Endometriosis MR mimickers: T1-hyperintense lesions

Abstract

Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers. Graphical Abstract

Targeted nanoparticles for imaging and therapy of endometriosis

“…Hemorrhagic components associated with endometriosis lead to hyperintense T1 and T2-weighted MR images (T1WI/T2WI) of endometriotic lesions [ 51 ]. While the sensitivity of T1/T2 imaging is superior to that of ultrasonography and PET/CT for deep infiltrating endometriosis, anatomical and histologic variation can produce a wide range of false-positive results [ 52 , 57 , 58 ]. These include fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post-treatment scars.…”

“…These include fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post-treatment scars. Therefore, contrasting T1 and T2-weighted images combined with T1 contrast agents such as paramagnetic gadolinium complexes can improve lesion resolution [ 57 ].…”