Presentation
Lower abdominal pain and vaginal bleeding
Patient Data
Age: 35 years
Gender: Female
From the case:
Ovarian endometriomas (MRI signs)
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Both ovaries are enlarged and located nearby, touching each other in the midline giving the "kissing ovaries sign". Both ovaries show multiple variable-sized cysts, most of them elicit high signal in T1& T1 fat sat, and low signal on T2 " shading sign" with fluid/ fluid levels. Some lesions elicit high signal in T1 & T2 and some show a spot of low signal on TWI "T2 dark spot sign". Minimal peripheral enhancement is noted in the post-contrast study
From the case:
Ovarian endometriomas (MRI signs)
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Annotated images highlight the MRI signs of ovarian endometriomas
Case Discussion
Here is a case of bilateral ovarian extensive endometriomas with associated three MRI signs:
Kissing ovaries sign is most frequently associated with the severe form of pelvic endometriosis, in which repeated bleeding causes adhesions with pulling of the ovaries toward the midline
Shading sign refers to T2 hypointensity of the endometrioma owing to the presence of deoxyhemoglobin and methemoglobin which is very suggestive of endometrioma
T2 dark spot sign is specific for chronic hemorrhage and helps diagnose endometriomas
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