Deep Infiltrating Endometriosis And Abdominal MRI Performance

Objective:Deep pelvic endometriosis is an important gynecologic disorder that is responsible for severe pelvic pain and is defined as subperitoneal invasion that exceeds5mm in depth. The aim of this retrospective study was to explore the characteristics of deep infiltrating endometriosis on MRI (magnetic resonance imaging) and offer a useful tool for diagnosis.Methods:The clinical and MRI data of21patients with deep infiltrating endometriosis between Juanary,2008and Juanary,2013were retrospectively collected and analyzed. MRI imaging of the pelvis was performed at1.5Tesla using a eight-channel pelvic phased-array coil. Sequences included fast spin echo (FSE) T2-weighted imaging (T2WI)[repetition time (TR)/echo time (TE):2500-4000ms/60-100ms, number of acquisitions:2] in the axial, sagittal and coronal planes, and spin echo (SE) T1-weighted imaging (T1WI)[400-600/10-20, number of excitations (NEX):2] in the axial plane. Slice thickness varied from3mm to7mm with a1mm interslice gap. Matrix size was256X256and field of view (FOV) ranged from250mm to300mm. Fat-suppressed spin echo T2-weighted imaging was required when necessary. Deep infiltrating endometriosis was analyzed for location, morphologic abnormalities, appearance on T1-weighted and T2-weighted imaging with and without fat suppression and coexistent abnormality was also recorded.Results:On MRI, deep infiltrating endometriosis mainly affected the uterosacral ligaments, vagina, pouch of Douglas, and rectum. The ureter was also involved sometimes. The main manifestations included the abnormalities of signal intensity and morphology, the deformation and tethering of surrounding organs and tissues as well as the irregular thickening of involved lesions or the formation of solid nodules. In this study, the uterosacral ligaments were involved in12cases (42.9%), the vagina was infiltrated in16cases (76.2%), lesions of3cases (14.3%) were located in the cul-de-sac, the rectum was invaded in7cases (33.3%) and ureteral involvement were present in2cases (9.5%).Conclusions:MRI manifestations of deep infiltrating endometriosis can provide information of the anatomic locations and the lesion extension, which is an important method for examination before surgery and follow-up after surgery. Objective:Abdominal wall endometriosis (AWE) is a special type of extra-pelvic endometriosis, which usually develops after cesarean section. Abdominal wall endometriosis is often difficult to diagnose, mimicking a broad spectrum of diseases. The aim of this retrospective study was to describe the appearance of AWE on magnetic resonance imaging and offered a useful tool for diagnosis.Methods:The clinical and MRI data of7patients (10lesions) with abdominal wall endometriosis between Juanary2008and Juanary2013were retrospectively collected and analyzed. MRI imaging of the pelvis was performed at1.5Tesla (Signa EXCITE Twin Speed HD, GE,USA) using a eight-channel pelvic phased-array coil. Sequences included fast spin echo (FSE) T2-weighted imaging (T2WI)[repetition time (TR)/echo time (TE):2500-4000ms/60-100ms, number of excitations (NEX):2] in the axial, sagittal and conoral planes, and spin echo (SE) T1-weighted imaging [400-600/10-20, number of excitations:2] in the axial plane. Slice thickness varied from3to7mm with a lmm interslice gap. Matrix size was256X256and field of view (FOV) ranged from250to300. AWE was analysed for number, location, size, appearance on T1-weighted and T2-weighted imaging with and without fat suppression and coexistent abnormality was also recorded.Results:The age of these7patients ranged from30-39years,and average age was36.0±3.2years. All of them had a history of cesarean section Mean time between a abdominal bump and surgery ranged from1month to48months. Five of the lesions were single and two were multifocal. Ten AWE lesions were found in7patients. Seven out of ten lesions were located in the left, two in the middle and one in the right. Five lesions were located in the subcutaneous tissue and fascia, the abdominal muscle were invaded in four lesions and one was located in the subcutaneous tissue fascia and muscle. The size of the lesions ranged from20.6mm*14.8mm to34.9mm*12.1mm in the axial plane and from19.4mm to44.3mm in the craniocaudal plane. Endometrial invasion from the scar into the abdominal cavity was observed in two patients, with anterior wall and fundus of the uterus for one patient and anterior wall of bladder for another woman. Nine lesions were solid and mainly showed isointense or hyperintense signal on T1WI and T2WI compared with muscle with foci of higher intensity on T2WI. Small foci of high intensity was observed in two lesions on T1WI. One patient had small foci of low signal intensity on T1WI and T2WI. In one patient a cystic hyperintense lesion was found on T1WI (including shading on T2WI). Coexistent abnormality was observed in five patients (71.4%), including adenomyosis in three, uterine malformation in two and fibroid in one patient. Conclusions:MRI manifestations of abdominal wall endometriosis can provide information of the anatomic location and the lesion extension, and the intensity can be characteristic in some circumstances, which is an important method for examination before surgery and follow-up after surgery.