From the Mayo Clinic Rochester, 200 1st Street SW, Rochester, MN 55905 (W.V.B., T.L.B., Z.K., C.C., P.I.C.A.); Cleveland Clinic, Cleveland, Ohio (M.F., C.K., M.P.); Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.S.S.B., A.K.); University of Michigan, Ann Arbor, Mich (M.D.S.); Mayo Clinic Arizona, Phoenix, Ariz (S.Y., M.Y.); Chamie Imagem da Mulher, São Paulo, Brazil (L.P.C.); University of California San Francisco, San Francisco, Calif (L.G., J.T.R., L.P.); NYU Grossman School of Medicine, New York, NY (N.M.H., A.T., M.T.T.); David Geffen School of Medicine, Los Angeles, Calif (H.D.D.); University of Arizona College of Medicine Phoenix/Banner University Medical Center-Phoenix (R.M.K.); Stanford University School of Medicine, Stanford, Calif (L.S.); Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (K.S.B.); Clinic Izabela Pires Franco, Belém, Brazil (I.V.P.F.); Temerty Faculty of Medicine (P.G.), University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Thomas Jefferson University Hospital, Philadelphia, Pa (L.M.K.); University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.B.); University of Arizona College of Medicine, Banner University Medicine, Tucson, Ariz (H.A.T.); Columbia University Irving Medical Center, New York, NY (S.L.N.); SUNY Upstate Medical University, Syracuse, NY (R.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.).
Radiology. 2024 Sep;312(3):e233482. doi: 10.1148/radiol.233482.
Endometriosis is a common condition impacting approximately 190 million individuals and up to 50% of women with infertility globally. The disease is characterized by endometrial-like tissue located outside of the uterine corpus, which causes cyclical hemorrhage, inflammation, and fibrosis. Based on clinical suspicion or findings at routine transvaginal pelvic US or other prior imaging, dedicated imaging for endometriosis may be warranted with MRI or advanced transvaginal US. Deep endometriosis (DE) in the pelvis includes evaluation for stromal and fibrotic components and architectural distortion resulting from fibrosis and tethering. It is a disease requiring a compartment-based, pattern-recognition approach. MRI has the benefit of global assessment of the pelvis and is effective in assessing for features of malignancy and for evaluating extrapelvic locations. Transvaginal US has the advantage of dynamic maneuvers to assess for adhesions and may achieve higher spatial resolution for assessing the depth of bowel wall invasion. T1-weighted MRI evaluation increases the specificity of diagnosis by identifying hemorrhagic components, but the presence of T1 signal hyperintensity is not essential for diagnosing DE. Endometriosis is a disease with a broad spectrum; understanding the mild through advanced manifestations, including malignancy evaluation, is within the scope and breadth of radiologists' interpretation.
子宫内膜异位症是一种常见疾病，影响着全球约 1.9 亿人，其中多达 50%的不孕女性患有该病。该病的特征是子宫内膜样组织位于子宫体外部，导致周期性出血、炎症和纤维化。基于临床怀疑或经阴道超声常规盆腔检查或其他先前影像学检查发现，可能需要 MRI 或高级经阴道超声检查来专门评估子宫内膜异位症。盆腔深部子宫内膜异位症（DE）包括评估基质和纤维组织成分以及纤维化和束缚引起的结构扭曲。这是一种需要基于腔室的、模式识别方法的疾病。MRI 具有评估整个盆腔的优势，在评估恶性特征和评估盆腔外位置方面非常有效。经阴道超声具有评估粘连的动态操作的优势，并且可以实现更高的空间分辨率来评估肠壁侵犯的深度。T1 加权 MRI 评估通过识别出血成分增加了诊断的特异性，但 T1 信号高信号的存在对于诊断 DE 并非必不可少。子宫内膜异位症是一种具有广泛谱的疾病；了解从轻度到重度的表现，包括恶性肿瘤评估，属于放射科医生解释的范围和广度。
