Endometrial cysts: diagnosis with MR imaging.

Abstract

The value of 1.5-T magnetic resonance (MR) imaging in diagnosing endometrial cysts and differentiating them from other gynecologic masses was prospectively evaluated in 374 female patients with clinically suspected adnexal masses. A suggestive diagnosis of endometrial cyst was made when a cyst that was hyperintense on T1-weighted images exhibited homogeneous hyperintensity on T2-weighted images. A definitive diagnosis was made when a cyst that was hyperintense on T1-weighted images exhibited hypointense signal on T2-weighted images (shading) or when the lesion consisted of multiple hyperintense cysts on T1-weighted images (multiplicity) regardless of the signal intensity on T2-weighted images. Surgery was performed in 293 patients, and confirmation was obtained in 354 lesions. MR imaging enabled accurate diagnosis of 77 of 86 endometrial cysts and exclusion of the diagnosis of endometrial cyst in 263 of 268 other gynecologic masses with or without internal hemorrhage. The overall diagnostic sensitivity, specificity, and accuracy were 90%, 98%, 96%, respectively. MR imaging seems to be an acceptable diagnostic test on which clinical decisions can be based in selecting treatment.

Variable MR findings in ovarian functional hemorrhagic cysts

“…This contrasts with the findings in endometriomas, in which 93% of cysts showed predominant high signal intensity on T1-weighted images (5). This can be explained by the absence of or low concentration of paramagnetic methemoglobin in FHC due to the relatively early age of the hemorrhage and the presence of preexisting fluid.…”

“…Although the MR pattern of endometriomas has been well known since the study of Togashi et al (5) in 1991, our knowledge of the MR pattern of FHC is limited to a few studies (5)(6)(7). The largest series reported by Outwater and Dunton (7) comprised 21 cysts but had two major limitations.…”

“…This last criterion excludes all FHC that have low signal intensity on T1-weighted images. The other studies (5,6) included a limited number of FHC. Our study, which has criteria of inclusion based on follow-up US or surgical verification, demonstrates that, contrary to endometriomas, a majority of FHC show low signal intensity on T1-weighted images.…”

Magnetic resonance imaging in the evaluation of (deep infiltrating) endometriosis: The value of diffusion‐weighted imaging

“…Second, pathology was not obtained in all cases because most patients were treated primarily medically. Nevertheless, MRI has been reported to accurately diagnose endometrial cysts and DIE (7,23) and most patients were known with endometriosis previously. Finally, in the present study no analysis was done to evaluate quantitative DWI in differentiating endometriosis from other pathologies.…”

Differentiation of Benign from Malignant Adnexal Masses by Functional 3 Tesla MRI Techniques: Diffusion-Weighted Imaging and Time-Intensity Curves of Dynamic Contrast-Enhanced MRI

“…The presence of T1-weighted hyperintensity and signal suppression on fat saturated sequences is diagnostic for dermoid cyst (Outwater et al, 2001). The signal intensity characteristics of endometrioma on conventional MR sequences as high signal intensity on T1-weighted and T2 shading are usually sufficient for the diagnosis, with specificity greater than 90% (Togashi et al, 1991;Siegelman and Oliver, 2012). Based on the results of a study by Busard et al, endometriomas demonstrate restricted diffusion and low ADC values (Busard et al, 2010).…”