DWI in the assessment of deep pelvic endometriosis

Genital / Reproductive system female, Obstetrics (Pregnancy / birth / postnatal period), Pelvis Authors: P. Paolantonio1, R. Ferrari2, M. Rengo2, F. Vecchietti2, P. Lucchesi2, A. Laghi2; 1Rome/IT, 2Latina/IT DOI: 10.1594/ecr2010/C-1287 Purpose To establish the appearance of deep pelvic endometriosis at diffusion weighted imaging (DWI).

and Materials We included 35 patients with suspected deep pelvic endometriosis scheduled for laparoscopy. Each subject underwent MR examination on a 1.5T MR scanner (HDe; GE). MR protocol included TSE T2W acquired on sagittal and axial plane. SE-EPI-DWI sequence was acquired on axial plane (TR/TE 3000/88; matrix: 128x128; Nex 5; slice thickness 6mm; b-factor 0/1000 sec/mm2). Each patient underwent laparoscopy within 2 weeks from MR examination. DW Images were reviewed by two radiologists in consensus in comparison with conventional TSE T2W images and laparoscopic results. Signal intensity...

Final diagnosis was deep pelvic endometriosis in 29 patients. Deep pelvic endometriosis showed low signal intensity on TSE T2W images and high signal intensity on heavy DW images in 24 patients (82.7%). In two cases (6.8%) pelvic endometriosis showed high signal intensity on heavy-DWI and was not recognizable on conventional pulse sequence. In one patient pelvic endometriosis was visible on TSE T2W imaging and not recognizable on DWI.

In the majority of cases of our series deep pelvic endometriosis showed high signal intensity on heavy DWI. This finding is probably related to restriction of water diffusibility within fibrotic tissue surrounding ectopic endometrium. DWI has a potential role in increasing sensitivity of MRI in the identification of deep pelvic endometriosis.

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