Evan Spencer Siegelman MD, Presenter: Consultant, BioClinica, Inc Consultant, ICON plc Consultant, ACR Image Metrix

1) Identify the clinical indications that should lead to imaging for the detection of endometriosis. 2) Assess the MR techniques for the detection and characterization of endometriosis. 3) Describe the classic and unusual locations of endometriosis.

Endometriosis, which is defined as the presence of ectopic endometrial glands and stroma outside the uterus, is a common cause of pelvic pain and infertility, affecting as many as 10% of premenopausal women. Because its effects may be devastating, radiologists should be familiar with the various imaging manifestations of the disease, especially those that allow its differentiation from other pelvic lesions. The MR  "pearls" offered here apply to the detection and characterization of pelvic endometriosis. First, the inclusion of T1-weighted fat-suppressed sequences is recommended for all MR examinations of the female pelvis because such sequences facilitate the detection of small endometriomas and aid in their differentiation from mature cystic teratomas. Second, it must be remembered that benign endometriomas, like many pelvic malignancies, may exhibit restricted diffusion. Although women with endometriosis are at risk for developing clear cell and endometrioid epithelial ovarian cancers (ie, endometriosis-associated ovarian cancers), imaging findings such as enhancing mural nodules should be confirmed before a diagnosis of ovarian malignancy is suggested. The presence of a dilated fallopian tube, especially one containing hemorrhagic content, is often associated with pelvic endometriosis. Deep (solid infiltrating) endometriosis can involve the pelvic ligaments, anterior rectosigmoid colon, bladder, uterus, and cul-de-sac, as well as surgical scars; the lesions often have poorly defined margins and T2 signal hypointensity as a result of fibrosis. The presence of subcentimeter foci with T2 hyperintensity representing ectopic endometrial glands within these infiltrating fibrotic masses may help establish the diagnosis.

http://pubs.rsna.org/doi/pdf/10.1148/rg.326125518

Siegelman, E, MR Imaging of Endometriosis: Pearls and Pitfalls.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/13010394.html