MRI Features of Malignant Transformation of Pelvic Endometriosis: A Systematic Review

Behnaz  Moradi; Masoumeh  Gity; Sara  Hassani; Mobin  Azami; Maryam  Rahmani; Fahimeh Azizi  Nik; Arash  Khameneh Bagheri; Shirin  Yaghoobpoor; Hamed  Ghorani

doi:10.18502/bccr.v15i4.18745

Behnaz Moradi Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Masoumeh Gity Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
Sara Hassani Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Mobin Azami Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Maryam Rahmani Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Fahimeh Azizi Nik Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Arash Khameneh Bagheri Shahid Beheshti University of Medical Sciences, Shohadaye Tajrish Hospital, Tehran, Iran.
Shirin Yaghoobpoor Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran
Hamed Ghorani Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran

DOI: https://doi.org/10.18502/bccr.v15i4.18745

Keywords: Endometriosis, magnetic resonance imaging (MRI), malignancy, mural nodules

Abstract

Background: Endometriosis is a benign gynecologic condition that is estrogen-de-pendent. Malignant transformation is one of the complications of endometriosis; it canaffect the woman`s ovarian and extra-ovarian regions. Diagnosing endometriosis-asso-ciated cancers has an essential role in treatment.Purpose: Our study aimed to review magnetic resonance imaging (MRI) features ofmalignant transformation of pelvic endometriosis.

Material and Methods: We searched three online databases including Web of Sci-ence, Scopus, and PubMed, applying relevant keywords up to May 2022. We includedEnglish observational studies using MRI for endometriosis patients and comparing theMRI features of malignant pelvic endometriosis with non-malignant ones or studiesreporting the MRI features of malignant pelvic endometriosis. Finally, a comprehen-sive systematic review of the included studies was conducted. The small number ofqualifying studies was the most significant limitation. Also, the eligible studies wereinsufficient for conducting a meta-analysis.

Results: A total of eight papers were included as they matched our inclusion require-ments. Eighty-seven individuals were included finally. Studies were published between1992 and 2021. The larger size of the lesion, loss of T2-weighted images shading, muralnodules, mural nodules contrast enhancement, and mural nodules protruding fromthe cyst wall at acute angles were the main MRI features suggesting potential malig-nant transformation of pelvic endometriosis.

Conclusion: The endometriosis›s malignant changes can be observed on MRI. Thepredominant MRI findings are a large cyst, loss of shading on T2-weighted imaging,mural nodules enhancement, and acutely angled protrusion of mural nodules fromthe cyst wall.