Endometriosis

Question 1

T1 and T2

Answer 1

Endometriomas tended to have higher T1 and lower T2 signal intensities than hemorrhagic cysts.

Question 2

DWI

Answer 2

The presence of restricted diffusion and low ADC values within an adnexal lesion does not have a high positive predictive value or specificity for the diagnosis of malignanc

Question 3

Other pelvic lesions with restricted diffusion?

Answer 3

Benign hemorrhagic ovarian cysts, endometriomas, and solid endometrial implants, as well as benign mature cystic teratomas also demonstrate restricted diffusion

Question 4

DWI low B values

Answer 4

On a diffusion- weighted image obtained with a low b value, which is a type of T2-weighted fat-suppressed image, an endometrioma exhibits low signal intensity resembling T2 shading

Question 5

Endometrioma

T2 low and ADC low

Answer 5

In a study evaluating both endometriomas and solid endometrial implants, Busard and colleagues showed a significant correlation between the T2 signal intensity ratio (ie, the signal intensity of the endometriomas or implants divided by the signal intensity of muscle) and the ADC value

Question 6

Hematosalpinx

Answer 6

Should be considered specific for pelvic endometriosis

Question 7

Dilated fallopian tube

Answer 7

The most common cause of a dilated fallopian tube encountered at pelvic imaging is pelvic inflammatory disease

In acute pelvic inflammatory disease, a dilated fallopian tube is usually a pyosalpinx

Dilated fallopian tubes
secondary to pelvic inflammatory disease do not
exhibit T1 shortening at MR imaging

Question 8

Multiple T1-
Hyperintense Adnexal Cysts

Answer 8

Specific for Endometriomas

Question 9

Benign Endometriomas Show Restricted Diffusion

Answer 9

Endometriomas have low ADC values in part because of “T2 blackout effects”

Question 10

30% of women with endometriosis demonstrating tubal involvement at laparoscopy

Answer 10

In women with endometriosis and a dilated
fallopian tube, approximately 40% of the tubes
had T1-hyperintense contents, whereas 60% had imaging features suggestive of a simple hydrosalpinx

Question 11

T2 shading may be absent in these
cases because women with endometriosis develop dilated fallopian tubes secondary to endometrial implants on the serosal surface of the tubes, as opposed to implants within the tubes

Answer 11

T2 shading may be absent in dilated fallopian tubes in endometriosis because endometriosis
dilates tubes by causing implants on the serosal surface of the tubes, as opposed to implants within the tubes.

Question 12

Müllerian duct anomalies and endometriosis

Answer 12

A subset of women with müllerian duct anomalies that cause obstruction of
antegrade menstruation are considered to have an increased risk for endometriosis

Unicornuate uterus with a noncommunicating rudimentary horn,
or uterus didelphys with a transverse
vaginal septum

Question 13

MR imaging is an ideal modality for evaluating primary amenorrhea in girls, as well as suspected uterine anomalies in women

Answer 13

If there is an obstruction, MR imaging can localize it, determine which segments of the reproductive tract are distended with blood, and determine whether endometriomas and other manifestations of endometriosis are present

Question 14

Hematometrocolpos (blood in the vagina), hematosalpinx, and endometriomas in a 15-year-old girl with?

Answer 14

Obstructing transverse vaginal septum

Question 15

Decidualized Endometriosis May Mimic Ovarian Malignancy in Pregnant Women

Answer 15

Endometrial stromal cells within endometriomas may respond to the hormonal changes of pregnancy by forming vascular
mural nodules ~ malignancy

Question 16

Decidualized endometriosis has
been described as a mimic of ovarian cancer at
ultrasonography (US) and MR imaging

Answer 16

Mural nodules with T2 high signal intensity within the endometriomas represent decidualized endometriosis

MR imaging feature that may be specific
for decidualized endometriosis is the T2 signal
hyperintensity of the mural nodules, which have similar signal to the thickened decidualized
endometrium

After childbirth or termination of a pregnancy, decidualized endometriosis has been reported to either resolve or regress to uncomplicated endometriomas

Question 17

Endometriomas Can
Transform into Clear Cell or Endometrioid Epithelial Ovarian Carcinomas

Answer 17

Risk for:
Clear cell and
Endometrioid Epithelial Ovarian Carcinomas

Question 18

2.5% of women with endometriosis develop
ovarian cancer

Answer 18

Clear cell and

Endometrioid Epithelial Ovarian Carcinomas

Question 19

Endometriosis-associated ovarian cancer have a better or worse prognosis?

Answer 19

endometriosis-associated ovarian cancer have a better prognosis (lower grade tumors and found at earlier stage)

than woman with ovarian cancer without endometriosis

Question 20

CA-125 elevated in endometriosis?

Answer 20

Endometriosis is one of several benign causes of an abnormal CA-125 level

Question 21

MR imaging features suggestive of
malignant endometriomas?

Answer 21

Increase in size

Increase T2-weighted signal intensity of an endometrioma

*Enhancing mural nodules (more specific)

Question 22

*Solid Fibrotic 
Masses of Endometriosis Are
Common and Easily Overlooked
(Teaching Point)

Solid Endometriosis =

Deep Pelvic Endometriosis

or Deeply Infiltrative
Endometriosis

Answer 22

Although most endometriomas are easily recognized on the basis of their T1 hyperintensity, solid masses of endometriosis can easily be overlooked

Part of the challenge in their recognition is due
to the fact that solid endometriosis

has low T2 signal intensity and may be located adjacent to normal T2-hypointense structures

Question 23

Deep pelvic or infiltrative endometriosis

> 5 mm.

Answer 23

Defined by the extension
of endometrial glands and stroma
*at least 5 mm beneath the peritoneal surface

Question 24

Unlike endometriomas, which contain viscous proteinaceous and hemorrhagic contents,

Solid masses of endometriosis are composed of ectopic endometrial gland and stromal cells embedded within dense fibrous tissue and smooth muscle.

Answer 24

The typical appearance of solid endometriosis can be appreciated by looking at

adenomyosis, also known

as *endometriosis interna

Question 25

Unlike endometriomas, which contain viscous proteinaceous and hemorrhagic contents,

Solid masses of endometriosis are composed of ectopic endometrial gland and stromal cells embedded within dense fibrous tissue and smooth muscle.

Answer 25

The typical appearance of solid endometriosis can be appreciated by looking at

adenomyosis, also known

as *endometriosis interna

Question 26

Uterine adenomyosis appears as poorly marginated tissue with T2 hypointensity and ?

Answer 26

variable internal 1–4-mm foci with T2 hyperintensity

Question 27

1) Poorly marginated soft tissue with T2 hypointensity

2) Internal foci with T2 hyperintensity (1-4 mm)

Answer 27

The former represents hypertrophied smooth
muscle and fibrous tissue,

and the latter represent ectopic endometrial glands.

Question 28

Unlike endometriomas, which contain viscous proteinaceous and hemorrhagic contents,

Solid masses of endometriosis are composed of ectopic endometrial gland and stromal cells embedded within dense fibrous tissue and smooth muscle.

Answer 28

The typical appearance of solid endometriosis can be appreciated by looking at

adenomyosis, also known as

endometriosis interna

Question 29

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