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Imaging features of pelvic endometriosis

Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK

View larger version (104K): [in a new window]   Figure 1. Transabdominal ultrasound showing a multiloculated right ovarian endometrioma containing low level echoes.

View larger version (182K): [in a new window]   Figure 2. Oral and intravenous contrast enhanced CT through the pelvis showing partly solid, partly cystic mass posterior to the uterus and anterior to the rectosigmoid junction (arrowheads). This was an endometrioma.

View larger version (78K): [in a new window]   Figure 3. Multiloculated left ovarian endometrioma showing (a) high signal intensity on T1 weighted spin echo axial image and (b) low signal intensity on T2 weighted turbo spin echo image (arrowheads), in keeping with the products of haemorrhage.

View larger version (77K): [in a new window]   Figure 4. The left pelvic endometrioma (arrow) is barely perceptible on the standard T1 weighted spin echo (T1WSE) axial image (a), but is much better appreciated as an area of high signal intensity on the T1WSE fat suppressed sequence (b) owing to the presence of methaemoglobin.

View larger version (83K): [in a new window]   Figure 5. Endometriosis of the round ligament. (a) T1 weighted spin echo (T1WSE) fat suppressed and (b) post-contrast T1WSE fat suppressed sequence showing enhancement of both round ligaments (arrows) owing to inflammation secondary to endometriosis. Note the two large endometriomas containing the products of haemorrhage anterior to the uterus and posterior to the right round ligament (arrowheads).

View larger version (90K): [in a new window]   Figure 6. Endometriosis of the serosal surface of the uterus. T1 weighted spin echo (T1WSE) (a) and T2 weighted turbo spin echo (T2WTSE) (b) sagittal images of the uterus showing mixed high and low signal foci on the posterior superior surface of the uterus (arrowheads) on T1WSE, which are of high signal intensity on T2WTSE.

View larger version (89K): [in a new window]   Figure 7. Endometriosis of the uterus. (a) T2 weighted turbo spin echo (T2WTSE) sagittal image of the uterus showing diffuse thickening of the junctional zone (low signal intensity area) with multiple areas of high and low signal intensity in the myometrium (arrows), which remained high signal on T1 weighted spin echo (T1WSE) sequences (not shown here). Areas of mainly high signal intensity on the posterior lip of the cervix on T2WTSE as well as intermediate signal intensity on the axial T1WSE (b) sequences may represent either a further area of endometriosis or a Nabothian cyst.

View larger version (144K): [in a new window]   Figure 8. Endometriosis of the rectovaginal septum. T2 weighted turbo spin echo sagittal image showing high signal intensity in the region of the rectovaginal septum (arrow), which was also of high signal on T1 weighted spin echo images (not shown here).

View larger version (103K): [in a new window]   Figure 9. Endometriosis in the pouch of Douglas. High signal intensity foci on (a) T1 weighted spin echo and (b) T2 weighted turbo spin echo sagittal sequences owing to extracellular methaemoglobin (arrows).

View larger version (70K): [in a new window]   Figure 10. Endometriosis of the bowel. (a) Double contrast barium enema examination showing extrinsic compression and puckering of the serosa (arrows) in the region of the rectosigmoid junction. (b) T1 weighted spin echo (T1WSE) and (c) T2 weighted turbo spin echo (T2WTSE) axial images through the pelvis of the same patient showing a left-sided multiloculated endometrioma (arrowheads) displaying high signal intensity and low signal intensity shading centrally on T1WSE and T2WTSE images, respectively. There are also multiple cysts in the right ovary.

View larger version (78K): [in a new window]   Figure 11. Bladder endometriosis. (a) Bladder view from an intravenous urography examination showing irregularity of the dome of the bladder. (b) Coronal T1 weighted spin echo image of the same patient showing an endometrial implant in the wall of the bladder dome containing foci of high signal intensity. A further area of high signal intensity in the uterus is in keeping with adenomyosis.