What is the role of radiography in the workup of endometrioma/endometriosis?

Answer

Plain film radiographs are not indicated in the radiologic workup of endometriosis. No specific findings are found on plain films.^[14]The findings on contrast studies (a barium enema and an intravenous [IV] urogram) are nonspecific.

Uncommonly, women with rectal pain or bleeding from endometriosis involvement of the bowel may undergo a barium enema examination. A tethered submucosal mass that is centered at the anterior midrectum—representing cul-de-sac implants involving the rectal wall—is typical.^[14]

An IV urogram in patients with endometriosis may show ureteral obstruction at or below the pelvic brim.^[15]This obstruction may be from an endometriosis implant invasion into the ureter or from a mass effect from endometrioma.

The appearance of endometriosis on a barium enema contrast study can be mimicked by rectal carcinoma or serosal metastases.

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Media Gallery

Endovaginal ultrasound scan of an endometrioma. Note the characteristic diffuse, low-level echoes of the endometrioma (E) giving a solid appearance.
Duplex ultrasound scan of an endometrioma. Note the resistive index of 0.48, indicating a low-resistance waveform. This value can also be seen with an ovarian neoplasm, yielding false-positive results.
Sagittal view shows an endometrioma (e) in the cul-de-sac with diffuse, low-level echoes. The endometrioma lies directly posterior to the uterus (u).
Transverse view of a left ovarian endometrioma shows a heterogeneous appearance, with diffuse, low-level echoes interspersed with echogenic and anechoic areas.
T1-weighted magnetic resonance image of an endometrioma. Note the characteristic high signal intensity (similar to that of fat) of this right-sided adnexal endometrioma (arrow).
Fat-saturated T1-weighted magnetic resonance image of an endometrioma. In this right adnexal endometrioma (same lesion as in the previous image), fat saturation has been applied. Note that the endometrioma's (arrow) signal intensity does not decrease. This signal characteristic differentiates endometriomas from fatty adnexal masses, such as dermoids.
T2-weighted magnetic resonance image of an adnexal endometrioma (arrow; same lesion as in the previous image). Note the characteristic low T2-weighted signal. This low T2 signal is a result of the high iron concentration in the endometrioma.

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What is the role of radiography in the workup of endometrioma/endometriosis?

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