Extra-ovarian endometriosis: Usual, unusual imaging manifestations, pitfalls and problem-solving MR techniques

Genital / Reproductive system female, Obstetrics (Pregnancy / birth / postnatal period), Pelvis Authors: M. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP DOI: 10.1594/ecr2010/C-1255 Learning objectives To demonstrate imaging manifestations of extra-ovarian endometriosis, and to describe clues for the diagnosis and problem-solving MR techniques.

Endometriosis is a common disease of women in their reproductive era. Endometriosis usually affects ovaries as endometriomas (Fig. 1), however, endometriosis may involve various extra-ovarian organs such as peritoneum, ligaments, lymphnodes, ureter, bladder, intestine, vagina, retroperitoneal region, abdominal wall, subcutaneous region, and thorax. Extra-ovarian endometriosis may mimic malignant tumors, and should be differentiated to avoid excessive surgical procedure. We present characteristic imaging manifestations, clinical features, and pitfalls of extra-ovarian endometriosis, and problem-solving MR techniques for the diagnosis. [Problem-solving MR techniques] -Fat-saturated T1-weighted images Because the... Imaging findings OR Procedure details Endometriosis is a condition characterized by the presence of ectopic functioning endometrial tissue outside the uterus. Extra-ovarian endometriosis may also cause cyclic repeated bleeding, and may often induce reactive fibrosis. Extra-ovarian endometriosis may appear as endometrioma-like hemorrhagic cyst, or inhomogeneous intense solid masses reflecting the admixture of endometrial tissue, fibrosis, and hemorrhage. Imaging manifestations of endometriosis may be influenced by various physiologic state of the patient such as the cycle of menstruation, menopause, pregnancy and exogenous hormonal stimulation. At the menstruation ectopic endometrium may bleed,...

By using problem-solving MR techniques, extra-ovarian endometriosis should be differentiated from malignant tumors at various organs. Personal Information Mayumi Takeuchi, MD, PhD [email protected] Department of Radiology, University of Tokushima 3-18-15, Kuramoto-cho, Tokushima, JAPAN

1) Kurman RJ ed. Blaustein's Pathologiy of the Female Genital Tract 4th ed. New York: Springer-Verlag, 1994 2) Gougoutas CA. Pelvic endometriosis: various manifestations and MR imaging findings. AJR 2000; 175:353-8. 3) Sugimura K. Pelvic endometriosis: detection and diagnosis with chemical shift MR imaging. Radiology 1993; 188:435-8. 4) Siegelman ES. Solid pelvic masses caused by endometriosis: MR imaging features. AJR 1994; 163:357-61. 5) Kurachi H. Imaging of peritoneal pseudocyst: value of MR imaging compared with sonography and CT. AJR 1993; 160:589-91. 6) Takeuchi M. A...