From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.).
Radiographics. 2024 Jan;44(1):e230106. doi: 10.1148/rg.230106.
Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.
子宫内膜异位症是一种常见的疾病，主要影响出生时被指定为女性的人群。子宫内膜异位症最常见的临床症状是疼痛。尽管这种疼痛的机制尚未完全了解，但在某些情况下，神经直接参与了子宫内膜异位症的发生。子宫内膜异位症是一种多灶性疾病，骨盆是最常见的受累部位。骨盆内的神经可能会被卷入并参与子宫内膜异位症的发生。骨盆神经在骨盆 MRI 上可见，尤其是在为神经评估量身定制的成像平面和序列中。特别是，高空间分辨率解剖成像，包括三维各向同性成像和对比增强三维短反转时间反转恢复（STIR）快速自旋回波序列，对神经成像很有用。最常受累的神经是坐骨神经、闭孔神经、股神经、阴部神经和下腹下丛神经以及下腹下丛和腰骶丛。虽然认为这种情况很少见，但子宫内膜异位症中神经受累的真实发生率尚不清楚。神经受累的症状包括疼痛、无力、麻木、失禁和截瘫，可能是持续的或周期性的（月经周期性）。早期诊断子宫内膜异位症中的神经受累对于防止不可逆的神经损伤和慢性感觉运动神经病很重要。MRI 也可以发现不可逆损伤的证据，放射科医生应该在其搜索模式和报告模板中评估常见于子宫内膜异位症的骨盆神经，以确保将这些信息纳入治疗计划中。
