الفهرس 
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Abstract
Endometriosis represents a common cause of pelvic pain and infertility in young women. The exact prevalence of endometriosis is unknown, but it is estimated that 10% of the female population in the reproductive age may be affected by endometriosis. Surgery remains the best treatment option for endometriosis, so preoperative evaluation to assess the extent of disease is essential. However, the diagnostic value of transvaginal sonography (TVS) for the assessment of deep pelvic endometriosis and superficial peritoneal lesions is unclear, but it is surely recommended as the first imaging modality done to evaluate patients with suspected endometriomas and endometriosis of bladder. Magnetic resonance imaging (MRI) is a non-invasive, non-ionizing radiation method, offering high contrast resolution, which allows multiplanar evaluation of endometriosis, thus facilitating a correct diagnosis and appropriate treatment. The aim of this work is to highlight the role of Functional magnetic resonance imaging (MRI) of the pelvis in diagnosis of endometriosis. The functional magnetic resonance imaging include Diffusion weighted image (DWI), suscepitiblity weighted image (SWI) and dynamic contrast enhanced MRI in suspected cases. This prospective study was conducted on thirty patients (their age ranged from 18 to 45 years) who Clinicaly or ultrasongraphicallhy suspected to have pelvic endometriosis, referred from gynachology outclinics to Radiodiagnosis and Medical Imaging department during the period from April 2020 to April 2022. All the selected cases were subjected to the following: full history talking, clinical examination and, trans vaginal Ultrasonography, conventional MRI and Functional MRI. MRI was performed on a 1.5 T system on MR unit of Diagnostic Radiology and Medical Imaging department of Tanta University Hospitals. The protocol included T2-weighted fast spin-echo sequences in the sagittal, axial, and coronal planes and T1-weighted fast spin-echo sequences in the sagittal, axial, and coronal planes with and without fat saturation. T1- weighted fast spin-echo axial sequences after injection of gadolinium (0.1 mmol /Kg of gadolinium chelate) were done for some cases and a Spectral Presaturation Inversion Recovery (SPIR) technique was done for some cases. DWI and SWI were done in all cases, DC MRI were added in some cases with atypical finding or suspected cases. Out of 30 patients in this study, there were 10 patients proved to be with adenomyosis, 9 patients with ovarian endometriosis, 1 patient with Tubal endometriosis, 2 patients with cs endometriosis and 5 patients with deep infilterationg endometriosis (2 involving rectum ,1 involve cecum ,1 in utrosacral ligament and 1 involve urinary bladder). Transvaginal ultrasonography diagnosed adenomyosis and ovarian endometrioma with 90% accuracy. But it could not diagnose the cases with tubal endometriosis. MRI considered the best method for detection of various types of endometriosis with the highest accuracy (100%). Functional MRI has very significant value especiallay SWI in assessment of deep infilterating endometriosis as this lesion usually has different signal criteria but all have the characterstic hemorrhagic content which give signal voids in SWI. MRI results were correlated with surgical findings in patients who underwent laparoscopy. 90% of the endometriosis lesions had restricted diffusion on DWI, and 100% of the endometriosis lesions had signal losses on the SWI sequence, whereas only 80% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the SWI sequence, compared to the conventional MR protocol. The conventional MRI gave 81.4% sensitivity, 33.3% specificity, 91.7% PPV, 16.7% NPV and 76.7 accuracy according to laparoscopic ana Histopathological examination. Functional MRI gave 96.3% sensitivity, 100% specificity, 100% PPV, 75% NPV and 96.7 % accuracy.