To describe and illustrate the spectrum of different imaging findings of endometriomas on ultrasonography (US) and magnetic resonance imaging (MRI).

To describe the MRI protocol for evaluation of endometriomas.

To discuss the differential diagnosis and pitfalls of this entity.

Endometriosis is a common and important gynecologic disorder that is defined as the presence of functional endometrial tissue outside the uterus. This disease affects predominantly women of reproductive age, with a prevalence of approximately 10%.

Patients can be asymptomatic or present with chronic pelvic pain and/or infertility. Symptoms do not necessarily correlate with the severity of the disease.

The exact aetiology and pathogenesis remain unclear, although several theories have been proposed.

Endometriosis typically manifests in 3 ways:

- superficial peritoneal lesions (ie, noninvasive implants < 5 mm deep)

- endometriomas (ie, cystic endometriosis), and

- deep infiltrating endometriosis (defined as an endometriotic implant > 5 mm deep to the peritoneal...

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Endometriosis is an important gynaecological disorder which can significantly impact an individual’s quality of life.

This complex disease process has a heterogeneous phenotype that ranges from superficial implants to deep infiltrative disease of various organs of the pelvis and beyond.

Imaging plays a key role in the detection and characterization of endometriomas. As these lesions contain blood products of different ages and concentrations, they may show variable imaging appearances. Knowledge of this spectrum of appearances is important so that endometrioma is not excluded from the differential diagnosis.

Radiologists should be familiar with the wide range of presentations of endometriomas, including the serious complications associated, to give an appropriate diagnosis and facilitate optimal patient management.