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Endometriosis

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MRI of the Female and Male Pelvis

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Abstract

Endometriosis, defined as the presence of endometrial glands and stroma outside the endometrium, is a common gynecological disorder affecting women in reproductive age, associated with chronic pelvic pain and infertility.

Its pathogenesis is complex and still unclear, probably multifactorial. The ovaries are the most common sites affected, but endometriosis can involve the gastrointestinal tract, urinary system, thorax, and soft tissue.

We consider the anatomic subdivision of pelvic endometriosis into three forms: the adenomyosis, the tubo-ovarian lesions, and the deep pelvic endometriosis (DPE), defined by the invasion of endometrial tissue at least 5 mm beneath the peritoneal surface.

The diagnosis and the accurate evaluation of the endometriosis extension are very important to avoid mutilating surgery and enhance fertility, but are often difficult only with physical examination and laparoscopy.

The laparoscopy with histological confirmation remains the reference standard for diagnosis and staging, but it has limitations in detecting deep locations hidden by adhesions or located in the subperitoneal space.

Ultrasound (transabdominal or transvaginal) is usually the first-line imaging modality in women with pelvic pain, but it has poor accuracy for deep pelvic endometriosic lesions. We would highlight the role of magnetic resonance (MR) imaging in the diagnosis of endometriosis that has already emerged as a high reproducible method to explore ovarian endometriosis; it demonstrates high accuracy also in the evaluation of DPE, allowing a complete survey of the anterior and posterior compartments of the pelvis, with high spatial resolution and good tissue characterization.

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References

  1. Revised American Fertility Society classification of endometriosis: 1985 (1985) Fertil Steril 43(3):351–352

    Google Scholar 

  2. Brosens I et al (2004) Diagnosis of endometriosis: pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol 18(2):285–303

    Article  PubMed  Google Scholar 

  3. Woodward PJ, Sohaey R, Mezzetti TP Jr (2001) Endometriosis: radiologic-pathologic correlation. Radiographics 21(1):193–216; questionnaire 288–294

    Article  CAS  PubMed  Google Scholar 

  4. Spaczynski RZ, Duleba AJ (2003) Diagnosis of endometriosis. Semin Reprod Med 21(2):193–208

    Article  PubMed  Google Scholar 

  5. Vigano P et al (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 18(2):177–200

    Article  PubMed  Google Scholar 

  6. Olive DL, Henderson DY (1987) Endometriosis and mullerian anomalies. Obstet Gynecol 69(3 Pt 1):412–415

    CAS  PubMed  Google Scholar 

  7. Clement PB (1990) Pathology of endometriosis. Pathol Annu 25(Pt 1):245–295

    PubMed  Google Scholar 

  8. Halme J et al (1984) Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol 64(2):151–154

    CAS  PubMed  Google Scholar 

  9. Liu DT, Hitchcock A (1986) Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. Br J Obstet Gynaecol 93(8):859–862

    Article  CAS  PubMed  Google Scholar 

  10. Jenkins S, Olive DL, Haney AF (1986) Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 67(3):335–338

    CAS  PubMed  Google Scholar 

  11. Dunselman GA, Groothuis PG (2004) Etiology of endometriosis: hypotheses and facts. Gynecol Obstet Invest 57(1):42–43

    CAS  PubMed  Google Scholar 

  12. Kurman RJ (2011) Diseases of the peritoneum. In: Blaustein’s pathology of the female genital tract, 6th edn. Springer, New York/London

    Chapter  Google Scholar 

  13. Kashima K et al (2004) Familial risk among Japanese patients with endometriosis. Int J Gynaecol Obstet 84(1):61–64

    Article  CAS  PubMed  Google Scholar 

  14. Rogers PA et al (2013) Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis in Montpellier, France. Reprod Sci 20(5):483–499

    Article  PubMed Central  PubMed  Google Scholar 

  15. Carvalho LF et al (2013) From conception to birth – how endometriosis affects the development of each stage of reproductive life. Minerva Ginecol 65(2):181–198

    CAS  PubMed  Google Scholar 

  16. Chapron C et al (2012) Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod 27(3):702–711

    Article  PubMed  Google Scholar 

  17. Gauche Cazalis C et al (2012) Preoperative imaging of deeply infiltrating endometriosis in: transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging. Gynecol Obstet Fertil 40(11):634–641

    Article  CAS  PubMed  Google Scholar 

  18. Saba L et al (2012) MRI and “tenderness guided” transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis. J Magn Reson Imaging 35(2):352–360

