Presentation
Left pelvic pain with dysmenorrhea.
Patient Data
Large well-defined bilobulated left ovarian cystic mass (8 x 6.7 x 6 cm), displacing the ovarian tissue and follicles peripherally. It exhibits a high signal on T1, T1 fat sat with T2 shading sign, containing rounded nodules of a low signal on T2 sequences "T2 dark spot sign". No enhancement is seen on postcontrast sequences.
Normal appearance of the uterus and right ovary.
Mild effusion in Douglas's pouch.
Annotated image: the red arrow indicates the T2 dark spot sign (small hypointense nodules against the cyst wall, result of chronic hemorrhage).
Case Discussion
MRI features of a large left ovarian endometrioma with T2 dark spot sign.
T2 dark spot sign is specific for chronic hemorrhage and is helpful in diagnosing a solitary endometrioma from a functional hemorrhagic ovarian cyst, as both might show high T1 signal with T2 shading.
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