title: Deep pelvic endometriosis: don't forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features.
abstract: Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Largo Agostino Gemelli 8, Rome, Italy, bgui@rm.unicatt.it.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Gui
authors.forename: Anna Lia
authors.initials: AL
authors.lastname: Valentini
authors.forename: Valeria
authors.initials: V
authors.lastname: Ninivaggi
authors.forename: Marzia
authors.initials: M
authors.lastname: Marino
authors.forename: Marta
authors.initials: M
authors.lastname: Iacobucci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D004715:Endometriosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010388:Pelvis / Q000473:pathology*; D012404:Round Ligament of Uterus / Q000033:anatomy & histology* / Q000473:pathology*