Endometrioma - T2 dark spot sign

Case contributed by Dr Ayaz Hidayatov


Pelvic pain. History of cesarean section few years ago.

Patient Data

Age: 25 years
Gender: Female

Right ovarian cystic lesion measuring  57 x 53 x 50 mm. Axial T1 and fat saturated T1 weighted images show diffuse hyperintensity consistent with hemorrhage. Axial T2WI shows relative hypointense internal shadows (T2 shading) and hypointense mural nodule within the cyst (T2 dark spot).

Case Discussion

The case of pathologically proved endometrioma. In most cases, the distinction between endometriomas from other hemorrhagic lesions, such as functional hemorrhagic ovarian cysts, can be difficult. MR findings show the T2 dark spot sign that is specific for chronic hemorrhage and therefore is useful in the diagnosis of ovarian endometriomas

The exact cause of this finding is unclear. T2 dark spots may represent chronic retracted blood clots that contain a high concentration of protein and/or hemosiderin.

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