Skip to main content
. 2022 Mar 8;23(4):426–445. doi: 10.3348/kjr.2021.0405

Table 1. Key MRI Findings of Ovarian Endometriotic Cyst, DIE, or Other Related Diseases.

MR/CT Sign MRI/CT Findings References
Ovary Ovarian endometrioma T1-high signal multiplicity Multiple high signal cysts on T1WI [31]
T2-Shading Marked T2 shortening or gradations on T2WI [31,33]
T2 dark spot sign Discrete well-defined markedly hypointense foci within the cyst on T2WI [32]
Decidualization Linear, broad-based nodular, or polypoid structures with high SI similar to placental tissue on T2WI [43,44]
Polypoid endometriosis Polypoid mass, slightly high SI similar to endometrium on T2WI [46,47,48]
Punctate high signal foci on T1WI
Peripheral rim by fibrous tissue on T2WI
Strong enhancement on contrast enhanced-T1WI
Small cysts on T2WI
EAOC Emergence of enhanced mural nodules within the ovarian endometrioma [7,57,58]
Increased tumor size (> 9 cm)
(suggestive) Dissapearance of shading on T2WI [59]
DIE Hypointense nodular lesions (T1/T2WI) [5,60,61,62]
Soft tissue thickening with irregular, indistinct, or stellate margins (T1/T2WI)
Posterior cul-de-sac obliteration (pouch of Douglas, rectouterine/ retrovaginal space) Retroflexed uterus [69]
Elevated posterior vaginal fornix on T1/T2WI
Intestinal tethering or tethered appearance of rectum in the direction of the uterus on T2WI [69]
Faint strands between the uterus and intestine on T2WI [69]
Fibrotic plaques or nodules covering the serosal surface of the uterus on T2WI [69,70]
Retrouterine fibrous mass on T2WI [69,70]
Intraperitoneal fluid displacement [70]
Torus uterinus, USL T2-low intensity thickening or mass with regular or irregular margins on MRI [63]
Ovary Kissing ovary Bilateral ovaries are located in the posterior cul-de-sac or at the cornua of the uterus on MRI [75]
Round ligament Thickened and irregular with a nodular appearance on MRI [77]
Rectosigmoid colon ‘Fan shaped’/‘mushroom cap’ Focal thickening of the rectal wall as an umbrella-like head of a mushroom on MRI [64,81]
Bladder endometriosis and vesicouterine space Hypointense nodular formation on T1/T2WI [60,85]
Extra-pelvic endomtriosis Abdominal wall endometriosis On CT, homogeneous density [93]
Gorgon’ sign Linear infiltration irradiating peripherally from a central soft tissue nodule on CT [93]
On MRI, hypointense solid mass on T2WI with/without hyperintense hemorrhagic cysts on T1WI [97]
Diaphragmatic endometriosis Hyperintense nodule on T1WI, mostly right side [100]

DIE = deeply infiltrating endometriosis, EAOC = endometriosis associated ovarian carcinoma, SI = signal intensity, T1WI = T1-weighted image, T2WI = T2-weighted image, US = ultrasonography, USL = uterosacral ligament