Pelvic endometriosis: An MRI guide for practicing radiologist

Not applicable, Inflammation, Diagnostic procedure, MR, Genital / Reproductive system female, Emergency, Genitourinary Authors: C. Kakkar1, K. Saggar2, A. Ahluwalia3, K. Mittal3; 1Ludhiana, Punjab/IN, 2LUDHIANA, PU/IN, 3Ludhiana/IN DOI: 10.26044/ecr2020/C-04812 Learning objectives Highlight the role of MR imaging in the assessment of pelvic endometriosis. Understand the importance of optimal protocols for assessment. Discuss the imaging approach of assessment of pelvic endometriosis and its complications on MRI.

Endometriosis is defined as functional endometrial glands and stroma outside of uterine cavity and myometrium, these ectopic glands respond to hormonal stimuli and depending on the location have varying symptomatology. Classification Superficial endometriosis:Asymptomatic and occult on imaging, usually less than 5 mm in size, diagnosed on laparoscopy (Fig 1) Endometriomas: Ovarian (Chocolate cysts). Deep infiltrating: Involves peritoneal attachments, ligaments and pelvic viscera. (Fig.2 and 3). Clinical symptoms The disease affects approximately 10% of the female population in the reproductive age group and may remain asymptomatic.... Findings and procedure details Compartmental Anatomy (Fig.9) Visceral involvementcan vary from adhesions to frank infiltration. Adhesions manifest as T2 hypointense spiculated bands which arrange in confluent angles resulting in tethering and angulations of the visceral organs (Fig.10 and 11). Signs of adhesions Posteriorly displaced and adherent ovaries (Kissing ovaries sign, Fig12,13) Angulated and retroflexed uterus (Fig.14,15) Angulated Rectosigmoid Elevation of the posterior fornix (Fig.14,15) Loculated ascites Hydrosalpinx. Genitourinary and anterior compartment involvement Adhesions (Fig 15) or implants (Fig.16) can lead to anteflexion of the uterus. Urinary bladder:Mostcommon location (Fig.16),...

Endometriosis should be looked for in all females presenting with chronic pelvic pain and infertility as the changes can be very subtle leading to delayed diagnosis. Ultrasound remains the first line of investigation, however, deep pelvic endometriosis may not be optimally assessed MRI is an excellent modality for assessment of deep pelvic endometriosis especially the fibrotic disease. MRI serves as a road map for management. The compartmental approach should be used and sites like cul de sac, torus uterinus, pelvic ligaments should be seen when... Personal information and conflict of interest C. Kakkar; Ludhiana, Punjab/IN - nothing to disclose K. Saggar; Ludhiana, PU/IN - nothing to disclose A. Ahluwalia; Ludhiana/IN - nothing to disclose K. Mittal; Ludhiana/IN - nothing to disclose

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