Bladder endometriosis: characterization by magnetic resonance imaging and the value of documenting ureteral involvement

Endometriosis: clinical features, MR imaging findings and pathologic correlation

“…At MR imaging bladder endometriosis may manifest as localized or diffuse wall thickening and signal intensity abnormalities [ 12 ]. The appearance is of low signal intensity on T2-weighted and intermediate signal intensity on T1-weighted images, with or without spots of high signal intensity on T1-weighted images, representing hemorrhagic content [ 32 ] (Figs. 8 and 9 ).…”

Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation

“…In the case of cancer suspicion, it is thought to be helpful because of higher contrast resolution, better delineation of bladder wall layers, better tissue characterization, and better multiplanar capability in comparison with ultrasonography [67]. The MRI appearance of BE is usually of low signal intensity on T2 weighting with intermediate signal intensity on T1 weighting, and spots of high signal intensity on T1 and T2 weighting [68]. Several studies have investigated the role of MRI in the diagnosis of DIE including bladder localizations ( [75].…”

Endometriosis: 10 Keys Points for MRI

“…For urographic imaging, we acquired a coronal 3D volumetric T1weighted gradient-echo sequence after the contrast-enhanced dynamic acquisitions and after an additional intravenous injection of 20 mg furosemide. Total acquisition time amounted to 25 minutes without contrast, 30 minutes for patients who were administered contrast agent and 40 minutes if urographic phases were required (36). The use of T1-weighted fat saturation sequences was part of the ordinary routine of the protocol for the evaluation of endometriosis and the specificity of the results would have been drastically reduced without its application (25).…”

“…-presence of macroscopic endometriosis implants (>5 mm) (36); -indirect signs of adhesions such as disappearance of the fat tissue which usually separates pelvic anatomical structures (28,35); -direct signs of adhesions are well displayed on T2-weighted imaging as hypointense bands with variable thickness that result in stretching and distortion of the surrounding organs (36); -uterosacral ligament (USL) involvement is suspected in case of increased and asymmetrical thickness associated with abnormal arciform and tethered appearance (36); -presence of specific signs of posterior cul-de-sac obliteration: retroflexed uterus, tethered appearance of the rectum in direction of the uterus, strands between uterus and intestine, fibrotic plaque covering the serosal surface of the uterus and elevated posterior cervical fornix (47); -evaluation of signal intensity of endometriosis lesions is required as it varies according to the microscopic characteristics of the ectopic tissue (48). Signal intensity can present 3 main patterns: (i) hypointense signal on both T1-weighted and T2-weighted sequences with hyperintense foci on T2-weighted sequences which may indicate fibrosis with glandular spots; (ii) hypointense signal on T1-weighted and T2-weighted images with hyperintense foci on T1-weighted image which are caused by hemorrhagic foci within the fibrotic tissue and (iii) hypointense signal in both T1-weighted and T2-weighted sequences if fibrotic reaction is abundant.…”

“…Signal intensity can present 3 main patterns: (i) hypointense signal on both T1-weighted and T2-weighted sequences with hyperintense foci on T2-weighted sequences which may indicate fibrosis with glandular spots; (ii) hypointense signal on T1-weighted and T2-weighted images with hyperintense foci on T1-weighted image which are caused by hemorrhagic foci within the fibrotic tissue and (iii) hypointense signal in both T1-weighted and T2-weighted sequences if fibrotic reaction is abundant. This last feature may be missed on MRI or lead to a different diagnosis (20,25,28,35,36).…”