Bourg Justine, Ruaux Edouard, Bolze Pierre Adrien, Gavrel Marie, Charlot Mathilde, Golfier François, Thomassin-Naggara Isabelle, Rousset Pascal
Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, Pierre Bénite, France.
Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France.
Insights Imaging. 2025 Jun 19;16(1):131. doi: 10.1186/s13244-025-02005-6.
Endometriosis is a prevalent gynecological disorder in women of reproductive age. It is the leading cause of chronic pelvic pain. While the mechanisms underlying this pain remain elusive, rare cases of pelvic nerve involvement can result in severe, debilitating symptoms, adding complexity to the clinical landscape. Nerve involvement typically results from the direct extension of deep infiltrating endometriosis, though it may also occur in isolation. The nerves most commonly affected include the inferior hypogastric and lumbosacral plexuses, as well as the sciatic, pudendal, obturator, and femoral nerves. Early and accurate diagnosis is essential for the effective management of the pain and the prevention of irreversible nerve damage. Given the limitations of transvaginal ultrasonography in visualizing the lateral compartment, MRI is considered the gold standard for detecting and evaluating pelvic nerve involvement. Through the use of optimized protocols to enhance the visualization of nerves and their anatomical landmarks, radiologists play a key role in the identification of endometriotic lesions. A comprehensive and structured radiology report is essential for surgical planning, as nerve involvement often requires precise interventions to alleviate symptoms and restore quality of life. CRITICAL RELEVANCE STATEMENT: Accurate identification and a structured reporting of pelvic nerve endometriosis in the lateral compartment are pivotal to guide surgical decision-making and optimize patient outcomes. KEY POINTS: Pelvic nerve endometriosis is often overlooked, underestimated by clinicians, and underdiagnosed on imaging. Timely nerve involvement diagnosis prevents permanent damage in pelvic pain with neurological symptoms. Deep endometriosis in the lateral compartment may extend to the pelvic nerves. The inferior hypogastric plexus, sacral plexus, sciatic, and pudendal nerves are commonly affected. A dedicated MRI protocol with 3D T2-weighted sequence ensures accurate pelvic nerve assessment.
子宫内膜异位症是育龄期女性中一种常见的妇科疾病。它是慢性盆腔疼痛的主要原因。虽然这种疼痛的潜在机制仍然不明，但罕见的盆腔神经受累情况可导致严重的、使人衰弱的症状，增加了临床情况的复杂性。神经受累通常是由深部浸润性子宫内膜异位症直接蔓延所致，不过也可能单独发生。最常受影响的神经包括下腹下丛和腰骶丛，以及坐骨神经、阴部神经、闭孔神经和股神经。早期准确诊断对于有效控制疼痛和预防不可逆的神经损伤至关重要。鉴于经阴道超声在观察外侧间隙方面的局限性，MRI被认为是检测和评估盆腔神经受累的金标准。通过使用优化方案来增强神经及其解剖标志的可视化，放射科医生在识别子宫内膜异位病变方面发挥着关键作用。一份全面且结构化的放射学报告对于手术规划至关重要，因为神经受累往往需要精确干预以缓解症状并恢复生活质量。关键相关性声明：准确识别和结构化报告外侧间隙的盆腔神经子宫内膜异位症对于指导手术决策和优化患者预后至关重要。关键点：盆腔神经子宫内膜异位症常被临床医生忽视、低估且在影像学上诊断不足。及时诊断神经受累可预防伴有神经症状的盆腔疼痛的永久性损伤。外侧间隙的深部子宫内膜异位症可能蔓延至盆腔神经。下腹下丛、骶丛、坐骨神经和阴部神经通常受累。采用3D T2加权序列的专用MRI方案可确保准确评估盆腔神经。
