Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features

Benedetta Gui, Valentini AL, Anna Lia Valentini, Valeria Ninivaggi, Ninivaggi V, Marino M, Marzia Marino, Marta Iacobucci, Iacobucci M, Bonomo L, Lorenzo Bonomo
Abdominal imaging · 2014 · vol. 39(3) , pp. 622–632 · doi:10.1007/s00261-014-0091-3 · PMID:24557639 · W2001573283
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This review examines the anatomy, clinical features, and MR imaging findings of deep pelvic endometriosis specifically affecting the round ligaments of the uterus, an often-overlooked location.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This paper is a narrative review of deep infiltrating pelvic endometriosis with a specific focus on endometriosis involving the uterine round ligaments (RLUs). It summarizes embryology and anatomy of the RLUs, associated clinical characteristics, and describes MR imaging protocols, normal MR appearances, and the most common MR findings of RLU involvement, while noting that accurate preoperative assessment of lesion extension is important. A key limitation acknowledged by the review format is that it is not an original study with new cohort results, and it does not quantify diagnostic performance across settings. This paper is centrally about endometriosis — specifically deep pelvic endometriosis of the uterine round ligaments and how to detect it on MRI.

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Abstract

Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.
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Abstract

Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images. Similar content being viewed by others

References

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Pelvis Round Ligament of Uterus Round Ligament of Uterus Endometriosis Female Humans Magnetic Resonance Imaging Pelvis Round Ligament of Uterus

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