The clinical importance of Magnetic Resonance Imaging with Diffusion weighted images in diagnosis and treatment planning of endometriosis.

Introduction: Endometriosis is a benign gynecologic disease affecting women of reproductive 
age. It is defined as the presence of endometrial tissue, glands, and stroma located outside the 
uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic disease 
that can manifest as superficial implants on the peritoneal surface; ovarian cysts called 
endometriomas; or deep lesions that infiltrate the peritoneal surface more than 5 mm, a condition 
known as deeply infiltrative endometriosis. Patients and Methods: This prospective study was
conducted at the radiology department, Minia university hospital. Our study included twenty 
three female patients suspected clinically endometriosis with age ranged from (18 to 40) years old 
and was referred from gynecology and obstetrics department in the period between June 2019 to 
June 2020 after fulfilling the inclusion criteria. A written consent is taken from all patients after 
approval of the Medical Ethical Committee of our institution (university). Discussion: 
Endometriosis is a chronic gynecological pathology that affects females of reproductive age. It is 
identified as presence of functional endometrial glands outside the uterus. Hormonal changes 
affect these ectopic tissue and consequently the disease's clinical characteristics. The exact 
underlying pathogenesis remains unclear, but there are three major theories that could explain the 
presence of endometrial tissue in ectopic locations; these include retrograde menstruation, 
celomic metaplasia and lymphatic or vascular metastases with the aid of endocrine and immune 
factors for the development of the clinical manifestations of the disease. The clinical features of 
endometriosis are variable; however the most common are chronic pelvic pain and infertility. 
There are three types of endometriosis: ovarian (endometrioma), superficial, and deep infiltrating.
Diagnosis of endometriosis depends mainly on the laparoscopy, with histologic confirmation, 
however it is an invasive procedure, has a risk of complications and false-negative results, also 
the complexities regarding to the surgical evaluation of the pelvis, so an increasing literature 
supporting the value of imaging is increasing, particularly ultrasound and MRI in the diagnosis of 
ovarian and deep infiltrating endometriosis. This prospective study was conducted at the 
radiology department, Minia university hospital from June 2019 to June 2020. The study 
included twenty three female patients suspected clinically for endometriosis with age ranged from 
22 to 44 years old and referred from gynecology and obstetrics department.