Endometriosis (ovarian endometrioma and pararectal implant)

MRI shows bilateral ovarian lesions with characteristic T2 shading (shading sign), with slight signal intensity layering in the left lesions. This is compatible with bilateral endometriomas.

A more subtle finding in this case is a nodular implant located on the right side of the superior rectum, with intermediate signal in T1 and T2. In the clinical context, it is compatible with an endometriosis implant. It is easier to see on the sagittal images (not shown here).