Learning objectives
To learn how endometriosis can affect the female body
To recognise the disease patterns of endometriosis- common appearances and radiological pitfalls- especially in non-gynaecological sites.
To understand that endometriosis can lead to fibrosis and scarring- and the longer term sequelae of this including pain,
infertility and increased risk of malignancy.
To learn techniques to improve the identification of endometriosis in pre and post surgical patients.
Background
Endometriosis occurs when functional ectopic endometrial tissue is found elsewhere in the body,
usually in the pelvis around the uterus,
ovaries and fallopian tubes.The ectopic tissue issensitive to hormones and leads to bleeding,
inflammation and fibrosis and longer term sequelae.
It is a common cause of pelvic pain and infertility and affects as many as 10% of premenopausal women,
with potential devastating effects (1).
It takes,
on average,
7.5 years for a woman to be diagnosed with endometriosis (2).
Radiologists should be familiar with various...
Findings and procedure details
A pictorial MRI pelvis 'journey' will demonstrate the early and late appearances of endometriosis and its commonly associated complications.
Cases illustrate the typical appearances followed by the malignant effects it can cause secondary to scarring and fibrosis; premalignant and malignant ovarian lesions as well as complications following repeated operations.
Ultrasound is the first-line imaging technique for the evaluation of endometriosis.
It is usually limited to the identification of endometriosis affecting the uterus and ovaries.
It has a poor sensitivity for disease elsewhere,
particularly bowel lesions....
Conclusion
Endometriosis is a benign condition but causes malignant effects due to fibrosis and scarring.
Pain is a common feature of endometriosis.
The disease also causes infertility,
adhesions,
obstruction,
pneumothoraces and increases the risk of gynaecological cancers.
MRI and TV ultrasound are the radiological investigations of choice.
Knowledge of endometriosis at different stages in the disease process and on different imaging modalities is key to best aid these patients.
Personal information
Dr Carolina Walker,
Trainee Radiologist (ST5)
Oxford University Hospitals,
Oxford,
UK
Dr Catherine A Johnson
Consultant Radiologist
Oxford University Hospitals,
Oxford,
UK
References
MR imaging of Endometriosis,
Ten imaging pearls.
Siegelman,
V and Oliver,
E Radiographics,https://pubs.rsna.org/doi/pdf/10.1148/rg.326125518
https://www.endometriosis-uk.org, last accessed 07/01/2019
Unusual manifestations and complications of endometriosis- spectrum of imaging findings:pictorial review,
Bennett,
G et al,
American Journal of Roentgenology,
Volume 194,
number 6 supplement.
Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation.
Tran-Harding,
K et al.
Clinical Imaging Nov-Dec 2018,
vol 52,
p 163-171
Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score.Di Paola,
V...