Diagnostic value of susceptibility-weighted imaging for endometrioma: preliminary results from a retrospective analysis

Background Endometrioma is a common manifestation of endometriosis that can be difficult to diagnose with conventional magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) may be more sensitive than conventional MRI in the detection of chronic, local hemorrhagic disease. Purpose To investigate whether signal voids in SWI sequences could be used in the preoperative diagnosis of endometrioma. Material and Methods This retrospective study included consecutive female patients with clinically suspected endometrioma. All patients underwent pelvic 3-T MRI (T1- and T2-weighted) and SWI within two weeks before laparoscopy. Two experienced radiologists blinded to the histopathologic/clinical diagnoses interpreted the images together, and any disagreements were resolved by consensus. Results The final analysis included 73 patients: 46 patients (mean age=37 years; age range=22–68 years) with 85 endometrioma lesions and 27 patients (mean age=34 years; age range=15–68 years) with 34 non-endometrioid cystic lesions (18 hemorrhagic corpus luteal cysts, three simple cysts, three mucinous cystadenomas, two mature teratomas, and one endometrioid cyst with corpus luteum rupture/hemorrhage). The presenting symptoms for patients with endometrioma were chronic pelvic pain (44.6%), dysmenorrhea (31.9%), infertility (12.8%), dyspareunia (6.4%), and menstrual irregularity (4.3%). MRI identified all 119 lesions observed laparoscopically. SWI visualized punctate or curvilinear signal voids along the cyst wall or within the lesion in 67 of 85 endometriomas (78.8%) and only 3 of 31 non-endometrioid cysts (8.8%). Conclusion The use of SWI to look for signal voids in the cyst wall or within the lesion could facilitate the preoperative diagnosis of endometrioma.