Differentiation of Endometriomas from Hemorrhagic Cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements

Roxana-Adelina Lupean, Paul-Andrei Ștefan, Andrei Lebovici, Csaba Csutak, Csutak C, Rusu GM, Georgeta Mihaela Rusu, Mihaela Rusu, Mihu CM, Carmen Mihaela Mihu
Current medical imaging · 2020 · vol. 17(4) , pp. 524–531 · doi:10.2174/1573405616999201027211132 · PMID:33115394 · W3096258761
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Quantitative T1-T2 signal intensity measurements on MRI effectively differentiate endometriomas from hemorrhagic cysts, outperforming subjective "T2 shading" evaluation, while diffusion parameters did not distinguish between the two.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-11 · read from full text ⓘ

This retrospective study compared MRI signal intensity–based methods for differentiating ovarian endometriomas (n=28) from functional hemorrhagic cysts (FHCs; n=18) in 46 patients. The authors evaluated the “T2 shading” sign both subjectively and quantitatively by measuring the T1–T2 signal intensity difference and calculating the percentage signal decrease from T1- to T2-weighted sequences, and they also assessed ADC and diffusion-weighted imaging signal intensities at b50, b400, and b800. Quantitative “T2 shading” measures had similar high efficiency (sensitivity 100%, specificity ~82%, AUC >0.86) and outperformed subjective “T2 shading,” while ADC and DWI measurements did not significantly distinguish the groups (all P>0.49). The study was limited by its retrospective design and small sample size, and it explicitly reports only statistical comparisons rather than external validation. This paper is centrally about endometriosis — it focuses on MRI differentiation of endometriomas (a manifestation of ovarian endometriosis) from functional hemorrhagic cysts.

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Abstract

Background: Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter. Objective: This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs. Methods: Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The “T2 shading” sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b 50 , b 400 , and b 800 ), were compared between groups by using the Mann–Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated. Results: The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P0.86), outperforming the classic subjective evaluation of the “T2 shading” sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities. Conclusion: The quantitative analysis and interpretation of the “T2 shading” sign can significantly improve the differential diagnosis between endometriomas and FHCs.
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Abstract

Background: Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter.

Objective

This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs.

Methods

Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The “T2 shading” sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b50, b400, and b800), were compared between groups by using the Mann–Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated.

Results

The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P0.86), outperforming the classic subjective evaluation of the “T2 shading” sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities.

Conclusion

The quantitative analysis and interpretation of the “T2 shading” sign can significantly improve the differential diagnosis between endometriomas and FHCs.

Keywords

Apparent Diffusion Coefficient (ADC), diffusion-weighted imaging, endometrioma, endometriosis, Magnetic Resonance Imaging (MRI), ovarian cyst. [http://dx.doi.org/10.1007/s00261-015-0465-1] [PMID: 26063071] [http://dx.doi.org/10.1177/0284185115609805] [PMID: 26543051] [http://dx.doi.org/10.1016/j.mefs.2015.08.001] [http://dx.doi.org/10.7863/jum.2002.21.8.879] [PMID: 12164573] [http://dx.doi.org/10.1371/journal.pone.0149465] [PMID: 26907919] [http://dx.doi.org/10.1007/s13244-015-0455-4] [PMID: 26671276] [http://dx.doi.org/10.1007/s00330-005-2882-y] [PMID: 16155722] [http://dx.doi.org/10.1148/radiol.2241010361] [PMID: 12091683] [http://dx.doi.org/10.1148/radiology.212.1.r99jl455] [PMID: 10405714] [http://dx.doi.org/10.1148/radiology.180.1.2052726] [PMID: 2052726] [http://dx.doi.org/10.1148/radiol.13131394] [PMID: 24475842] [http://dx.doi.org/10.1148/radiology.186.2.8421756] [PMID: 8421756] [http://dx.doi.org/10.1002/jmri.20640] [PMID: 16791858] [http://dx.doi.org/10.1016/j.clinimag.2015.05.003] [PMID: 25986161] [http://dx.doi.org/10.1148/radiol.10100213] [PMID: 20505067] [http://dx.doi.org/10.1097/OGX.0000000000000157] [PMID: 25769433] [http://dx.doi.org/10.1159/000334002] [PMID: 8842166] [http://dx.doi.org/10.1177/1933719115570907] [PMID: 25676579] [http://dx.doi.org/10.1148/radiology.189.1.8372185] [PMID: 8372185] [http://dx.doi.org/10.1097/00004728-199407000-00019] [PMID: 8040448] [http://dx.doi.org/10.1097/00001703-200312000-00011] [PMID: 14624220] [http://dx.doi.org/10.1148/radiographics.21.1.g01ja14193] [http://dx.doi.org/10.2214/AJR.06.1403] [PMID: 17515386]

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Condition tags

endometriosis

MeSH descriptors

Cysts Endometriosis Endometriosis Ovarian Neoplasms Female Humans Magnetic Resonance Spectroscopy Retrospective Studies

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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