T2 dark spot sign (endometrioma)
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T2 dark spot sign is an MRI appearance of endometriomas seen as a result of chronic hemorrhage. The sign is useful in differentiating a solitary endometrioma from a functional hemorrhagic ovarian cyst, as both might show high T1 signal with T2 shading.
The T2 dark spot, described in the sign, is seen within the cyst, often against the cyst wall, but not within the cyst wall itself (which is usually of low T2 signal due to hemosiderin-laden macrophages and fibrous component of the cyst wall).
T2 dark spot sign has high specificity (93%) in diagnosing endometriomas but lower sensitivity (36%). The T2 shading sign has high sensitivity (93%) and lower specificity (45%) 1.
This sign can also be seen in cystic ovarian tumors like serous cystadenomas, in which the T2 dark spot is part of a hemorrhagic tumor or calcification 1,2.
- 1. Corwin MT, Gerscovich EO, Lamba R et-al. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 2014;271 (1): 126-32. doi:10.1148/radiol.13131394 - Pubmed citation
- 4. Cansu A, Bulut E, Dinc G et al. Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts. J Comput Assist Tomogr. 2019;43(4):619-22. doi:10.1097/rct.0000000000000892 - Pubmed