Endometriosis MR mimickers: T2-hypointense lesions

Area of Science:

• Radiology
• Women's Health
• Medical Imaging

Background:

• Endometriosis is a prevalent condition affecting women of reproductive age.
• Magnetic resonance imaging (MRI) is the primary tool for diagnosing and managing endometriosis.
• While MRI offers high sensitivity for deep infiltrating endometriosis (DIE), it suffers from a lack of specificity due to false-positive findings.

Purpose of the Study:

• To educate radiologists on MRI criteria for deep pelvic infiltrating endometriosis.
• To highlight common pitfalls and differential diagnoses that lead to false-positive MRI results.
• To improve the accuracy of endometriosis diagnosis by reducing overdiagnosis.

Main Methods:

• Review of MRI criteria for diagnosing deep pelvic infiltrating endometriosis.
• Analysis of common sources of T2-hypointense lesions that mimic endometriosis.
• Emphasis on multisequence interpretation, morphologic assessment, and precise anatomic localization.

Main Results:

• MRI in deep infiltrating endometriosis demonstrates a 23% false-positive rate.
• T2-hypointense lesions mimicking DIE arise from anatomical variants, fibrous tissues, tumors, feces, surgical materials, and scars.
• Accurate diagnosis requires careful evaluation to differentiate these mimickers from actual endometriosis.

Conclusions:

• Reducing false-positive MRI findings in deep infiltrating endometriosis is essential for appropriate patient management.
• Radiologists must be aware of differential diagnoses, including anatomical variations and neoplasms.
• Multisequence MRI interpretation and precise localization are key to preventing misdiagnosis.