Imaging of Endometriosis (Case-based approach) | Radiology Board Review Case
Pathophysiology of endometriosis
- Functional endometrial glands OUTSIDE the uterus.
- Reproductive age group.
- Chronic pain and infertility.
- Potential mechanisms
- Types
- Superficial
- Ovarian
- Deep pelvic endometriosis
Ultrasound features of endometriosis
- Homogeneous, hypoechoic focal lesion.
- Can be unilocular or multilocular
- Low-level internal echoes.
- Echogenic wall foci – Best single predictor.
- No vascularity.
How to differentiate hemorrhagic cyst from endometriosis?
Features of hemorrhagic cyst:
- Acute history
- Evolve into more complex appearing cysts.
- Fibrin strands are thinner than septa seen in endometriomas
- Absent echogenic wall foci
- Resolves in 4-6 weeks.
MR imaging of endometriosis
- Include T1 fat-saturated sequence.
- T2 shading: Cyst that is hyperintense on a T1-weighted image becomes hypointense on a T2-weighted image.
- Reflects the chronic nature of an endometrioma and helps differentiate it from other blood-containing lesions.
- Deep pelvic endometriosis
- Differentials: Hemorrhagic cyst, dermoid cyst, mucinous carcinoma.
- Watch the video for detailed PACS based case images.
MRI imaging pearls for Endometriosis
- Include T1 fat-sat sequence in MRI female pelvis.
- Multiple T1 hyperintense ovarian lesions = Endometriomas.
- Low Signal Intensity of Adnexal Masses on STIR MR Images Is Not Specific for Mature Cystic Teratoma and Does Not Exclude Endometrioma
- Benign Endometriomas Show Restricted Diffusion.
- Hematosalpinx Should Be Considered Specific for Pelvic Endometriosis
- Obstruction of Antegrade Menstrual Flow Increases the Risk for Endometriosis.
- Endometriomas Can Transform into Clear Cell or Endometrioid Epithelial Ovarian Carcinomas -Development of enhancing mural nodules.
- Solid Fibrotic Masses of Endometriosis Are Common and Easily Overlooked -Uterosacral Ligaments, rectovaginal pouch, bladder
- Solid Invasive Endometriosis of the Posterior Uterus Can Mimic Posterior Segmental Adenomyosis.
- Decidualized Endometriosis May Mimic Ovarian Malignancy in Pregnant Women – Vascular mural nodules
Reference and further reading
To attend live, join our Telegram group to get regular updates for these webinars:
More Radiology videos:
