Volume 83, Issue 9 (December 2025)
Tehran Univ Med J. 2025, 83(9): 628-637 |
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Moradi B, Rahmani M, Maqsoodlou S, Fazelnia F, Malek M, Davari Tanha F et al . Evaluation of signal characteristics of extrapelvic deep infiltrating endometriosis on MRI and comparison with myometrium. Tehran Univ Med J. 2025; 83 (9) :628-637
URL: http://tumj.tums.ac.ir/article-1-13858-en.html
URL: http://tumj.tums.ac.ir/article-1-13858-en.html
Behnaaz Moradi1, Maryam Rahmani1, Salome Maqsoodlou1, Faezeh Fazelnia1, Mehrooz Malek1, Fatima Davari Tanha2, Mohammad Ali Kazemi1
1- Department of Radiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: (131 Views)
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Background: Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of endometrial tissue deeper than 5 mm beneath the peritoneal surface. Accurate preoperative mapping of lesions is essential because DIE commonly involves the rectosigmoid colon, uterosacral ligaments, retrocervical space, bladder, and abdominal wall. Magnetic resonance imaging (MRI) is considered one of the most valuable noninvasive imaging modalities for evaluating the extent of disease; however, overlap between MRI signal characteristics of DIE lesions and normal myometrium may reduce diagnostic specificity in certain anatomical regions. This study aimed to evaluate MRI signal characteristics of extrapelvic DIE lesions and compare them with those of the myometrium across different MRI sequences.
Methods: In this retrospective cross-sectional study, 170 patients with confirmed extrapelvic DIE who underwent dedicated pelvic MRI between June 2017 and September 2022 at Imam Khomeini Hospital, Tehran, were evaluated. MRI examinations included T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) mapping, and post-contrast dynamic sequences. Signal intensity measurements were obtained using ROI-based analysis and compared with outer myometrium. Statistical analysis was performed using the Mann–Whitney U test, and p≤0.05 was considered statistically significant. Results: A total of 170 patients with deep infiltrating extrapelvic endometriosis were evaluated. Compared with myometrium, lesions involving the rectum and rectosigmoid, retrocervical space, uterosacral ligaments, anterior compartment, and abdominal wall demonstrated significant differences in multiparametric MRI characteristics, whereas posterior fornix lesions showed no significant differences. Conclusion: MRI signal characteristics of extrapelvic DIE are location-dependent and may partially overlap with those of the myometrium. Multi-parametric MRI, particularly functional and dynamic sequences, improves lesion characterization and provides valuable information for accurate preoperative assessment and lesion mapping in patients with DIE. These findings may also contribute to improved surgical planning, optimized therapeutic decision-making, and reduction of unnecessary invasive diagnostic procedures in affected patients. |
Type of Study: Original Article |
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