Interactive Transcript
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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
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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
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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
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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
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from implants on the outside surface.
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