ObjectiveWe illustrate the magnetic resonance imaging (MRI) features of endometriosis.BackgroundEndometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation.ConclusionOwing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work.Teaching Points
• Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis.
• MRI is a second-line imaging technique after US.
• Deep pelvic endometriosis is associated with chronic pelvic pain and infertility.
• Endometriosis is characterized by considerable diagnostic delay.
• MRI is the best imaging technique for preoperative staging of endometriosis.
ObjectiveWe propose a Magnetic Resonance Imaging (MRI) guided approach to differential diagnosis of ovarian tumours based on morphological appearance.BackgroundCharacterization of ovarian lesions is of great importance in order to plan adequate therapeutic procedures, and may influence patient’s management. Optimal assessment of adnexal masses requires a multidisciplinary approach, based on physical examination, laboratory tests and imaging techniques. Primary ovarian tumours can be classified into three main categories according to tumour origin: epithelial, germ cell and sex cord-stromal tumours. Ovarian neoplasms may be benign, borderline or malignant. Using an imaging-guided approach based on morphological appearance, we classified adnexal masses into four main groups: unilocular cyst, multilocular cyst, cystic and solid, predominantly solid. We describe MR signal intensity features and enhancement behaviour of ovarian lesions using pathologically proven examples from our institution.ConclusionMRI is an essential problem-solving tool to determine the site of origin of a pelvic mass, to characterize an adnexal mass, and to detect local invasion. The main advantages of MRI are the high contrast resolution and lack of ionizing radiation exposure. Although different pathological conditions may show similar radiologic manifestations, radiologists should be aware of MRI features of ovarian lesions that may orientate differential diagnosis.Teaching Points• Diagnostic imaging plays a crucial role in detection, characterization and staging of adnexal masses.• Characterization of an ovarian lesion may influence patient’s management.• Different pathological conditions may have similar radiologic manifestations.• Non-neoplastic lesions should always be taken into consideration.
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