Can Magnetic Resonance Imaging (MRI) diagnose endometriosis?

From the Guidelines

MRI is a highly effective imaging modality for diagnosing endometriosis, particularly in moderate to severe cases, with a sensitivity of 82% to 90% and specificity of 91% to 98% for the diagnosis of endometriomas. MRI is especially useful for identifying deep infiltrating endometriosis, endometriomas (chocolate cysts), and adhesions, as it can provide detailed images of soft tissues, allowing doctors to see the extent and location of endometrial implants throughout the pelvis 1.

To get the best results, a specialized pelvic MRI protocol should be used, which may include:

• High-resolution T1 and T2-weighted sequences
• Fat-suppression techniques
• Possible use of gadolinium contrast, which can aid in the differentiation of benign ovarian endometriomas from ovarian malignancies 1 Patients should be aware that MRI may not detect very small or superficial endometriosis lesions. Additionally, timing the MRI with the menstrual cycle (ideally during menses) can improve visualization of endometriotic lesions.

The use of MRI in diagnosing endometriosis is supported by recent studies, including a 2024 study published in the Journal of the American College of Radiology, which highlights the importance of MRI in the preoperative diagnosis of endometriosis and its ability to correspond well with surgical staging systems and histopathologic findings 1.

Some key benefits of using MRI for endometriosis diagnosis include:

• Better soft tissue contrast compared to CT scans
• No use of ionizing radiation
• Ability to detect deep infiltrating endometriosis and endometriomas with high sensitivity and specificity
• Helpful in establishing the diagnosis of other pelvic conditions that may present with similar symptoms, such as uterine fibroids or other infectious or inflammatory disorders 1

However, it's essential to note that while MRI is a valuable diagnostic tool, a definitive diagnosis of endometriosis typically requires laparoscopic surgery with biopsy.

From the Research

Diagnosis of Endometriosis using MRI

• Magnetic Resonance Imaging (MRI) is a useful tool in the diagnosis of endometriosis, particularly in detecting deep infiltrating endometriotic implants 2.
• MRI has been shown to be more sensitive than physical examination and transvaginal ultrasonography in detecting deep endometriosis 3.
• The combination of physical examination, transvaginal ultrasonography, and MRI can provide a more accurate diagnosis of deep endometriosis than each technique alone 3.

Advantages of MRI in Diagnosing Endometriosis

• MRI provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound 4.
• MRI can identify implants in sites that can be difficult to access in endoscopic or laparoscopic explorations 5.
• MRI has a high diagnostic accuracy in detecting endometriosis, similar to that of ultrasound 6.

Limitations of MRI in Diagnosing Endometriosis

• MRI may not be as widely available as ultrasound, and its use may be limited by cost and accessibility 6.
• The diagnostic accuracy of MRI can be affected by the quality of the imaging technique and the interpretation of the results 5.

Comparison with Other Diagnostic Techniques

• Transvaginal ultrasound is often used as a first-line imaging technique for diagnosing endometriosis, but it may not be as accurate as MRI in detecting deep infiltrating endometriosis 6, 4.
• Laparoscopy with surgical biopsies is considered the gold standard for diagnosing endometriosis, but it is an invasive procedure and may not be necessary for all patients 4.