European Radiology

, Volume 16, Issue 2, pp 285–298

Diagnosis of endometriosis with imaging: a review

  • Karen Kinkel
  • Kathrin A. Frei
  • Corinne Balleyguier
  • Charles Chapron

DOI: 10.1007/s00330-005-2882-y

Cite this article as:
Kinkel, K., Frei, K.A., Balleyguier, C. et al. Eur Radiol (2006) 16: 285. doi:10.1007/s00330-005-2882-y


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.


Endometriosis Ovary, cysts Ultrasound, comparative studies Magnetic Resonance, comparative studies Pelvis, MR 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Karen Kinkel
    • 1
  • Kathrin A. Frei
    • 2
  • Corinne Balleyguier
    • 3
  • Charles Chapron
    • 4
  1. 1.Institut de RadiologieClinique et fondation des GrangettesChêne-Bougeries/GenevaSwitzerland
  2. 2.Department of Obstetrics and GynaecologyUniversity Hospital BernBernSwitzerland
  3. 3.Radiology DepartmentInstitut Gustave RoussyVillejuifFrance
  4. 4.Service de Gynécologie Obstétrique II, Unité de ChirurgieClinique Universitaire Baudelocque, CHU Cochin, Groupe Hospitalier Ouest, Assistance Publique—Hôpitaux de ParisParisFrance

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