    Article  PubMed  Google Scholar 

  19. Bazot M et al (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232(2):379–389

    Article  PubMed  Google Scholar 

  20. Siegler AM, Camilien L (1994) Adenomyosis. J Reprod Med 39(11):841–853

    CAS  PubMed  Google Scholar 

  21. Levy G et al (2013) An update on adenomyosis. Diagn Interv Imaging 94(1):3–25

    Article  CAS  PubMed  Google Scholar 

  22. Kishi Y et al (2012) Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 207(2):114 e1-7

    Article  PubMed  Google Scholar 

  23. Bazot M et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16(11):2427–2433

    CAS  PubMed  Google Scholar 

  24. Reinhold C et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199(1):151–158

    Article  CAS  PubMed  Google Scholar 

  25. Novellas S et al (2011) MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol 196(5):1206–1213

    Article  PubMed  Google Scholar 

  26. Takeuchi M, Matsuzaki K, Nishitani H (2010) Manifestations of the female reproductive organs on MR images: changes induced by various physiologic states. Radiographics 30(4):1147

    Article  PubMed  Google Scholar 

  27. Utsunomiya D et al (2004) Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images. AJR Am J Roentgenol 182(2):399–404

    Article  PubMed  Google Scholar 

  28. Patel MD et al (1999) Endometriomas: diagnostic performance of US. Radiology 210(3):739–745

    Article  CAS  PubMed  Google Scholar 

  29. Togashi K et al (1991) Endometrial cysts: diagnosis with MR imaging. Radiology 180(1):73–78

    Article  CAS  PubMed  Google Scholar 

  30. Wu TT et al (2004) Magnetic resonance imaging of ovarian cancer arising in endometriomas. J Comput Assist Tomogr 28(6):836–838

    Article  PubMed  Google Scholar 

  31. Coutinho AC Jr et al (2011) Pelvic applications of diffusion magnetic resonance images. Magn Reson Imaging Clin N Am 19(1):133–157

    Article  PubMed  Google Scholar 

  32. Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32(6):1675–1691

    Article  PubMed  Google Scholar 

  33. McDermott S et al (2012) MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics 32(3):845–863

    Article  PubMed  Google Scholar 

  34. Takeuchi M, Matsuzaki K, Nishitani H (2008) Magnetic resonance manifestations of decidualized endometriomas during pregnancy. J Comput Assist Tomogr 32(3):353–355

    Article  PubMed  Google Scholar 

  35. Takeuchi M et al (2006) Malignant transformation of pelvic endometriosis: MR imaging findings and pathologic correlation. Radiographics 26(2):407–417

    Article  PubMed  Google Scholar 

  36. Kim MY et al (2009) MR Imaging findings of hydrosalpinx: a comprehensive review. Radiographics 29(2):495–507

    Article  PubMed  Google Scholar 

  37. Rezvani M, Shaaban AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31(2):527–548

    Article  PubMed  Google Scholar 

  38. Del Frate C et al (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26(6):1705–1718

    Article  PubMed  Google Scholar 

  39. Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76(2):358–365

    Article  CAS  PubMed  Google Scholar 

  40. Darai E et al (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192(2):394–400

    Article  PubMed  Google Scholar 

  41. Darai E et al (2005) Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril 84(4):945–950

    Article  PubMed  Google Scholar 

  42. Abrao MS et al (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22(12):3092–3097

    Article  PubMed  Google Scholar 

  43. Kinkel K et al (1999) Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod 14(4):1080–1086

    Article  CAS  PubMed  Google Scholar 

  44. Chapron C et al (1998) Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis. Hum Reprod 13(8):2266–2270

    Article  CAS  PubMed  Google Scholar 

  45. Fedele L et al (1998) Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol 91(3):444–448

    Article  CAS  PubMed  Google Scholar 

  46. Chapron C et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18(1):157–161

    Article  PubMed  Google Scholar 

  47. Faccioli N et al (2008) Barium enema evaluation of colonic involvement in endometriosis. AJR Am J Roentgenol 190(4):1050–1054

    Article  PubMed  Google Scholar 

  48. Rock JA (1995) The revised American Fertility Society classification of endometriosis: reproducibility of scoring. ZOLADEX Endometriosis Study Group. Fertil Steril 63(5):1108–1110

    CAS  PubMed  Google Scholar 

  49. Prystowsky JB et al (1988) Gastrointestinal endometriosis. Incidence and indications for resection. Arch Surg 123(7):855–858

    Article  CAS  PubMed  Google Scholar 

  50. Landi S et al (2004) Preoperative double-contrast barium enema in patients with suspected intestinal endometriosis. J Am Assoc Gynecol Laparosc 11(2):223–228

