The MRI findings are mostly representing extra-uterine endometriosis manifested by bilateral combined endometriomas with hematosalpinx sequel to extra-uterine deep pelvic endometriosis notably on the uterine serosal surface.
Some of the multiple pelvic cysts seen demonstrate high T1 signal with T2 shading suggestive of hemorrhagic cysts. These cysts also demonstrate T2 dark spot sign which is a black dot adherent to cyst wall seen in T2 images as a result of chronic hemorrhage. It helps to differentiate endometrioma from a functional hemorrhagic ovarian cyst. The associated clear fluid cysts are mostly representing peritoneal inclusion cysts which can be present in the setting of pelvic endometriosis.