Department of Radiological, Oncological and Pathological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy.
Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy.
Minerva Obstet Gynecol. 2021 Oct;73(5):553-571. doi: 10.23736/S2724-606X.21.04782-1. Epub 2021 Apr 27.
Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI).
A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and pelvic pain" OR "endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review.
TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance, but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in preoperative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities.
Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
子宫内膜异位症影响 10%-15%的育龄妇女，可能导致非周期性慢性盆腔疼痛、痛经、性交困难、尿路症状，且常与不孕相关。发病高峰在 24-29 岁之间，子宫内膜异位症的临床诊断通常延迟 6-7 年。腹腔镜手术活检是子宫内膜异位症的“金标准”，具有子宫内膜异位腺体和/或基质的组织学验证。然而，目前有两种不同的非侵入性方法常规用于推测性诊断：经阴道超声（TVUS）和磁共振成像（MRI）。
从 2020 年 10 月开始，我们使用 PubMed 进行了结构化搜索，纳入了自 2000 年以来发表的所有相关原始和综述文章。搜索使用了以下关键词组合：“子宫内膜异位症 MRI”和“深部浸润型子宫内膜异位症和 MRI”（45）；“MRI 子宫内膜异位症和盆腔疼痛”或“子宫内膜异位症和 MRI 技术发展”（296）。最终，有 87 篇文章被认为是相关的，并作为本综述的文献基础。
TVUS 是子宫内膜异位症的首选影像学检查方法，具有良好的诊断性能，但高度依赖操作者。MRI 是 TVUS 检查结果不确定或术前计划的复杂病例的二级检查。MRI 被认为是子宫内膜异位症的最佳影像学技术，因为它比体格检查和经阴道超声更可靠地绘制深部浸润型子宫内膜异位症的地图。我们分析并描述了主要的子宫内膜异位症形式：附件子宫内膜异位症、子宫腺肌病、腹膜种植和深部浸润型子宫内膜异位症，展示了它们在这两种影像学模式下的表现。
子宫内膜异位症是最常见的妇科疾病之一，与慢性盆腔疼痛相关，其治疗至今仍很复杂且存在争议。在这种情况下，MRI 已成为一种重要的额外非侵入性工具，可用于调查与深部浸润型子宫内膜异位症（DIE）相关的慢性盆腔疼痛病例，无论是否有神经受累。
