Shining light in a dark landscape: MRI evaluation of unusual endometriosis localization.

Tissue characterisation, Imaging sequences, MR, Pelvis, Genital / Reproductive system female, Abdomen Authors: B. Gui, A. L. Valentini, V. Ninivaggi, M. Miccò, M. Giuliani, L. Bonomo; Rome/IT DOI: 10.1594/ecr2015/C-1264 Learning objectives To help radiologists in correctly identifying and characterizing unusual endometriosis localization on magnetic resonance images (MRI).

Endometriosis is a systemic disease that is defined as presence of endometrial glands and stroma outside the uterine cavity that affects approximately 10 to 20% of women in their reproductive–age [1] The lesions are characterized by intra-lesional recurrent bleeding during menses because of the hormonal responsiveness of ectopic endometrial tissue with resulting fibrosis. Typical symptoms are cyclic or chronic pelvic pain, dysmenorrhea, dyspareunia, pain during defecation or urinating. Unusual endometriosis localizations may be associated with more specific symptoms depending on the site of the localization.... Findings and procedure details The MRI signal of hemorrhagic lesions could be various and is influenced by the age of hemoglobin. MRI should be performed after the 8th day from the menstruation because of the blood degradation products that show active endometriosis localizations as very bright lesions on T1-weighted images [5]. The use of fat saturation is recommended. Chemically frequency-selective fat saturation suppresses the high signal intensity of fat tissue, improving the dynamic range of T1-weighted images and enhancing differences among non-fat T1-weighted hyperintense structures. That’s why it magnifies...

Radiologists should consider this wide range of locations in patients with clinical suspect of endometriosis, because the correct diagnosis is extremely helpful for a correct treatment strategy. Treatment of endometriosis can be pharmacological or surgical. When surgery is indicated a complete excision of all lesions is recommended and a correct interpretation of MRIcould improve diagnosis and complete eradication with significant quality of life improvement for patients. Personal information Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Largo Agostino Gemelli 8, Rome, Italy [email protected]

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