Deep Retroperitoneal Pelvic Endometriosis: MR Imaging Appearance with Laparoscopic Correlation

Abstract

Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. It is responsible for severe pelvic pain. Accurate preoperative assessment of disease extension is required for planning complete surgical excision, but such assessment is difficult with physical examination. Various sonographic approaches (transvaginal, transrectal, endoscopic transrectal) have been used for this purpose but do not allow panoramic evaluation. Furthermore, exploratory laparoscopy has limitations in demonstrating deep endometriotic lesions hidden by adhesions or located in the subperitoneal space. Despite some limitations, magnetic resonance (MR) imaging is able to directly demonstrate deep pelvic endometriosis. The MR imaging features depend on the type of lesions: infiltrating small implants, solid deep lesions mainly located in the posterior cul-de-sac and involving the uterosacral ligaments and torus uterinus, or visceral endometriosis involving the bladder and rectal wall. Solid deep lesions have low to intermediate signal intensity with punctate regions of high signal intensity on T1-weighted images, show uniform low signal intensity on T2-weighted images, and can demonstrate enhancement on contrast-enhanced images. MR imaging is a useful adjunct to physical examination and transvaginal or transrectal sonography in evaluation of patients with deep infiltrating endometriosis.

Endometriosis of Right Inguinal Subcutaneous Tissue

“…On T2-weighted images, high signal intensity is common; however, diffuse hemosiderin deposition reflecting cyclic hemorrhage can result in low signal intensity appearance. Shading or variable loss of signal intensity on T2-weighted images is a frequent feature of endometriosis [11][12][13]. In the current case, the mass showed iso-signal intensity both on T1-and T2-weighted images.…”

Multi-Focal Endometriosis in a Young Woman with Adnexal Para-Mesonephric Cyst: Role of MRI in Surgical Planning

“…Deep endometriosis is the sub peritoneal invasion by endometriotic lesion that exceeds 5 mm in depth. It can affect the rectovaginal septum and uterosacral ligaments, as well as the vagina, the urinary and the alimentary tract [1,2]. The etio-pathogenesis of endometriosis is still unclear and probably multifactorial.…”

Magnetinio Rezonanso Tomografijos Reikšmė Diagnozuojant Endometriozę

“…Endometriozė kliniškai gali pasireikšti įvairiai: mėnesinių ciklo sutrikimu, skausmingais lytiniais santykiais, skausmu tuštinantis, lėtiniu dubens skausmu, nevaisingumu. Visa tai blogina pacienčių gyvenimo kokybę ir gali sukelti net invalidumą, nors kartais simptomai ir nepasireiškia [4,5]. Giliai infiltruojanti endometriozė (GIE) histologiškai apibūdinama kaip endometriumo židiniai, išplintantys bent 5 mm į dubens organų sieną ir sukeliantys aplinkinio raumeninio-skaidulinio audinio hiperplaziją [6].…”