Comprehensive Review: Various Clinical and Radiologic Manifestations of Endometriosis

Genital / Reproductive system female, MR, Ultrasound, CT, Decision analysis, Imaging sequences, Education and training, Tissue characterisation Authors: B. H. Han, S. B. Park; Seoul/KR DOI: 10.1594/ecr2014/C-1322 Learning objectives Learning Objectives: 1. Describe the various clinical and imaging manifestations of endometriosis. 2. Identify which imaging features are more specific for endometriosis. 3. Discuss MR strategies for identification and characterization of endometriosis. 4. Identify unusual imaging features and involving sites.

Endometriosis is an important gynecologic disorder primarily affecting women during their reproductive years, and defined as functional endometrium located outside the uterus. The clinical manifestations may provide only limited information which often overlaps that of other diseases, and are protean, from asymptomatic to the disabling chronic pelvic pain. The three hallmarks of endometriosis are peritoneal endometrial implants inperitoneal cavity, endometriomas(endometriotic cysts)in ovary, and adhesions. Pathogenesis: Three theories of histogenesis have been proposed: (a) metastatic theory (retrograde menstrual implantation, vascular and lymphatic spread, and intraoperative implantation),... Findings and procedure details In this exhibit, we demonstrate the usual and unusual manifestations of endometriosis. Usual manifestations include radiologic diagnostic strategies according modalities and clinical issues such as adhesion, malignant transformation, deep pelvic endometriosis, rupture, decidualized endometriosis, associated with uterine anomaly, and associated with adenomyosis. Unusual manifestations include gastrointestinal tract (rectosigmoid colon, appendix), genitourinary tract (bladder, ureter), chest, subcutaneous and muscular lesion (abdominal wall, perineum) and vagina. We also discuss possible differential point from various mimicking ovarian cystic lesions such as hemorrhagic cyst, mucinous tumor.

The major teaching points of this exhibit are: 1. The imaging characteristics of endometriosis vary widely, with masses ranging from cystic to solid and complex, which depend on the hormonal response of the ectopic tissue during the menstrual cycle. 2. Familiarity with the clinical setting and imaging feature of both usual and unusual endometriosis as depicted with US, CT, and MR will facilitate prompt and accurate diagnosis and treatment. Personal information Byoung Hee Han, MD1, Sung Bin Park, MD2 1Department of Radiology, Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul, 100-380, Korea 2Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea

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