[Imaging features of endometriosis]

Deep pelvic endometriosis is responsible of a painful syndrome dominated by deep dyspareunia and pelvic pain that recur according to the menstrual cycle. The semiology is directly correlated with the location of the lesions but is not specific. It is essential to investigate (clinically and with magnetic resonance imaging (MRI)) these deep endometriosis lesions and to draw up a precise map, which is the only way to be sure that surgical excisions will be complete. For the diagnosis of deep endometriosis, MRI is more sensitive and specific than endovaginal ultrasonography. Bowel and utero-sacral ligament lesions are often underestimated by clinical examination and ultrasonography. The MR diagnosis of these deep lesions is also difficult and require adapted sequences but may vary following experience of the radiologist. Preoperative endorectal ultrasonography or MRI are reliable techniques to visualize perirectal endometriomas and to assess rectal wall involvement. Surgical management can be based on preoperative imaging diagnosis, the Bladder and ureteral lesions are also underestimated. Renal ultrasonography must be performed in women affected by severe deeply infiltrating endometriosis. MRI does not improve sensitivity nor specificity of the radiologic diagnosis of ovarian endometriomas. Nevertheless, MRI is a reliable technique to visualize deeply infiltrating endometriosis lesions associated with ovarian endometriomas.