[Pelvic endometriosis].

Area of Science:

• Reproductive Medicine
• Diagnostic Imaging
• Gynecologic Surgery

Background:

• Endometriosis affects approximately 20% of women of reproductive age.
• Ovarian endometriosis typically presents as homogeneous, low-echo lesions on ultrasound, often with clot-like appearances.
• Ultrasound has limitations in detecting associated endometriosis lesions beyond the ovaries.

Purpose of the Study:

• To compare the efficacy of ultrasound and MRI in detecting ovarian endometriosis.
• To highlight MRI's advantage in identifying associated subperitoneal endometriosis implants.
• To discuss the imaging characteristics of endometriosis on MRI, including T1W and fat-suppressed sequences.

Main Methods:

• Review of imaging findings for ovarian endometriosis using transabdominal and endovaginal ultrasound.
• Analysis of MRI characteristics for ovarian and subperitoneal endometriosis, including signal intensity on T1W and fat-suppressed images.
• Comparison of diagnostic accuracy between ultrasound and MRI for various endometriosis locations.

Main Results:

• Ultrasound detects ovarian endometriosis in 90% of cases, but is insufficient for associated lesions.
• MRI demonstrates comparable accuracy to ultrasound for ovarian endometriosis.
• MRI effectively detects subperitoneal implants (bladder, uterosacral ligaments, rectovaginal septum, rectum), appearing as fibromuscular masses or fibrotic lesions with specific signal characteristics on T1W and fat-suppressed images.

Conclusions:

• While ultrasound is effective for ovarian endometriosis, MRI offers superior detection of associated subperitoneal disease.
• MRI's ability to visualize specific signal intensities on T1W and fat-suppressed images aids in diagnosing endometriosis.
• Laparoscopy remains the gold standard for detecting peritoneal endometriosis implants.