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Three Step Interpretation – Endometriosis

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Okay, so we've seen a few

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patterns of endometriosis.

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So I just wanted to summarize what your

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approach should be when evaluating patients

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with this disease to get maximum yield.

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So firstly, use the compartment model.

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So remember to look at the anterior, the

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middle, and the posterior compartments.

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And then this is what we tend to normally do

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anyway because we're so conditioned to look

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for ovarian lesions or endometriomas.

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And remember that those develop

0:31

because of hemorrhage of variable age.

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And then remember to also look around

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the ovary that Candle wax phenomenon,

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that we saw on the last case.

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And then don't forget to look for extra

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ovarian disease, because this can be the only

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manifestation of a patient with endometriosis

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in a pretty large subset of patients.

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So we want to look at those areas that are

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blind to the laparoscopist, that are visible

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to the radiologist, and this is the value add

1:00

of MRI imaging in patients with endometriosis.

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And.

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Quite specifically, we're looking at the deep

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or solid infiltrative type of endometriosis.

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And in terms of the signal characteristics,

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remember that extra-ovarian manifestations

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of endometriosis usually show fibrosis,

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which shows up as low signal on T2 images.

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You might see a little focus of high T2

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signal, like we saw on the last case as well.

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So just to close off endometriosis, this is an

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example of a patient with extra-ovarian disease.

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So this patient had subcutaneous endometrioma.

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And this is actually not uncommon,

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particularly in patients who've

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had caesarean sections previously.

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So I've seen maybe five or six of these

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now, where the patient has cyclical

1:46

pain and an abdominal wall mass.

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You can see on the CT the right rectus sheath

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is enlarged and has a mass-like appearance.

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And what's kind of neat is that the margins

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of the deposit that's in the subcutaneous

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tissue are very similar to the peritoneal

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deposits that we saw on the last case.

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So you've got this irregular-looking mass

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with angular margins, and it's really the

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history and the MRI signal which gives

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you the diagnosis in this sort of case.

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So you probably will see one of

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these at some point in your career.

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And then finally, another MRI pearl, which

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we talked about earlier, and we saw in one

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of the earlier cases, was that the presence

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of hematocysts should be considered a

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specific finding for pelvic endometriosis.

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So, in about 30 percent of patients

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with endometriosis, we might see dilated

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tubes containing hemorrhagic material,

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like we see in this image here with the

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high T1 signal in the dilated left tube.

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And interestingly, this may be the only

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finding in some women with endometriosis.

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So we really have to be aware of this

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finding and recognize that its presence

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suggests that it's not a disease.

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The diagnosis of endometriosis, even in the

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absence of other findings such as endometriomas.

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Another point to remember is that we may

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not see T2 shading as the endometriotic

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implants are often on the outside

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of the tube rather than inside it.

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So the hemorrhage that you see inside the

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tube is often a reaction to the irritation

3:20

from implants on the outside surface.

Report

Faculty

Zahra Kassam, MD, FRCPC

Associate Professor of Medical Imaging, Division Head of Body Imaging

Western University

Tags

Uterus

Ultrasound

Pelvic Wall and Floor

Ovaries

Non-infectious Inflammatory

Neoplastic

MRI

Idiopathic

Gynecologic (GYN)

CT

Body

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