PDF(Pubmed)
Abstract：
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results. Critical relevance statement MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars. Key points • MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
摘要：
子宫内膜异位症是育龄妇女常见的致残性疾病。磁共振成像（MRI）被认为是诊断和治疗子宫内膜异位症的基础放射学技术。虽然它的敏感性，尤其是深层浸润型子宫内膜异位症,优于超声检查，存在许多假阳性结果的来源，导致缺乏特异性。T2加权图像上的点性病变或假性病变包括解剖变异，纤维结缔组织，良性和恶性肿瘤，粪便,手术材料,和治疗后的疤痕可能模仿深盆腔浸润性子宫内膜异位症。误报可能会对患者管理产生重大影响，从诊断到医学或手术治疗。这篇教育综述旨在帮助放射科医生确认MRI标准，陷阱,深盆腔浸润性子宫内膜异位症的鉴别诊断，以减少假阳性结果。深浸润性子宫内膜异位症的关键相关性陈述MRI具有23％的假阳性率，导致误诊。T2-低信号病变主要是由解剖学变异引起的，纤维结缔组织，良性和恶性肿瘤，粪便,手术材料,和治疗后的疤痕。关键点•DIE的MRI假阳性率为23%，导致潜在的误诊。•解剖学变异，纤维结缔组织，肿瘤，手术改变是T2低信号模数的主要来源。•多序列解释，形态学评估，精确的解剖定位对于防止过度诊断至关重要。•钆注射仅在特定条件下对评估子宫内膜异位症的鉴别诊断是有益的。