    Article  PubMed  Google Scholar 

  51. Siegelman ES, Outwater EK (1999) Tissue characterization in the female pelvis by means of MR imaging. Radiology 212(1):5–18

    Article  CAS  PubMed  Google Scholar 

  52. Loubeyre P et al (2009) Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification. AJR Am J Roentgenol 192(6):1625–1631

    Article  PubMed  Google Scholar 

  53. Coutinho A Jr et al (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31(2):549–567

    Article  PubMed  Google Scholar 

  54. Savelli L et al (2009) Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis. Ultrasound Obstet Gynecol 34(5):595–600

    Article  CAS  PubMed  Google Scholar 

  55. Kinkel K et al (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16(2):285–298

    Article  PubMed  Google Scholar 

  56. Frachet O et al (2006) Ureteral obstruction from endometriosis: a case report and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 35(5 Pt 1):500–503

    Article  CAS  Google Scholar 

  57. Perez-Utrilla Perez M et al (2009) Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urology 73(1):47–51

    Article  PubMed  Google Scholar 

  58. Kataoka ML et al (2005) Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology 234(3):815–823

    Article  PubMed  Google Scholar 

  59. Kinkel K. (2005) Management of endometriosis. Informa Healthcare, Philadelphia, pp 448–451

    Google Scholar 

  60. Bazot M et al (2011) Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod 26(2):346–353

    Article  PubMed  Google Scholar 

  61. Ercoli A et al (2005) Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: a dissection-based comparative study. Am J Obstet Gynecol 193(4):1565–1573

    Article  PubMed  Google Scholar 

  62. Touboul C et al (2008) The lateral infraureteral parametrium: myth or reality? Am J Obstet Gynecol 199(3):242 e1-6

    Article  PubMed  Google Scholar 

  63. Bazot M et al (2012) The value of MRI in assessing parametrial involvement in endometriosis. Hum Reprod 27(8):2352–2358

    Article  PubMed  Google Scholar 

  64. Faccioli N et al (2010) Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging. Abdom Imaging 35(4):414–421

    Article  CAS  PubMed  Google Scholar 

  65. Olive DL, Schwartz LB (1993) Endometriosis. N Engl J Med 328(24):1759–1769

    Article  CAS  PubMed  Google Scholar 

  66. Bazot M et al (2007) Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod 22(5):1457–1463

    Article  PubMed  Google Scholar 

  67. Chapron C et al (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol 24(2):175–179

    Article  CAS  PubMed  Google Scholar 

  68. Ascher SM et al (1995) Endometriosis: appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques. J Magn Reson Imaging 5(3):251–257

    Article  CAS  PubMed  Google Scholar 

  69. Zanardi R et al (2003) Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging 28(5):733–742

    Article  CAS  PubMed  Google Scholar 

  70. Bazot M et al (2011) Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images. Eur J Radiol 80(3):e331–e339

    Article  PubMed  Google Scholar 

  71. Scardapane A et al (2013) Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography. Radiol Med 118(2):323–338

    Article  CAS  PubMed  Google Scholar 

  72. Bis KG et al (1997) Pelvic endometriosis: MR imaging spectrum with laparoscopic correlation and diagnostic pitfalls. Radiographics 17(3):639–655

    Article  CAS  PubMed  Google Scholar 

  73. Sonavane SK, Kantawala KP, Menias CO (2011) Beyond the boundaries-endometriosis: typical and atypical locations. Curr Probl Diagn Radiol 40(6):219–232

    PubMed  Google Scholar 

  74. Tokue H, Tsushima Y, Endo K (2009) Magnetic resonance imaging findings of extrapelvic endometriosis of the round ligament. Jpn J Radiol 27(1):45–47

    Article  PubMed  Google Scholar 

  75. Novellas S et al (2010) Anterior pelvic endometriosis: MRI features. Abdom Imaging 35(6):742–749

    Article  CAS  PubMed  Google Scholar 

  76. Ideyi SC et al (2003) Spontaneous endometriosis of the abdominal wall. Dig Surg 20(3):246–248

    Article  PubMed  Google Scholar 

  77. Crespo R, Puig F, Marquina I (2005) Pyramidalis muscle endometriosis in absence of previous surgery. Int J Gynaecol Obstet 89(2):148–149

