Gynaecological MRI: Endometriosis, Fibroids & Adnexal Masses
Ultrasound is the first look in the pelvis; MRI is the problem-solver, characterising masses, mapping endometriosis, and staging cancer.
Adnexal masses
When ultrasound is indeterminate, MRI characterises ovarian/adnexal lesions, identifying fat (dermoid), blood (endometrioma), and solid enhancing components that raise concern. The O-RADS MRI system stratifies the risk of malignancy to guide management.
MRI’s tissue specificity (fat, blood, fibrous tissue) is what lets it confidently call many “indeterminate on US” masses benign, avoiding unnecessary surgery.
Endometriosis, fibroids & adenomyosis
- Deep infiltrating endometriosis: MRI maps disease across compartments (uterosacral ligaments, rectovaginal septum, bowel, bladder) for surgical planning (things laparoscopy may not fully appreciate pre-op).
- Fibroids: number, size, location and degeneration, and suitability for uterine artery embolisation or MRgFUS.
- Adenomyosis: junctional-zone thickening, a diagnosis MRI makes well.
Cancer staging
MRI is central to local staging of endometrial cancer (depth of myometrial invasion, cervical involvement) and cervical cancer (tumour size, parametrial invasion), directly influencing surgery vs chemoradiotherapy.
Sources
- Nougaret S et al. and ESUR guidelines on female pelvic imaging; O-RADS MRI risk stratification system (Thomassin-Naggara I et al.).
Educational summary for clinicians; staging and management are multidisciplinary. Not medical advice.
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