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Citation:
Venkatesh M, Yu Y, Elfeky M, et al. Mushroom cap sign (endometriosis). Reference article, Radiopaedia.org (Accessed on 22 Mar 2025) https://doi.org/10.53347/rID-26022
The mushroom cap sign is one of the important signs of deep rectosigmoid endometriosis on T2-weighted MRI sequences. It is highly specific for submucosal involvement of the rectosigmoid colon and can be useful for differentiating endometriosis from other infiltrating lesions, such as malignancies 1.
The sign describes the resemblance to a mushroom cap invading the rectosigmoid colon 1. The overlying mucosa and submucosa are T2 hyperintense, like the top skin of a mushroom 1. The hypertrophic muscularis propria is heterogenously T2 hypointense, like the gills of a mushroom, radiating towards a central stalk due to fibrotic convergence at the serosal surface 1.
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1. Yoon J, Choi D, Jang K et al. Deep Rectosigmoid Endometriosis: "Mushroom Cap" Sign on T2-Weighted MR Imaging. Abdom Imaging. 2010;35(6):726-31. doi:10.1007/s00261-010-9643-3 - Pubmed
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2. Chamié L, Blasbalg R, Pereira R, Warmbrand G, Serafini P. Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy. Radiographics. 2011;31(4):E77-100. doi:10.1148/rg.314105193 - Pubmed
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3. Siegelman E & Oliver E. MR Imaging of Endometriosis: Ten Imaging Pearls. Radiographics. 2012;32(6):1675-91. doi:10.1148/rg.326125518 - Pubmed
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