Abdominal Imaging - Review
Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis
Institute of Radiology, Diagnostic Area, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
Institute of Obstetrics and Gynecology, Female Health Area, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome and "F. Miulli" Regional General Hospital, Acquaviva delle Fonti, Bari, Italy
Diagn Interv Radiol ; : -
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Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intra-lesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, the pelvic peritoneum, uterosacral ligaments and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter and nerves. Moreover, rare extra pelvic endometriosis implants can be localized in the upper abdomen, sub-phrenic fold, or in the abdominal wall. Magnetic Resonance Imaging (MRI) represents a problem-solving tool over other imaging modalities. MRI is advantageous technique, because of its multiplanarity, high contrast resolution and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extra-pelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should take in mind these atypical localizations in patients with suspect of endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.