Endometriosis MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]


MRI is preferred over CT scan for the assessment of the anatomical locations and severity of the disease. The typical appearance of endometriosis includes a characteristic hyperintensity on T1-weighted images and a hypointensity on T2-weighted images.


  • MRI is the diagnostic evaluation of choice to assess the locations of the endometrial lesions and to assess the severity of the disease.[1][2]
  • The typical appearance of endometrial lesions is a characteristic hyperintensity on T1-weighted images and a hypointensity on T2-weighted images.[3]  
  • Powder burn hemorrhages
    • Lesions appear hyperintense on T1 and hypointense on T2. Adhesions and distortion of normal anatomy such as posterior displacement of the uterus and angulation of bowel loops.[4]
  • Uterosacral involvement:
    • Irregular margins, asymmetry and nodularity and thickening medially. If bilateral uterosacral involvement with additional involvement, torus uterinus involvement results in an arciform abnormality.
  • Vaginal involvement:
    • Loss of hypointense signal of the posterior vaginal wall on T2 thickening, nodules or masses may also be seen.
  • Partial to complete obliteration, suspended or lateralised fluid collections.[5]
  • Gastrointestinal tract:
    • Sensitivity may be increased with the use of water enema and endovaginal coils, rectal wall thickening, anterior displacement of the rectum, abnormal angulation, loss of fat plane between uterus and bowel inflammatory response due to repeated hemorrhage can lead to adhesions, strictures, and bowel obstructions.
  • Urinary tract:
    • Localized or diffuse bladder wall thickening, signal intensity abnormality. Nodules or masses usually located at the level of the vesicouterine pouch.

MRI showing endometriosis of the urinary bladder.

MRI showing endometriosis of uterosacral ligament.


  1. Tanaka YO, Okada S, Yagi T, Satoh T, Oki A, Tsunoda H; et al. (2010). "MRI of endometriotic cysts in association with ovarian carcinoma". AJR Am J Roentgenol. 194 (2): 355–61. doi:10.2214/AJR.09.2985. PMID 20093596.
  2. Grasso RF, Di Giacomo V, Sedati P, Sizzi O, Florio G, Faiella E; et al. (2010). "Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography". Abdom Imaging. 35 (6): 716–25. doi:10.1007/s00261-009-9587-7. PMID 19924468.
  3. Caramella T, Novellas S, Fournol M, Bafghi A, Mondot L, Chassang M; et al. (2008). "[Deep pelvic endometriosis: MRI features]". J Radiol. 89 (4): 473–9. PMID 18477953.
  4. Sugimura K, Imaoka I, Okizuka H (1996). "Pelvic endometriosis: impact of magnetic resonance imaging on treatment decisions and costs". Acad Radiol. 3 Suppl 1: S66–8. PMID 8796518.
  5. Kinkel K, Chapron C, Balleyguier C, Fritel X, Dubuisson JB, Moreau JF (1999). "Magnetic resonance imaging characteristics of deep endometriosis". Hum Reprod. 14 (4): 1080–6. PMID 10221244.