Radiology State-of-the-art Review: Endometriosis Imaging Interpretation and Reporting
Wendaline VanBuren1, Myra Feldman1, Anuradha S Shenoy-Bhangle1
1From the Mayo Clinic Rochester, 200 1st Street SW, Rochester, MN 55905 (W.V.B., T.L.B., Z.K., C.C., P.I.C.A.); Cleveland Clinic, Cleveland, Ohio (M.F., C.K., M.P.); Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.S.S.B., A.K.); University of Michigan, Ann Arbor, Mich (M.D.S.); Mayo Clinic Arizona, Phoenix, Ariz (S.Y., M.Y.); Chamie Imagem da Mulher, São Paulo, Brazil (L.P.C.); University of California San Francisco, San Francisco, Calif (L.G., J.T.R., L.P.); NYU Grossman School of Medicine, New York, NY (N.M.H., A.T., M.T.T.); David Geffen School of Medicine, Los Angeles, Calif (H.D.D.); University of Arizona College of Medicine Phoenix/Banner University Medical Center-Phoenix (R.M.K.); Stanford University School of Medicine, Stanford, Calif (L.S.); Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (K.S.B.); Clinic Izabela Pires Franco, Belém, Brazil (I.V.P.F.); Temerty Faculty of Medicine (P.G.), University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Thomas Jefferson University Hospital, Philadelphia, Pa (L.M.K.); University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.B.); University of Arizona College of Medicine, Banner University Medicine, Tucson, Ariz (H.A.T.); Columbia University Irving Medical Center, New York, NY (S.L.N.); SUNY Upstate Medical University, Syracuse, NY (R.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.).
None:
Endometriosis is a common condition impacting approximately 190 million individuals and up to 50% of women with infertility globally. The disease is characterized by endometrial-like tissue located outside of the uterine corpus, which causes cyclical hemorrhage, inflammation, and fibrosis. Based on clinical suspicion or findings at routine transvaginal pelvic US or other prior imaging, dedicated imaging for endometriosis may be warranted with MRI or advanced transvaginal US. Deep endometriosis (DE) in the pelvis includes evaluation for stromal and fibrotic components and architectural distortion resulting from fibrosis and tethering. It is a disease requiring a compartment-based, pattern-recognition approach. MRI has the benefit of global assessment of the pelvis and is effective in assessing for features of malignancy and for evaluating extrapelvic locations. Transvaginal US has the advantage of dynamic maneuvers to assess for adhesions and may achieve higher spatial resolution for assessing the depth of bowel wall invasion. T1-weighted MRI evaluation increases the specificity of diagnosis by identifying hemorrhagic components, but the presence of T1 signal hyperintensity is not essential for diagnosing DE. Endometriosis is a disease with a broad spectrum; understanding the mild through advanced manifestations, including malignancy evaluation, is within the scope and breadth of radiologists' interpretation.
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