Discussion of Endometriosis
- Classically defined as the presence of ectopic functional endometrial glands and stroma (outside the uterine cavity).
- It may vary from microscopic endometriotic implants to large cysts (endometriomas).
- The most widely accepted theory is that endometriosis results from metastatic implantation from retrograde menstruation.
- Endometriomas generally occur within the ovaries and are the result of repeated cyclic hemorrhage within a deep implant.
- Symptoms associated with endometriosis include infertility and pelvic pain.
- Endometriosis is found in 25%–50% of infertile women
- 30%–50% of women with endometriosis are infertile.
- Laparoscopy is the mainstay for diagnosis, staging, and treatment of the disease.
 Imaging Findings for Endometriosis
- Radiologic evaluation of small endometriotic implants is limited; therefore, the radiologist's role is generally to identify and evaluate endometriomas.
- Adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present.
- The diagnostic MR imaging findings for ovarian endometriomas are:
- Adnexal cysts of high signal intensity on both T1- and T2-weighted images or
- T2 shading: High signal intensity on T1-weighted images and low signal intensity on T2-weighted images (shading). The dense concentration of cyclic hemorrhage and the high viscosity of the contents in the endometrioma cause T2 shortening and produce shading.
- These adnexal lesions are often multiple.
Patient #1: Endometrioma
Patient #2: Endometrioma
Patient #3: MR images demonstrate multiple endometriomas
 See Also
 External Links
 References for Endometriosis
- Izumi Imaoka, Akihiko Wada, Michimasa Matsuo, Masumi Yoshida, Hajime Kitagaki, and Kazuro Sugimura. MR Imaging of Disorders Associated with Female Infertility: Use in Diagnosis, Treatment, and Management. RadioGraphics 2003 23: 1401-1421.
- Paula J. Woodward, Roya Sohaey, and Thomas P. Mezzetti, Jr. Endometriosis: Radiologic-Pathologic Correlation. RadioGraphics 2001 21: 193-216.