Multidisciplinary approach of endometriosis: do’s and dont’s

Pathology, Education, Comparative studies, MR, Genital / Reproductive system female Authors: A. Guerra, A. Setubal, F. Osorio, F. Faustino, D. Vilarinho, V. Mascarenhas, A. Gaspar, H. M. R. Marques; Lisbon/PT DOI: 10.1594/ecr2013/C-2024 Learning objectives To correlate the manifestations of endometriosis with Magnetic Resonance Imaging (MRI) and Laparoscopy (LAP) as well as to explain how to work on a multidisciplinary basis.

Endometriosis affects approximately 12% of all reproductive-age women, leading to different types of pain, complications related to the spread of the disease and finally to infertility. Endometriosis is defined as the presence of functional endometrial glands and stroma outside the uterine cavity (1). This functional tissue responds to hormonal stimulation with various degrees of pelvic haemorrhage resulting in bleeding inflammatory response at adjacent tissues (2). See(FIG 1): The pathophysiology of the endometriotic lesions These two phenomena will cause two types of tissue changes: endometrial glands... Imaging findings OR Procedure details PELVIC ENDOMETRIOSIS The most commonly affected sites by pelvic endometriosis are the pelvic organs and peritoneum (4). To understand the different LAP/MRI aspects of pelvic endometriosis we classified the endometriosis in three types: A) Superficial peritoneal lesions B) Ovarian endometrioma C) Deep or solid infiltrating endometriosis. A) Superficial Peritoneal lesions: At laparoscopy the endometriosis typically appears as superficial “powder- burn” or “gunshot” lesions on the ovaries, serosal surfaces and peritoneum – black, dark-brown or blueish puckered lesions, nodules or small cysts containing old haemorrhage surrounded...

MRI allows characterization of endometriomas, extraovarian endometriotic implants and associated inflammation and fibrosis (all severe deep endometriosis) with a very good correlation with laparoscopy findings. MRI provides a road map that allows the surgeon to establish a surgical strategy to minimize the length and invasiveness of the laparoscopy providing an optimal guide to identify and treat all extra peritoneum lesions in severe endometriosis.

1) MR Imaging in Deep Pelvic endometriosis: A Pictorial Essay. Coutinho, Antônio; Kayat Bittencourt, Leonardo; E Pires, Cíntia; Junqueira, Flávia; Lima, Cláudio Márcio; Coutinho, Elisa; Domingues, Marisa ; Domingues, Romeu ; Marchiori, Edson. Radiographics 2011; 31: 549-567. 2) Findings of Pelvic endometriosis at transvaginal US, MR Imaging and Laparoscopy. Chamié ,Luciana; Blasbald Roberto; Alves Pereira, Ricardo; Warmbrand, Gisele; Serafini, Paulo Cesar. Radiographics 2011; E77-E100. 3) Deep pelvic Endometriosis: MR Imaging. Marcal, Leonardo; Nothaf, M. Angela; Coelho, Francisco; Choi, Haesun. Abdominal Imaging 2010; 35:708-715. 4) ESHRE... Personal Information Adalgisa Guerra, Imagiology Department, Hospital da Luz, Lisbon, Portugal. [email protected]