MRI of endometriosis: A comprehensive review

Endometriosis is a complex disease process with a heterogeneous phenotype that ranges from superficial implants to deep infiltrative disease of various organs of the pelvis and beyond. The imaging features may be highly varied, from classic ovarian endometriomas to DIE of the bowel, bladder, ureters, uterus, pelvic ligaments, abdominal wall and pelvic nerves. The radiographic appearance depends on the acuity or chronicity of repeat hemorrhage and on the degree of fibrosis. Although endometriosis is a benign disease, it rarely undergoes malignant degeneration. The role of MRI in the diagnosis and management of endometriosis is gaining recognition and becoming increasingly prevalent.

- Bennett G, Slywotzky C, Cantera M. Unusual manifestations and complications of endometriosis–spectrum of imaging findings: pictorial review. AJR Am J Roent. 2010;194. - Agarwal N, Subramanian A. Endometriosis - morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2((1)):1-9. - Coutinho A, Bittencourt L, Pires C. MR imaging in deep pelvic endometriosis: a pictorial essay. RadioGraphics. 2011;31((2)):549-567. - Hsu A, Khachikyan I, Stratton P. Invasive and noninvasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010;53((2)):413-419. - Togashi K, Nishimura K, Kimura I. Endometrial cysts: diagnosis with MR imaging. Radiology. 1991;180((1)):73-78. - Theodoridis T, Zepiridis L, Mikos T. Comparison of diagnostic accuracy of transvaginal ultrasound with laparoscopy in the management of patients with adnexal masses. Arch Gynecol Obstet. 2009;280((5)):767-773. - Corwin M, Gerscovich E, Lamba R. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 2014;271((1)):126-132. - Outwater E, Schiebler M, Owen R. Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study. Radiology. 1993;186((2)):489-494. - Siegelman E, Oliver E. MR imaging of endometriosis: ten imaging pearls. RadioGraphics. 2012;32((6)):1675-1691. - Tanaka Y, Okada S, Yagi T. MRI of endometriotic cysts in association with ovarian carcinoma. AJR Am J Roentgenol. 2010;194((2)):355-361. - Gougoutas C, Siegelman E, Hunt J. Pelvic endometriosis: various manifestations and MR imaging findings. AJR Am J Roentgenol. 2000;175((2)):353-358. - Izza Rozalli F, Rahmat K, Fadzli F. Decidualized ovarian endometrioma in a pregnant woman mimicking ovarian malignancy: magnetic resonance imaging and ultrasonographic findings. Iran J Radiol. 2015;12((4)). - Takeuchi M, Matsuzaki K, Uehara H. Malignant transformation of pelvic endometriosis: MR imaging findings and pathologic correlation. RadioGraphics. 2006;26((2)):407-417. - Chaudhry S, Glanc P, Salem S. Detection and differential diagnosis of suspected malignant transformation of an endometrioma during pregnancy. BMJ Case Rep. 2013;2013. - Dallaudiere B, Salut C, Hummel V. MRI atlas of ectopic endometriosis. Diagn Interv Imaging. 2013;94((3)):263-280. - Reinhold C, Tafazoli F, Mehio A. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. RadioGraphics. 1999;19(1):) Spec No:S147-160. - Leyendecker G, Bilgicyildirim A, Inacker M. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet. 2015;291((4)):917-932. - McDermott S, Oei T, Iyer V. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. RadioGraphics. 2012;32((3)):845-863. Citation MRI of endometriosis: A comprehensive review. Applied Radiology. 2019;48(5):6-12. doi:10.37549/AR2603. .