Functional MRI in Endometriosis: Diffusion, Blood Oxygen Level–Dependent (BOLD), and Intravoxel Incoherent Motion (IVIM)

Genital / Reproductive system female, Pelvis, MR-Functional imaging, Diagnostic procedure, Imaging sequences, Outcomes, Pathology Authors: F. Abubacker Sulaiman, R. Praveenkumar, M. Nivitha, S. Zainamb Begum, J. Lydia, A. Raashid Ibrahim DOI: 10.26044/ecr2026/C-26632 Purpose To evaluate the role of advanced functional MRI techniques—Diffusion-Weighted Imaging (DWI), Blood Oxygen Level–Dependent (BOLD) imaging, and Intravoxel Incoherent Motion (IVIM)—in assessing endometriotic lesions and to correlate quantitative imaging biomarkers with clinical severity and histopathologic features.Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by the presence of functional endometrial glands and stroma outside the uterine cavity. It affects nearly 10% of women of reproductive age and is a significant cause of chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Deep infiltrating endometriosis (DIE) represents an aggressive...

and materials A prospective observational study was conducted over 18 months and included 60 women aged 22–42 years who were clinically suspected or surgically confirmed to have endometriosis. Presenting complaints included chronic pelvic pain, severe dysmenorrhea, dyspareunia, infertility, or adnexal masses suggestive of endometrioma on ultrasound.Exclusion criteria included pregnancy, prior pelvic malignancy, recent hormonal therapy (within three months), contraindications to MRI, or incomplete imaging datasets.All patients underwent MRI on a 1.5T system using a standardized pelvic protocol. Imaging included conventional sequences followed by functional sequences.Conventional MRI sequences...

Among the 60 patients included: Ovarian endometriomas: 28 (46.7%) Deep infiltrating endometriosis (DIE): 22 (36.7%) Superficial peritoneal implants: 10 (16.6%) The mean VAS pain score was 6.8 ± 1.9. Mean serum CA-125 level was 48.6 ± 21.3 U/mL. Diffusion Findings Mean ADC values were significantly lower in endometriotic lesions compared to normal myometrium: Endometriotic lesions: 0.92 ± 0.14 × 10⁻³ mm²/s Normal myometrium: 1.34 ± 0.18 × 10⁻³ mm²/s p < 0.001 Subgroup analysis demonstrated: DIE: 0.84 ± 0.11 × 10⁻³ mm²/s Ovarian endometriomas: 0.97...

Functional MRI techniques including DWI, IVIM, and BOLD imaging provide comprehensive assessment of tissue diffusion, microvascular perfusion, and oxygenation in endometriosis. Endometriotic lesions demonstrate restricted diffusion, increased perfusion fraction, and elevated R2* values, particularly in deep infiltrating disease.Quantitative imaging biomarkers correlate significantly with clinical severity and serum CA-125 levels. Multiparametric functional MRI significantly enhances diagnostic accuracy compared with conventional MRI.These findings support the integration of advanced functional MRI into routine pelvic imaging protocols for improved disease characterization, severity assessment, and potential therapeutic monitoring Personal information and conflict of interest F. Abubacker Sulaiman: Nothing to disclose R. Praveenkumar: Nothing to disclose M. Nivitha: Nothing to disclose S. Zainamb Begum: Nothing to disclose J. Lydia: Nothing to disclose A. Raashid Ibrahim: Nothing to disclose

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