**7. References**


**25** 

 *Italy* 

**Pelvic Endometriosis: A MR Pictorial Review** 

Endometriosis is one of the most common benign gynaecological conditions. It is defined as the presence of ectopic endometrial glands and stroma outside the uterus. The ectopic endometrium responds to hormonal stimulation with a cyclic hemorrhage, resulting in a

Pain is the cardinal symptom of endometriosis, even though patients may experience several different types of pain, such as dysmenorrhea, deep dyspareunia, discomfort during defecation or while urinating, according to the anatomic location of this disorder. Endometriotic implants, pelvic adhesions and ovarian endometriomas are commonly associated with chronic pelvic pain. Haemorrhage into an endometrioma may result in acute

The exact prevalence of endometriosis is not well defined, as the diagnostic gold standard is represented by laparoscopy or laparotomy. It is estimated about 5-10%, including both symptomatic and asymptomatic women. Nulliparous women and women reporting short and heavy menstrual cycles are at increased risk [1]; these epidemiological findings support the metastatic implantation from retrograde menstruation hypothesis. Other theories include the metaplastic differentiation of serosal surfaces or müllerian remnant tissue, and the induction of undifferentiated mesenchyme to form endometriotic tissue due to released

The most common locations of endometriosis are the ovaries and the pelvic peritoneum, followed in order of decreasing frequency by deep lesions of the pelvic subperitoneal space, the intestinal system and the urinary system. Deep pelvic endometriosis is a pathologically distinct entity: deep endometriotic lesions penetrate under the surface of peritoneum (infiltration > 5mm) and are tipically found in the uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder, and induce a fibromuscolar hyperplasia that

The diagnosis of endometriosis still remains a challenge for clinicians, resulting from similarities in clinical symptoms to other benign or malignant gynaecological diseases.

Laparoscopy is the standard of reference in the diagnosis of endometriosis; histological analysis of biopsy specimens should confirm the diagnosis, even if it is not necessary.

On the other hand, laparoscopy is also required for staging the disease. The most widely used staging system is the 1985 Revised Classification of Endometriosis published by the

**1. Introduction** 

complex spectrum of symptoms.

surrounds endometriosis foci [3].

pain. Infertility is another commonly associated complaint.

substances from the shed endometrium (induction theory) [2].

Rosario Francesco Grasso, Riccardo Del Vescovo, Roberto Luigi Cazzato and Bruno Beomonte Zobel *Department of Radiology, Campus Bio-Medico University of Rome,* 

Stratton P, Winkel C, Premkumar A et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examimation for the detection of endometriosis. Fertil Steril 2003; 79: 1078-1085
