Ruaux Edouard, VanBuren Wendaline M, Nougaret Stéphanie, Gavrel Marie, Charlot Mathilde, Grangeon Flavia, Bolze Pierre-Adrien, Thomassin-Naggara Isabelle, Rousset Pascal
Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France.
Department of Radiology, Mayo Clinic, Rochester, MN55905, USA.
Insights Imaging. 2024 Jan 25;15(1):20. doi: 10.1186/s13244-023-01588-2.
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results. Critical relevance statement MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars. Key points • MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
子宫内膜异位症是育龄期女性常见的致残性疾病。磁共振成像（MRI）被认为是子宫内膜异位症诊断和管理的基石性放射学技术。虽然其敏感性，尤其是在深部浸润性子宫内膜异位症中，优于超声检查，但存在许多假阳性结果的来源，导致缺乏特异性。T2加权图像上的低信号病变或假病变包括解剖变异、纤维结缔组织、良性和恶性肿瘤、粪便、手术材料以及治疗后瘢痕，这些可能会模仿深部盆腔浸润性子宫内膜异位症。假阳性结果可能对患者管理产生重大影响，从诊断到药物或手术治疗。这篇教育性综述旨在帮助放射科医生认识深部盆腔浸润性子宫内膜异位症的MRI标准、陷阱及鉴别诊断，以减少假阳性结果。关键相关性声明：深部浸润性子宫内膜异位症的MRI假阳性率为23%，会导致误诊。T2低信号病变主要由解剖变异、纤维结缔组织、良性和恶性肿瘤、粪便、手术材料以及治疗后瘢痕引起。要点：• 深部浸润性子宫内膜异位症的MRI假阳性率为23%，可能导致误诊。• 解剖变异、纤维结缔组织、肿瘤及手术改变是T2低信号模仿物的主要来源。• 多序列解读、形态学评估及精确的解剖定位对于防止过度诊断至关重要。• 钆注射仅在特定情况下有助于评估子宫内膜异位症的鉴别诊断。
