Magnetic resonance imaging of endometriosis: a common but often hidden, missed, and misdiagnosed entity

Abstract

Endometriosis is a common benign and chronic inflammatory gynaecological disease due to functional endometrial glands and stroma in an ectopic location outside the uterine cavity. It affects 5-10% of reproductive age group women in the peak age of 24-29 years. However, women with infertility and chronic pelvic pain have an even greater prevalence, accounting for 30-50% and 90% of cases, respectively. Although it is a common entity, patients often get a delayed diagnosis because it is often subtle (hidden), missed, or confused with mimics, leading to misdiagnosis, which significantly affects patients' quality of life because they live in constant pain from undiagnosed endometriosis. Laparoscopy followed by histopathological confirmation is the gold standard for diagnosis, but it is an invasive procedure. MRI is an excellent non-invasive modality that helps in non-invasive diagnosis, with excellent delineation of the disease extent, and thus provides a presurgical mapping of the disease, which is helpful for the operating surgeon. Radiologists should be aware of all possible spectrum and diagnose this early and provide a detailed structured report mapping the entire extent of the disease process, which helps in effective treatment planning and successful outcomes in improving patients' quality of life.

Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features

“…MRI, by contrast, provides rather accurate diagnostic means for endometriosis including deep infiltrative forms, and these are informative in terms of organ involvement and adhesive process severity [ 32 ]. Superficial peritoneal implants < 5 mm in diameter are formally below the resolution of MRI; still, a tentative search for the presence of small T1-weighted hyperintense foci may provide crucial grounds for the diagnosis [ 20 ]. Our data confirm the fundamentally higher diagnostic accuracy for PE achieved with MRI compared to ultrasonography.…”

“…The advancements in noninvasive diagnosis with respect to imaging modalities have been reported mainly for deep endometriosis with 83–91% sensitivity and 98% specificity for ultrasound and MRI [ 9 ]. Superficial noninvasive endometrioses with tiny implants less than 2–3 mm in size on the surface of the peritoneum are often below the resolution of MRI and are not commonly visualized [ 20 ]. It is generally recognized that imaging evaluation could be particularly difficult in the early stages of peritoneal endometriosis, and it requires experience and specific training in this field [ 1 , 11 ].…”

Postmenopausal endometriosis: a challenging condition beyond menopause

“…37,40 However, to date, the lack of specific radiological markers for endometriosis further complicates the imaging-based diagnosis of postmenopausal cases. 41 MANAGEMENT APPROACHES Management of postmenopausal endometriosis requires a multidisciplinary approach that involves gynecologists, radiologists, and, sometimes, colorectal or urological specialists. 42 The treatment options may include a combination of surgical intervention and hormonal therapies (Table 1).…”

“…Traditional imaging techniques like transvaginal ultrasound or pelvic magnetic resonance imaging may have limitations in detecting endometriotic lesions, especially when they are small or located in deep pelvic regions 37,40 . However, to date, the lack of specific radiological markers for endometriosis further complicates the imaging-based diagnosis of postmenopausal cases 41 …”