Endometrial imaging

Imaging remains fundamental to the diagnosis and management of endometrial disorders. Recognition of the normal endometrium in premenarchal, menstruating, post-partum and post-menopausal patients, as well as patients taking medications such as hormone replacement therapy and tamoxifen, is essential to exclude endometrial pathology. In addition, endometrial cancer is now the most common gynaecological malignancy in the United Kingdom, and imaging remains central to the diagnosis and management of these patients.

This paper explores multimodality imaging appearances of the endometrium, including normal appearances and abnormalities such as polypoid lesions, hyperplasia and endometrial cancer. Secondary endometrial tumours as well as infective/inflammatory endometrial pathologies are also considered.

Transvaginal ultrasound (TVUS) is the first-line imaging for endometrial assessment, and the normal appearances vary according to menstrual cycle and menopausal status. Most endometrial pathologies are identified and characterised with TVUS. Further imaging with magnetic resonance imaging (MRI) is useful to stage endometrial cancer, while computed tomography (CT) is usually reserved for the staging and post treatment follow up of distant metastases.

This review article provides a current summary of endometrial imaging in the United Kingdom, including normal endometrial appearances and endometrial disorders across the range of imaging modalities.