Ghosh Soumyadeep, Alhamshari Ahmad, Prajapati Priyanka, Nakrour Nabih, Carnelli Carlos, Kilcoyne Aoife, Harisinghani Mukesh G, Tsai Leo L, Catalano Onofrio A, Kambadakone Avinash, Shenoy-Bhangle Anuradha S
Massachusetts General Hospital, Boston, USA.
University of the Republic, Montevideo, Uruguay.
Abdom Radiol (NY). 2025 Mar 27. doi: 10.1007/s00261-025-04907-x.
Endometriosis is a chronic systemic disease characterized by the presence of endometrium-like glands and/or stroma outside the uterus, usually with an associated inflammatory process. It affects around 5-10% of women worldwide, with chronic pelvic pain and infertility being the predominant symptoms. Although suspected clinically, transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) are the primary imaging tools for diagnosing pelvic endometriosis, as well as helping in pre-surgical mapping. Computed tomography (CT) is not the preferred imaging modality for detection or depiction of disease extent. However, CT of the abdomen and pelvis is often performed as the initial imaging test in women presenting with acute or non-specific abdominal/ pelvic pain. CT features of endometriosis can vary depending on the organ affected, and the correct diagnosis is often not suspected due to its nonspecific CT appearance and overlap with other pathologies. Ovarian endometriomas (OMAs), the most recognized phenotype of endometriosis, may appear as hyperdense adnexal masses either in the expected location of the ovaries or positioned posterior to the uterus. Endometriomas may rupture, presenting with hemoperitoneum. The uterus may be distorted and acutely retroflexed from deep endometriosis along the posterior uterine surface. The bowel can be affected by endometriosis, especially the rectosigmoid colon, presenting as enhancing soft tissue bridging from the posterior uterine surface to the anterior rectal wall. Small bowel involvement may present with recurrent small bowel obstructions. Involvement of the urinary system may present with ureteral obstruction or a bladder wall mass. Given such varied appearances, a high degree of clinical suspicion and knowledge of CT features suggestive of endometriosis is required to facilitate an early diagnosis. This review paper therefore describes the imaging findings of endometriosis that can be recognized on an abdominopelvic CT, with the goal of decreasing the existing delay to accurate diagnosis and improving long term patient outcomes.
子宫内膜异位症是一种慢性全身性疾病，其特征是子宫外存在类似子宫内膜的腺体和/或间质，通常伴有炎症过程。全球约5%-10%的女性受其影响，主要症状为慢性盆腔疼痛和不孕。尽管临床上可怀疑，但经阴道超声（TVUS）和磁共振成像（MRI）是诊断盆腔子宫内膜异位症的主要影像学工具，也有助于术前定位。计算机断层扫描（CT）不是检测或描绘疾病范围的首选影像学方式。然而，腹部和盆腔CT常作为出现急性或非特异性腹部/盆腔疼痛的女性的初始影像学检查。子宫内膜异位症的CT表现因受累器官而异，由于其CT表现不具特异性且与其他病变有重叠，往往无法正确诊断。卵巢子宫内膜异位囊肿（OMA）是子宫内膜异位症最典型的表现，可表现为卵巢预期位置或子宫后方的高密度附件肿块。子宫内膜异位囊肿可能破裂，导致腹腔积血。子宫可能因子宫后表面深部的子宫内膜异位症而变形并急性后屈。肠道可受子宫内膜异位症影响，尤其是直肠乙状结肠，表现为从子宫后表面到直肠前壁的强化软组织桥接。小肠受累可能表现为复发性小肠梗阻。泌尿系统受累可能表现为输尿管梗阻或膀胱壁肿块。鉴于表现多样，需要高度的临床怀疑以及对提示子宫内膜异位症的CT特征的了解，以促进早期诊断。因此，这篇综述文章描述了在腹部盆腔CT上可识别的子宫内膜异位症的影像学表现，目的是减少目前准确诊断的延迟并改善患者的长期预后。
