[Imaging features of endometriosis]

Area of Science:

• Gynecology
• Radiology
• Surgical Oncology

Context:

• Deep pelvic endometriosis presents as a painful syndrome, including deep dyspareunia and cyclical pelvic pain.
• Clinical semiology correlates with lesion location but lacks specificity.
• Accurate mapping of deep endometriosis lesions is vital for complete surgical excision.

Purpose:

• To highlight the importance of clinical and magnetic resonance imaging (MRI) investigations for deep pelvic endometriosis.
• To compare the diagnostic efficacy of MRI against endovaginal ultrasonography and clinical examination.
• To emphasize the necessity of precise imaging for surgical planning.

Summary:

• MRI demonstrates higher sensitivity and specificity than endovaginal ultrasonography for diagnosing deep endometriosis.
• Bowel, utero-sacral ligament, bladder, and ureteral lesions are frequently underestimated by clinical assessment and ultrasonography.
• Adapted MRI sequences are essential for accurate diagnosis of deep lesions, though radiologist experience influences results.
• Preoperative imaging, including endorectal ultrasonography and MRI, reliably visualizes perirectal endometriomas and rectal wall involvement.
• Renal ultrasonography is recommended for severe deeply infiltrating endometriosis; MRI aids in visualizing associated ovarian endometriomas and deeply infiltrating lesions.

Impact:

• Improved diagnostic accuracy for deep pelvic endometriosis, particularly for bowel and ligamentous involvement.
• Enhanced surgical planning and execution through precise lesion mapping, leading to more complete excisions.
• Reduced underestimation of deep endometriosis lesions, potentially improving patient outcomes and pain management.