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Type:
Educational Exhibit
Keywords:
Tissue characterisation, Pathology, Diagnostic procedure, MR, Management, Genital / Reproductive system female, Abdomen
Authors:
R. M. Viguer Benavent, G. Montoliu Fornas, P. Rudenko, M. �. Sánchez Fuster; Valencia/ES
DOI:
10.1594/ecr2015/C-1364
Background
Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus.
Depending on its location,
three forms of pelvic endometriosis are defined:
- Endometrioma.
Endometriosis located in the ovarian,
with characteristic cyst formation due to cyclical bleeding.
Fig. 1: Hysterectomized patient. Bilateral ovarian endometriomas. Multiple hyperintense cysts in T1 fat-suppressed image (T1 FS), with intermediate-low signal in T2w image
References: Department of Radiology. La Fe University and Polytechnic Hospital. Valencia/ES
- Superficial lesions or noninvasive peritoneal implants.
- Deep pelvic endometriosis or infiltrating endometriosis,
subperitoneal invasion greater than 5mm.
The ectopic endometrial tissue responds to hormonal stimuli causing variable degrees of bleeding and symptoms depending on its grade and location.
While superficial lesions and endometriomas are often asymptomatic,
deep pelvic endometriosis is associated with increased frequency to a wide range of manifestations: Dysmenorrhea,
dyspareunia,
pelvic pain,
urinary or/and gastrointestinal symptoms and infertility.
Ovarian and peritoneal endometriosis often respond to hormonal treatment.
The treatment of deep pelvic endometriosis is more complex and usually requires surgical resection of lesions,
including partial resection of bladder or bowel segments when they are affected.
Proper diagnosis of location and extent facilitates planning and performing surgery.
Its detection and extent with physical examination and transvaginal US is limited.
Exploratory laparoscopy defined as "gold standard" technique is also limited in evaluating subperitoneal space and through adherences,
which are frequent in this entity,
and it is an invasive technique.
MRI allows detection of deep pelvic endometriosis and establish a map of the disease useful in surgical planning.