Abstract
Endometriosis, a chronic condition that often starts in adolescence, can have a significant impact on quality of life due to symptoms of dysmenorrhea and pelvic pain. Although laparoscopy with direct visualization and pathologic correlation is the reference standard for the diagnosis of endometriosis, some authors have called for a greater emphasis on clinical diagnosis – including imaging. Magnetic resonance imaging (MRI) provides highly reproducible, large field of view, multiplanar, and multiparametric imaging of pelvic endometriosis and is well tolerated in adolescent patients. As such, pediatric radiologists need to be familiar with the manifestations of endometriosis on MRI and how these findings may differ from those seen in adult populations.
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DiVasta AD, Vitonis AF, Laufer MR, Missmer SA (2018) Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood. Am J Obstet Gynecol 218:324.e321-324.e311
(2018) ACOG Committee Opinion No. 760: dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol 132:e249-e258. https://doi.org/10.1097/AOG.0000000000002978
Greene R, Stratton P, Cleary SD et al (2009) Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril 91:32–39
Agarwal SK, Chapron C, Giudice LC et al (2019) Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 220:354.e351-354.e312
Shim JY, Laufer MR, King CR, Lee TTM, Einarsson JI, Tyson N (2024) Evaluation and management of endometriosis in the adolescent. Obstet Gynecol 143:44–51
Pascoal E, Wessels JM, Aas-Eng MK et al (2022) Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. Ultrasound Obstet Gynecol 60:309–327
Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10:261–275
Rousset P, Florin M, Bharwani N et al (2023) Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging 104:95–112
Tomassetti C, Johnson NP, Petrozza J et al (2021) An international terminology for endometriosis, 2021. J Minim Invasive Gynecol 28:1849–1859
American Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 67:817–821
Hirsch M, Dhillon-Smith R, Cutner AS et al (2020) The prevalence of endometriosis in adolescents with pelvic pain: a systematic review. J Pediatr Adolesc Gynecol 33:623–630
Smorgick N, As-Sanie S, Marsh CA et al (2014) Advanced stage endometriosis in adolescents and young women. J Pediatr Adolesc Gynecol 27:320–323
Millischer AE, Santulli P, Da Costa S et al (2023) Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril 119:626–633
Chapron C, Santulli P, Ziegler D et al (2012) Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod 27:702–711
Tong A, VanBuren WM, Chamié L et al (2020) Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol (NY) 45:1569–1586
Fiaschetti V, Crusco S, Meschini A et al (2012) Deeply infiltrating endometriosis: evaluation of retro-cervical space on MRI after vaginal opacification. Eur J Radiol 81:3638–3645
Brown MA, Mattrey RF, Stamato S, Sirlin CB (2005) MRI of the female pelvis using vaginal gel. AJR Am J Roentgenol 185:1221–1227
Kikuchi I, Kuwatsuru R, Yamazaki K et al (2014) Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration. Biomed Res Int 2014:437962
Chassang M, Novellas S, Bloch-Marcotte C et al (2010) Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis. Eur Radiol 20:1003–1010
Takeuchi H, Kuwatsuru R, Kitade M et al (2005) A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril 83:442–447
GlucaGen (Glucagon) [package insert]. 2018, Novo Nordisk: Bagsvaerd, Denmark
Sanagapalli S, Agnihotri K, Leong R, Corte CJ (2017) Antispasmodic drugs in colonoscopy: a review of their pharmacology, safety and efficacy in improving polyp detection and related outcomes. Therap Adv Gastroenterol 10:101–113
Coutinho A Jr, Bittencourt LK, Pires CE et al (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31:549–567
Jha P, Sakala M, Chamie LP et al (2020) Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY) 45:1552–1568
Colak C, Chamie LP, Youngner J et al (2024) MRI features of pelvic nerve involvement in endometriosis. Radiographics 44:e230106
Feldman MK, VanBuren WM, Barnard H et al (2020) Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care. Abdom Radiol (NY) 45:1608–1622
Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691
Sakala MD, Jha P, Tong A et al (2023) MR imaging of endometriosis of the adnexa. Magn Reson Imaging Clin N Am 31:121–135
Cox M, Gould SW, Podberesky DJ, Epelman M (2016) Magnetic resonance imaging of acquired disorders of the pediatric female pelvis other than neoplasm. Pediatr Radiol 46:806–817
Bourdon M, Santulli P, Marcellin L et al (2021) Adenomyosis: an update regarding its diagnosis and clinical features. J Gynecol Obstet Hum Reprod 50:102228
Leyendecker G, Bilgicyildirim A, Inacker M et al (2015) Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study Arch Gynecol Obstet 291:917–932
Maruyama S, Imanaka S, Nagayasu M et al (2020) Relationship between adenomyosis and endometriosis; different phenotypes of a single disease? Eur J Obstet Gynecol Reprod Biol 253:191–197
Exacoustos C, Lazzeri L, Martire FG et al (2022) Ultrasound findings of adenomyosis in adolescents: type and grade of the disease. J Minim Invasive Gynecol 29:291-299.e291
Martire FG, Lazzeri L, Conway F et al (2020) Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertil Steril 114:1049–1057
Zhang W, Sun H, Luo F (2017) The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation. Medicine (Baltimore) 96:e8287
Peyron N, Jacquemier E, Charlot M et al (2019) Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity. Eur Radiol 29:1144–1152
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AME: manuscript creation, review, and figure creation.
AT: manuscript review.
PS: illustration creation, manuscript review.
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The authors deny any conflicts of interest. Angela Tong received honorarium for speaking at a conference for Siemens Healthineers. Shailee V. Lala is the Assistant Editor of the journal Pediatric Radiology.
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El-Ali, A.M., Tong, A., Smereka, P. et al. MRI for endometriosis in adolescent patients. Pediatr Radiol 55, 24–35 (2025). https://doi.org/10.1007/s00247-024-06050-z
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DOI: https://doi.org/10.1007/s00247-024-06050-z