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Diagnosis of endometriosis with imaging: a review

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Abstract

Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.

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Acknowledgements

PD Dr. med Karen Kinkel received a salary support for research and education from the Clinique des Grangettes, Chêne-Bougeries, Switzerland.

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Authors and Affiliations

  1. Institut de Radiologie, Clinique et fondation des Grangettes, 7, chemin des Grangettes, 1224, Chêne-Bougeries/Geneva, Switzerland

    Karen Kinkel

  2. Department of Obstetrics and Gynaecology, University Hospital Bern, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland

    Kathrin A. Frei

  3. Radiology Department, Institut Gustave Roussy, 39, rue Chemin Camille Desmoulins, 94805, Villejuif, France

    Corinne Balleyguier

  4. Service de Gynécologie Obstétrique II, Unité de Chirurgie, Clinique Universitaire Baudelocque, CHU Cochin, Groupe Hospitalier Ouest, Assistance Publique—Hôpitaux de Paris, 123, bd Port-Royal, 75014, Paris, France

    Charles Chapron

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  1. Karen Kinkel
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Correspondence to Karen Kinkel.

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Kinkel, K., Frei, K.A., Balleyguier, C. et al. Diagnosis of endometriosis with imaging: a review. Eur Radiol 16, 285–298 (2006). https://doi.org/10.1007/s00330-005-2882-y

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