The Role of MRI in Deep Infiltrating Endometriosis

Genital / Reproductive system female, MR, Imaging sequences, Hyperplasia / Hypertrophy Authors: O. Fatima Zahra, Y. Sijlamassi, F. El Oualladi, C. C. Mountassir, L. Mohamed, G. Lembarki, M. Sabiri, S. Lezar DOI: 10.26044/ecr2026/C-21313 Learning objectives To illustrate the pivotal role of magnetic resonance imaging (MRI) in the diagnosis, mapping, and preoperative assessment of deep infiltrating endometriosis (DIE). This poster aims to describe optimized MRI protocols, characteristic imaging findings, and a compartment-based approach that improves diagnostic accuracy and surgical planning.

Deep infiltrating endometriosis is defined as endometriotic lesions infiltrating more than 5 mm beneath the peritoneal surface. DIE commonly involves the posterior compartment, including the uterosacral ligaments, rectovaginal septum, torus uterinus, bowel, bladder, and ureters.MRI is a second-line imaging modality after ultrasound, particularly indicated in complex cases, posterior compartment disease, multifocal involvement, or when surgery is planned. MRI offers a panoramic, reproducible, and operator-independent assessment of pelvic anatomy and disease extent. Findings and procedure details MRI Technique and ProtocolMRI is performed using a high-resolution pelvic protocol. Optimal patient preparation includes moderate bladder filling and, when available, the use of antiperistaltic agents to reduce bowel motion. The recommended protocol relies primarily on multiplanar high-resolution T2-weighted imaging, complemented by T1-weighted sequences with and without fat suppression to identify hemorrhagic components. Axial oblique T2-weighted images oriented along the uterosacral ligaments are particularly useful for posterior compartment assessment. Diffusion-weighted imaging has a limited but complementary role, while gadolinium-based contrast administration is not routinely required...

MRI plays a pivotal role in the comprehensive evaluation of deep infiltrating endometriosis. Through a structured, compartment-based approach and optimized imaging protocol, MRI provides essential information for diagnosis, surgical planning, and patient management, complementing ultrasound and clinical findings. Personal information and conflict of interest O. Fatima Zahra: Nothing to disclose Y. Sijlamassi: Nothing to disclose F. El Oualladi: Nothing to disclose C. Mountassir: Nothing to disclose L. Mohamed: Nothing to disclose G. Lembarki: Nothing to disclose M. Sabiri: Nothing to disclose S. Lezar: Nothing to disclose

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