0:01

Now this is a really important slide

0:04

because it breaks down the different

0:06

pelvic compartments for the radiologist.

0:08

And I find this a very useful approach when

0:11

I'm interpreting these MRI cases because,

0:14

you know, if you're just looking for the

0:16

ovary or you're just looking, you know,

0:18

generally at the pelvic organs, you might

0:20

forget to look in certain areas where

0:23

endometriotic deposits can be hidden.

0:26

So, um, this color-coded diagram just goes

0:29

through the spaces in the pelvis and the dotted

0:32

lines here just show you the breakdown between

0:35

the anterior compartment, which is anterior

0:37

to the dashed line, the posterior compartment,

0:40

which is posterior to this dotted line, and

0:43

in between, which is really the, the uterus.

0:46

The cervix and the vagina, which is

0:48

the middle compartment of the uterus.

0:50

So the ovaries and fallopian tubes are also

0:52

considered part of the middle compartment.

0:54

And then we've got several anatomic structures

0:56

here, which are outlined for you, which

0:59

are important to be aware of as well.

1:02

And we'll talk about those

1:02

in a little bit more detail.

1:05

I find it very useful too, to think about

1:07

The patterns of endometriosis, which I like

1:10

to break down into three main categories.

1:13

So the first category is the ovarian

1:16

deposit, which we know as the endometrioma.

1:18

So this is an ovarian mass with

1:20

ground glass or low-level echoes.

1:23

And then we've got superficial

1:25

peritoneal lesions, which cause

1:27

fibrosis, scarring, and hemorrhage.

1:29

And these usually are recognized at laparoscopy.

1:33

And one common manifestation is kissing ovaries.

1:36

And we'll talk about that in just a moment.

1:39

And then finally, we've got the deep, solid,

1:42

and infiltrating type, which happens when

1:45

endometrial glands burrow deep below the

1:48

peritoneal surface by five millimeters or more.

1:51

So those can be very difficult

1:53

to detect by the laparoscopist.

1:56

And that's where MRI really has a role to

1:58

play because we might be able to see them even

2:01

though they're not visible to the laparoscopist.

2:04

And these are likely the biggest culprit

2:07

of pain and infertility, which are commonly

2:09

experienced by patients with endometriosis.

2:12

So once you think about endometriosis with those

2:14

three approaches, it's a little bit easier to

2:18

look for all of those manifestations on MRI.

2:21

And now we're going to go through

2:22

each of those three patterns.