A review of more than 2000 cases of site-specific pelvic endometriosis rates by MRI: a guide to minimizing under/overdiagnosis non-invasively

Azadeh Hajati, Omid Hajati
Insights into imaging · 2022 · vol. 13(1) , pp. 129 · doi:10.1186/s13244-022-01270-z · PMID:35939136 · PMC9360300 · W4290635952
review OA: gold CC0 ⤵ 6 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This MRI study of 2040 patients found pelvic endometriosis in 79.1%, most commonly involving uterosacral ligaments, to guide non-invasive diagnosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective cross-sectional review analyzed 2040 women (age 12–65) referred for suspected pelvic endometriosis, using contrast-enhanced transvaginal MRI interpreted independently by two expert radiologists with compartment-based reporting across 10 pelvic regions. Among these patients, 79.1% had at least one site of endometrioma or deep infiltrating endometriosis, with both ovarian endometrioma and DIE present in 78.2% of positive cases; isolated endometrioma occurred in 13.7% and isolated DIE in 8.1%, and uterosacral ligaments were the most common DIE site (73.8%). The study states limitations that include its single-institution, retrospective design and reliance on MRI-based site assessment without an explicit surgery-verified gold standard for all cases. This paper is centrally about endometriosis—large-scale MRI mapping of site-specific rates and co-existence patterns of endometrioma and deep infiltrating endometriosis.

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Abstract

OBJECTIVES: To statistically study the incidence of endometrioma and deep infiltrating endometriosis (DIE) in various anatomical sites and to illustrate the significance and potential implications for each site. Furthermore, to improve the knowledge of the community for a non-invasive diagnosis alternative to laparoscopy. METHODS: This study includes 2040 patients who had been referred with clinical evidence of pelvic endometriosis. These patients had been examined and undergone transvaginal sonography by the referring gynecologists. The imaging modality used to discover and locate various anatomical locations of involvement was MRI with contrast. Two radiologists with expertise in endometriosis separately assessed the patients' MRIs and highlighted the involved areas. RESULTS: In total, 79.1% were positive for either endometrioma or DIE. We detected both DIE and ovarian endometrioma in 78.2% of positive cases. Isolated endometrioma or DIE was present exclusively in 13.7% and 8.1% of patients, respectively. Uterosacral ligaments were detected as the most common (73.8%) site of DIE involvements and in 2.9% of cases were the sole affected location. Interestingly, very rare independent involvement of the genitourinary tract was seen in two patients. CONCLUSIONS: In this study, MRI was used to assess the likely involvement sites of endometrioma and DIE, as well as the frequency of incidences in various places and their relationships over a large dataset. Understanding the possibly involved sites, their statistics, and their co-existence can provide radiologists with a roadmap for non-invasive endometriosis diagnosis and treatment planning. These principles should hopefully assist reduce under- and overdiagnosis.

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Condition tags

endometriosisdie_deep_infiltratingendometrioma

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