    Article  PubMed  Google Scholar 

  78. Hassanin-Negila A et al (2006) Endometriomas of the abdominal wall: imaging findings. J Radiol 87(11 Pt 1):1691–1695

    Article  CAS  PubMed  Google Scholar 

  79. Zhao X et al (2005) Abdominal wall endometriomas. Int J Gynaecol Obstet 90(3):218–222

    Article  PubMed  Google Scholar 

  80. Gougoutas CA et al (2000) Pelvic endometriosis: various manifestations and MR imaging findings. AJR Am J Roentgenol 175(2):353–358

    Article  CAS  PubMed  Google Scholar 

  81. Gunes M et al (2005) Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. J Obstet Gynaecol Res 31(5):471–475

    Article  PubMed  Google Scholar 

  82. Choudhary S et al (2009) Unusual imaging appearances of endometriosis. AJR Am J Roentgenol 192(6):1632–1644

    Article  PubMed  Google Scholar 

  83. Kirkpatrick A et al (2006) Radiologic-pathologic conference of Brooke Army Medical Center: endometriosis of the canal of Nuck. AJR Am J Roentgenol 186(1):56–57

    Article  PubMed  Google Scholar 

  84. Cervini P, Mahoney J, Wu L (2005) Endometriosis in the canal of Nuck: atypical manifestations in an unusual location. AJR Am J Roentgenol 185(1):284–285

    Article  PubMed  Google Scholar 

  85. Strasser EJ, Davis RM (1977) Extraperitoneal inguinal endometriosis. Am Surg 43(6):421–422

    CAS  PubMed  Google Scholar 

  86. Mashfiqul MA, Tan YM, Chintana CW (2007) Endometriosis of the inguinal canal mimicking a hernia. Singapore Med J 48(6):e157–e159

    CAS  PubMed  Google Scholar 

  87. Wadhwa V et al (2012) Sciatic nerve tumor and tumor-like lesions – uncommon pathologies. Skeletal Radiol 41(7):763–774

    Article  PubMed  Google Scholar 

  88. Goldsmith PJ et al (2009) Case hepatic endometriosis: a continuing diagnostic dilemma. HPB Surg 2009:407206

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  89. Keichel S et al (2011) Lymphangiogenesis in deep infiltrating endometriosis. Hum Reprod 26(10):2713–2720

    Article  CAS  PubMed  Google Scholar 

  90. Inal M et al (2000) Hepatic endometrioma: a case report and review of the literature. Eur Radiol 10(3):431–434

    Article  CAS  PubMed  Google Scholar 

  91. Fluegen G et al (2013) Intrahepatic endometriosis as differential diagnosis: case report and literature review. World J Gastroenterol 19(29):4818–4822

    Article  PubMed Central  PubMed  Google Scholar 

  92. Asran M, Rashid A, Szklaruk J (2010) Hepatic endometriosis mimicking metastatic disease: a case report and review of the literature. J Radiol Case Rep 4(11):26–31

    PubMed Central  PubMed  Google Scholar 

  93. Rousset-Jablonski C et al (2011) Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod 26(9):2322–2329

    Article  PubMed  Google Scholar 

  94. Laghzaoui O, Laghzaoui M (2001) Nasal endometriosis: apropos of 1 case. J Gynecol Obstet Biol Reprod (Paris) 30(8):786–788

    CAS  Google Scholar 

  95. Mignemi G et al (2012) A case report of nasal endometriosis in a patient affected by Behcet’s disease. J Minim Invasive Gynecol 19(4):514–516

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Radiologia di Verona, Azienda Ospedaliera Universitaria di Verona, Policlinico “G. B. Rossi”, P.le L.A. Scuro 10, Verona, 37100, Italy

    Simona Mautone, Salvatore Belluardo, Valerio Di Paola, Riccardo Manfredi & Roberto Pozzi Mucelli

  2. Dipartimento di Radiologia, Ospedale “Sacro Cuore – Don Calabria”, V. don Sempreboni 5, Verona, Negrar, Italy

    Luigi Romano & Giovanni Foti

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  1. Simona Mautone
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  2. Salvatore Belluardo
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  3. Valerio Di Paola
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  4. Luigi Romano
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Correspondence to Simona Mautone .

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  1. Department of Radiology, University of Verona, “G.B.Ross” University Hospital, Verona, Italy

    Riccardo Manfredi

  2. Department of Radiology, University of Verona, “G.B.Ross” University Hospital, Verona, Italy

    Roberto Pozzi Mucelli

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Mautone, S. et al. (2015). Endometriosis. In: Manfredi, R., Pozzi Mucelli, R. (eds) MRI of the Female and Male Pelvis. Springer, Cham. https://doi.org/10.1007/978-3-319-09659-9_4

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