الفهرس 
Anatomical BackgroundOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
Endometriosis is an important gynecologic disorder that
is responsible for severe pelvic pain, for which surgery remains
the best therapeutic option. Because successful treatment
requires lesion removal with radical surgery, the accurate
preoperative assessment of the extension of endometriotic
disease is extremely important.
Peritoneal fibrotic nodules, ovarian cysts with old
hemorrhagic content, and adhesions are the most representative
findings of the disease.
Clinical evaluation and various sonographic approaches
are not sufficiently sensitive to detect deep implants of
endometriosis. Furthermore, exploratory laparoscopy is limited
in demonstrating deep endometriotic lesions that may be hidden
by adhesions or located in the subperitoneal space.
Pelvic MRI is a non invasive method with high spatial
resolution that allows multiplanar evaluation and good tissue
characterization, but without the use of ionizing radiation or
iodinated contrast agents. MRI demonstrates high sensitivity,
specificity, positive and negative predictive values, and
accuracy in prediction of the locations and in evaluation of the
extension of lesions in patients with this disease. All the
information offered by MRI is useful in planning the best
treatment, surgical or medical, for the disease. Recently, investigators have applied, diffusion weighted
imaging (DWI), susceptibility weighted imaging (SWI), and
dynamic contrast enhanced (DCE) MRI in order to improve the
diagnostic performance of MRI in detecting atypical findings of
endometriotic lesions and malignant transformation.
Depending on the fact that endometriotic nodules are
ectopic endometrial tissue, they have the same vascularity, and
hence the same DCE-MRI features and pattern of enhancement.
Adding DWI as well as the quantitative value of ADC to
the conventional MRI may help in differentiating benign from
malignant nodules and functional ovarian cysts from
endometriotic cysts.
SWI may help in diagnosis of atypical endometriomas by
depicting hemosiderin deposition along the cyst wall of
endometriomas.
Although all these recent modalities added to the
conventional MRI have shown promising preliminary results,
yet they still need many research works to determine their cost
effectiveness and to put a fixed protocol for diagnosis and
clinical guidelines for patients with endometriosis.
The suggested imaging algorithm for patients in whom
the presence of endometriosis is suspected is demonstrated in
the following charts: