Pelvic Endometriosis: A MR Pictorial Review

Rosario Francesco, Riccardo Del, Roberto Luigi, B. Zobel Beomonte
In: Endometriosis - Basic Concepts and Current Research Trends · 2012 · doi:10.5772/31395 · W1600490291
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This review examines the imaging characteristics of pelvic endometriosis, a common gynecological condition defined by ectopic endometrial tissue that can cause pain and infertility.

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This chapter provides a pictorial review of magnetic resonance imaging findings associated with pelvic endometriosis. It details the characteristic MRI appearances of various endometriotic lesions, including ovarian endometriomas and deep infiltrating disease, to aid in radiological diagnosis. The authors emphasize the utility of MR imaging in evaluating the extent of disease and its relationship with surrounding pelvic structures. This paper is centrally about endometriosis — specifically focusing on the diagnostic imaging characteristics of pelvic lesions.

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Abstract

IntroductionEndometriosis is one of the most common benign gynaecological conditions.It is defined as the presence of ectopic endometrial glands and stroma outside the uterus.The ectopic endometrium responds to hormonal stimulation with a cyclic hemorrhage, resulting in a complex spectrum of symptoms.Pain is the cardinal symptom of endometriosis, even though patients may experience several different types of pain, such as dysmenorrhea, deep dyspareunia, discomfort during defecation or while urinating, according to the anatomic location of this disorder.Endometriotic implants, pelvic adhesions and ovarian endometriomas are commonly associated with chronic pelvic pain.Haemorrhage into an endometrioma may result in acute pain.Infertility is another commonly associated complaint.The exact prevalence of endometriosis is not well defined, as the diagnostic gold standard is represented by laparoscopy or laparotomy.It is estimated about 5-10%, including both symptomatic and asymptomatic women.Nulliparous women and women reporting short and heavy menstrual cycles are at increased risk [1]; these epidemiological findings support the metastatic implantation from retrograde menstruation hypothesis.Other theories include the metaplastic differentiation of serosal surfaces or müllerian remnant tissue, and the induction of undifferentiated mesenchyme to form endometriotic tissue due to released substances from the shed endometrium (induction theory) [2].The most common locations of endometriosis are the ovaries and the pelvic peritoneum, followed in order of decreasing frequency by deep lesions of the pelvic subperitoneal space, the intestinal system and the urinary system.Deep pelvic endometriosis is a pathologically distinct entity: deep endometriotic lesions penetrate under the surface of peritoneum (infiltration > 5mm) and are tipically found in the uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder, and induce a fibromuscolar hyperplasia that surrounds endometriosis foci [3].The diagnosis of endometriosis still remains a challenge for clinicians, resulting from similarities in clinical symptoms to other benign or malignant gynaecological diseases.Laparoscopy is the standard of reference in the diagnosis of endometriosis; histological analysis of biopsy specimens should confirm the diagnosis, even if it is not necessary.On the other hand, laparoscopy is also required for staging the disease.The most widely used staging system is the 1985 Revised Classification of Endometriosis
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Open access Submitted: 30 March 2011 Published: 09 May 2012 DOI: 10.5772/31395 From the Edited Volume Edited by Koel Chaudhury and Baidyanath Chakravarty Submitted: 30 March 2011 Published: 09 May 2012 © 2012 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Discover 2026 Nobel Laureate Francis Halzen’s chapter on IntechOpen >

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endometriosisendometriomachronic_pelvic_paindysmenorrheadyspareuniainfertility

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