords up to May 2022. We included English articles reporting MRI features of pelvic endometriosis pointing to malignant transformation. Results: Totally eight papers were included as they matched our inclusion requirements. Eighty-seven individuals were included finally. Studies were published between 1992 and 2021. The larger size of the lesion, loss of T2-weighted images shading, mural nodules, mural nodules contrast enhancement, and mural nodules protruding from the cyst wall at acute angles were the main MRI features suggesting potential malignant transformation of pelvic endometriosis. Conclusion: The endometriosis's malignant changes can be observed on MRI. The predominant MRI findings are a large cyst, loss of shading on T2-weighted imaging, mural nodules enhancement, and acutely angled protrusion of mural nodules from the cyst wall.
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Basic & Clinical Cancer Research (Feb 2025) MRI Features of Malignant Transformation of Pelvic Endometriosis: A Systematic Review Abstract Background: Endometriosis is a benign gynecologic condition that is estrogen-dependent. Malignant transformation is one of the complications of endometriosis; it can affect the woman's ovarian and extra-ovarian regions. Diagnosing endometriosis-associated cancers has an essential role in treatment. Purpose: Our study aimed to review magnetic resonance imaging (MRI) features of malignant transformation of pelvic endometriosis. Material and Methods: We searched three online databases including Web of Science, Scopus, and PubMed, applying relevant keywords up to May 2022. We included English articles reporting MRI features of pelvic endometriosis pointing to malignant transformation. Results: Totally eight papers were included as they matched our inclusion requirements. Eighty-seven individuals were included finally. Studies were published between 1992 and 2021. The larger size of the lesion, loss of T2-weighted images shading, mural nodules, mural nodules contrast enhancement, and mural nodules protruding from the cyst wall at acute angles were the main MRI features suggesting potential malignant transformation of pelvic endometriosis. Conclusion: The endometriosis's malignant changes can be observed on MRI. The predominant MRI findings are a large cyst, loss of shading on T2-weighted imaging, mural nodules enhancement, and acutely angled protrusion of mural nodules from the cyst wall.

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