E2764. Surgical Anatomical Atlas for Accurate MR Interpretation in Endometriosis
  1. Anuradha Shenoy-Bhangle; Massachusetts General Hospital
  2. Nabih Nakrour; Massachusetts General Hospital
  3. Peter Movilla; Newton-Wellesley Hospital
  4. Hannah French; Newton-Wellesley Hospital
  5. Avinash Kambadakone Ramesh; Massachusetts General Hospital
  6. Aoife Kilcoyne; Massachusetts General Hospital
  7. Stephanie Morris; Newton-Wellesley Hospital
Endometriosis is a common gynecological problem prevalent in women of reproductive age. Although nonmalignant, the process of endometrial and stromal implants outside the endometrial cavity, can have debilitating sequela for the affected individuals which include chronic pain, infertility, and compromised quality of life. Laparoscopy is still considered the gold standard for staging and diagnosis with treatment options ranging from medical to surgical intervention. Magnetic Resonance Imaging (MRI) is an important noninvasive tool for presurgical mapping of established pelvic endometriosis.

Educational Goals / Teaching Points
Through this atlas, our goal is to illustrate correlative MR-surgical endoscopic anatomy for key pelvic structures and how superficial and deep endometriosis affecting these structures appears. We will display MR images and correlative endoscopic views to illustrate varied patterns of endometriosis to promote accurate presurgical mapping, thereby achieving optimal surgical outcomes for the patient.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Using MRI to locate and stage endometriotic plaques relies highly on the radiologist’s experience and in-depth anatomical knowledge of the female pelvic structures. Although endometriotic plaques are known to demonstrate typical MRI features on fat-saturated T1-weighted and T2-weighted images, there is a wide spectrum of presentation ranging from superficial to endometriomas to deep infiltrative endometriosis. Demonstrating the correlation of MRI with endoscopic images will enable both the radiologist as well as the endoscopist to gain better insight into this complex process.

MRI pelvis can be a powerful noninvasive tool for accurate presurgical planning of established pelvic endometriosis. As illustrated in the MR Atlas, understanding normal anatomy and the MR appearance of endometriotic implants as seen by the endoscopist, will enable better detection by the radiologist and in turn impact better post-surgical outcomes.