Magnetic Resonance and Diffusion-Weighted Imaging Characteristics of Abdominal Wall Endometriosis: A Cross-Sectional Study

Abstract

Aim: To characterize MRI and diffusion-weighted imaging (DWI) of histologically confirmed abdominal wall endometriosis (AWE) lesions and investigate the potential role of apparent diffusion coefficient (ADC) measurements in preoperative diagnosis. Materials and Methods: This retrospective cross-sectional study included twenty-four women aged 24–44 years with histologically confirmed AWE. MRI protocols included T1-weighted, T2-weighted, fat-suppressed contrast-enhanced sequences, and DWI (b-values: 50, 400, 800 sec/mm2). ADC values were measured for AWE lesions and the normal rectus abdominis muscle. MRI signal characteristics, enhancement patterns, and quantitative ADC values were analyzed. Results: The endometrial lesions on the abdominal wall appeared predominantly heterogeneous or slightly hyperintense on the T2-weighted images and were isointense or slightly hyperintense on the T1-weighted images. Patchy T1-hyperintense hemorrhagic foci were observed in 70.8% of cases. Quantitative analysis of diffusion-weighted imaging showed that the mean ADC value of the AWE lesions (1.19 ±0.26 × 10-³ mm²/sec) was significantly lower than that of the normal rectus abdominis muscle (1.32 ± 0.20 × 10-³ mm²/sec). The difference between the two groups reached statistical significance (p = 0.042). Conclusion: MRI in combination with DWI provides valuable morphologic and microstructural information for the evaluation of AWE. ADC measurements can serve as supportive parameters in preoperative assessment, although further comparative studies with other abdominal wall masses are warranted.

Keywords

• Abdominal wall
• Diffusion-weighted imaging
• Endometriosis
• Magnetic resonance imaging

References

1. 1. Grigore M, Sokolov D, Pavaleanu I, Scripcariu I, Grigore AM, Micu R. Abdominal wall endometriosis: an update in clinical, imagistic features, and management options. Med Ultrason. 2017;19:430–437. https://doi.org/10.11152/mu-1248
2. 2. Foley CE, Ayers PG, Lee TT. Abdominal wall endometriosis. Obstet Gynecol Clin North Am. 2022;49:369–380. https://doi.org/10.1016/j.ogc.2022.02.013
3. 3. Thanasa A, Thanasa E, Antoniou IR, Kontogeorgis G, Gerokostas EE, Kamaretsos E, et al. Abdominal wall endometriosis: early diagnosis of a rare iatrogenic complication following cesarean section. Cureus. 2024;16:e56284. https://doi.org/10.7759/cureus.56284
4. 4. Bacanakgil BH, Özçam H, Deveci M, Yıldırım SG. Abdominal wall endometriosis: analysis of 66 patients at a tertiary center. Istanbul Med J. 2019;20(2):94–97. https://doi.org/10.4274/imj.galenos.2018.50490
5. 5. Benedetto C, Cacozza D, de Sousa Costa D, Coloma Cruz A, Tessmann Zomer M, Cosma S, et al. Abdominal wall endometriosis: report of 83 cases. Int J Gynaecol Obstet. 2022;159:530–536. https://doi.org/10.1002/ijgo.14167
6. 6. Bozkurt M, Cil AS, Bozkurt DK. Intramuscular abdominal wall endometriosis treated by ultrasound-guided ethanol injection. Clin Med Res. 2014;12:160–165. https://doi.org/10.3121/cmr.2013.1183
7. 7. Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, et al. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics. 2012;32:2031–2043. https://doi.org/10.1148/rg.327125024
8. 8. Stein L, Elsayes KM, Wagner-Bartak N. Subcutaneous abdominal wall masses: radiological reasoning. AJR Am J Roentgenol. 2012;198:W146–W151. https://doi.org/10.2214/AJR.10.7238

9. 9. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152:83–85. https://doi.org/10.1016/j.ejogrb.2010.05.001
10. 10. Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, Macintyre IM, et al. Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg. 1995;82:1349–1351. https://doi.org/10.1002/bjs.1800821017
11. 11. Jaramillo-Cardoso A, Balcacer P, Garces-Descovich A, Beker K, Roth E, Glickman J, et al. Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma. Abdom Radiol (NY). 2020;45:1800–1811. https://doi.org/10.1007/s00261-018-1666-1
12. 12. Busard MP, Mijatovic V, van Kuijk C, Hompes PG, van Waesberghe JH. Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol. 2010;20:1267–1276. https://doi.org/10.1007/s00330-009-1658-1
13. 13. Franz M, Klotz T, Montoriol PF, Garcier JM, Canis M, Da Ines D; Clermont-Ferrand/FR. Abdominal wall endometriosis: MRI features of 31 lesions with histological confirmation. ECR 2014; C–1798. https://doi.org/10.1594/ecr2014/C-1798
14. 14. Genc B, Solak A, Sahin N, Genç M, Ogul H, Sivrikoz ON, et al. Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas. Clin Radiol. 2014;69:130–136. https://doi.org/10.1016/j.crad.2013.08.015
15. 15. Hu S, Liu Y, Chen R, Xiao Z. Exploring the diagnostic performance of magnetic resonance imaging in ultrasound-guided high-intensity focused ultrasound ablation for abdominal wall endometriosis. Front Physiol. 2022;13:819259. https://doi.org/10.3389/fphys.2022.819259
16. 16. Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, et al. Imaging of abdominal wall masses, mass-like lesions, and diffuse processes. Radiographics. 2020;40:684–706. https://doi.org/10.1148/rg.2020190170
17. 17. Khanna M, Ramanathan S, Kambal AS, Al-Berawi M, Yadav S, Kumar D, et al. Multi-parametric MRI for the diagnosis of abdominal wall desmoid tumors. Eur J Radiol. 2017;92:103–110. https://doi.org/10.1016/j.ejrad.2017.04.010