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Rectouterine and torus uterinus deep infiltrating endometriosis causing uterine retroversion. a Sagittal and b axial T2-weighted images show a stromal/fibrotic plaque of the posterior uterus (white arrowhead) with adhesions extending from the torus uterinus and uterus through the rectouterine space (white arrows). Bowel-invasive endometriosis of the rectum is also present with a “mushroom cap” lesion (black arrowhead). B bladder, C cervix, U uterus, R rectum
Source publication
Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of...
Citations
... Two consensus MRI lexicons from the Society of Abdominal Radiology (SAR) (Jha et al., 2020) and from the French Society of Women's Imaging (SIFEM) were published recently. They both describe the different locations of DE according to a compartment-based approach of the pelvis. ...
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on a review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling and planning of surgical treatment strategies.
... Two consensus MRI lexicons from the Society of Abdominal Radiology (SAR) 65 and from the French Society of Women's Imaging (SIFEM) 66 were published recently. They both describe the different locations of DE according to a compartment-based approach of the pelvis. ...
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers, and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling, and planning of surgical treatment strategies.
... Two consensus MRI lexicons from the Society of Abdominal Radiology (SAR) 65 and from the French Society of Women's Imaging (SIFEM) 66 were published recently. They both describe the different locations of DE according to a compartment-based approach of the pelvis. ...
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence‐based and clinically relevant statements on the use of imaging techniques for non‐invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies
... Two consensus MRI lexicons from the Society of Abdominal Radiology (SAR) (Jha et al., 2020) and from the French Society of Women's Imaging (SIFEM) (Rousset et al., 2023) were published recently. They both describe the different locations of DE according to a compartment-based approach of the pelvis. ...
... Two consensus MRI lexicons from the Society of Abdominal Radiology (SAR) (Jha et al., 2020) and from the French Society of Women's Imaging (SIFEM) (Rousset et al., 2023) were published recently. They both describe the different locations of DE according to a compartment-based approach of the pelvis. ...
... Clinically, "adenomyosis externa" at the rectosigmoid, Douglas' pouch, uterosacral ligament, rectovaginal septum, vesico-uterine pouch, etc. is considered deep endometriosis [28]. Deep endometriosis of the peritoneum, ligaments, or organs may cause solid masses exhibiting T2-low signal intensity and intense contrast enhancement reflecting fibromuscular hyperplasia around sparse ectopic endometrial glands (Fig. 3) [29][30][31][32][33][34][35]. The cyclic hemorrhage of the ectopic endometrial tissue may cause a variable inflammatory response and fibrous reaction. ...
... The cyclic hemorrhage of the ectopic endometrial tissue may cause a variable inflammatory response and fibrous reaction. The endometrial tissue infiltrates the adjacent fibromuscular tissue and induces smooth muscle proliferation and fibrous reaction, resulting in the formation of T2-low signal intensity solid masses as "adenomyosis extern" with irregular, indistinct, or stellate margins, or T2-low signal intensity soft tissue thickening [29][30][31][32][33][34][35]. T1-high signal intensity hemorrhagic foci and SWI-signal voids due to hemosiderin deposits may be observed. ...
Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.
... Лишь небольшой процент из них диагностируется и получает соответствующее лечение. Глубокий инфильтративный эндометриоз составляет около 15-30 % всех случаев эндометриоза [4,5]. ...
Objective . To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods . We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p<0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P<0.001). Conclusion . Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.
... It affects approximately 10% of reproductive-age women and up to 50% of infertile women [1] . In women with chronic pelvic pain, some sources cite up to 90% incidence of endometriosis [2] . However, there is often a delay in diagnosing endometriosis, highlighting the need for improved recognition and early intervention. ...
... There are 3 recognized types of endometriosis: superficial peritoneal endometriosis ( < 5 mm), deep infiltrative endometriosis, and ovarian endometriomas, which can coexist [2] . Ovarian involvement is the most common site, occurring in approximately 20%-40% of cases, with the majority of endometriomas measuring less than 6 cm in diameter. ...
Endometriosis is a chronic inflammatory gynecologic disorder characterized by the presence of endometrial-like tissue, including endometrial glands and stroma, outside of the uterine cavity. It is a prevalent condition worldwide, affecting approximately 10% of reproductive-age women and up to 50% of infertile women. Endometriosis manifests in three ways: superficial peritoneal endometriosis, deep infiltrative endometriosis, and ovarian endometriomas, with the possibility of coexistence among them. The disease presents with a range of symptoms, including chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Additionally, patients may experience nongynecological symptoms such as dyschezia, dysuria, hematuria, flank pain, and fatigue, among others. The ovaries are the most affected site in endometriosis, typically with cysts measuring less than 6 cm in diameter. Therefore, even in the presence of a large ovarian cyst or in asymptomatic patients, the consideration of an endometrial cyst should not be overlooked.
... -Endometrioma: Endometriomas are typically larger and demonstrate homogeneous T1-weighted hyperintensity and variable T2-weighted hypointensity (known as "T2 shading"), with a thin enhancing wall. Endometriomas result from chronic repetitive bleeding over multiple menstrual cycles, which is not observed with a corpus luteum [18][19][20]. ...
In 2021, the American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee developed a risk stratification system and lexicon for assessing adnexal lesions using MRI. Like the BI-RADS classification, O-RADS MRI provides a standardized language for communication between radiologists and clinicians. It is essential for radiologists to be familiar with the O-RADS algorithmic approach to avoid misclassifications. Training, like that offered by International Ovarian Tumor Analysis (IOTA), is essential to ensure accurate and consistent application of the O-RADS MRI system. Tools such as the O-RADS MRI calculator aim to ensure an algorithmic approach. This review highlights the key teaching points, pearls, and pitfalls when using the O-RADS MRI risk stratification system.
Critical relevance statement This article highlights the pearls and pitfalls of using the O-RADS MRI scoring system in clinical practice.
Key points
• Solid tissue is described as displaying post- contrast enhancement.
• Endosalpingeal folds, fimbriated end of the tube, smooth wall, or septa are not solid tissue.
• Low-risk TIC has no shoulder or plateau. An intermediate-risk TIC has a shoulder and plateau, though the shoulder is less steep compared to outer myometrium.
Graphical Abstract
... The right round ligament is often more affected than the left due to retrograde implantation of endometrial tissue in the peritoneal cavity. In cases of a large lesion, it is frequently associated with external adenomyosis [15]. More rarely, DIE involves the extra-pelvic segment within the canal of Nuck [16]. ...
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results.
Critical relevance statement
MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars.
Key points
• MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.
• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.
• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.
• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
Graphical Abstract
