Skip to main content

Advertisement

SpringerLink
Log in

What abdominal radiologists should know about extragenital endometriosis-associated neuropathy

  • Special Section: Endometriosis
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to provide an overview of endometriosis-associated neuropathy and to review main anatomical concepts of intrapelvic peripheral nerves.

Methods

In this pictorial essay, we review the anatomy of pelvic nerves and imaging features of endometriosis-associated neuropathy. We also evaluate clinical findings, imaging features, and outcome of seven patients with endometriosis-associated neuropathy.

Results

Nerve involvement by endometriosis is rare and may manifest with neurological symptoms, including pain, muscle weakness, bowel and bladder incontinence, and paraplegia. The neural involvement may be isolated or caused by a direct extension of a deep infiltrating endometriosis of the pelvic structure. Magnetic resonance imaging (MRI) is a reliable imaging modality for detecting neural involvement of endometriosis. On MRI, the main imaging features are retractile fibrous tissue and endometriomas. The signal intensity of the endometriotic tissue may vary depending on the age of the hemorrhage and the proportion of endometrial cells and stroma. Early diagnosis and treatment may avoid permanent neural damage.

Conclusion

Considering that patients with endometriosis usually undergo pelvic MRI, which is generally reported by a non-musculoskeletal-trained radiologist, abdominal radiologists need to be familiar with the pelvic nerve anatomy and the possible patterns of presentation of neural endometriosis. Early diagnosis may obviate permanent nerve damage and MRI is a reliable tool for the diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Giudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799

    Article  Google Scholar 

  2. Morassutto C, Monasta L, Ricci G, Barbone F, Ronfani L (2016) Incidence and estimated prevalence of endometriosis and adenomyosis in Northeast Italy: a data linkage study. PLoS ONE 11(4):e0154227

    Article  Google Scholar 

  3. Gordts S, Koninckx P, Brosens I (2017) Pathogenesis of deep endometriosis. Fertil Steril. 108(6):872–885

    Article  Google Scholar 

  4. Coutinho A, Bittencourt LK, Pires CE, Junqueira F, Lima CM, Coutinho E, et al. (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 31(2):549–567

    Article  Google Scholar 

  5. Parasar P, Ozcan P, Terry KL (2017) Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 6(1):34–41

    Article  Google Scholar 

  6. Ceccaroni M, Clarizia R, Roviglione G, Bruni F, Ruffo G, Peters I, et al. (2010) Deep rectal and parametrial infiltrating endometriosis with monolateral pudendal nerve involvement: case report and laparoscopic nerve-sparing approach. Eur J Obstet Gynecol Reprod Biol. 153(2):227–229

    Article  Google Scholar 

  7. Descamps P, Cottier JP, Barre I, Rosset P, Laffont J, Lansac J, et al. (1995) Endometriosis of the sciatic nerve: case report demonstrating the value of MR imaging. Eur J Obstet Gynecol Reprod Biol. 58(2):199–202

    Article  CAS  Google Scholar 

  8. Jeswani S, Drazin D, Shirzadi A, Fan X, Johnson JP (2011) Endometriosis in the lumbar plexus mimicking a nerve sheath tumor. World J Oncol. 2(6):314–318

    PubMed  PubMed Central  Google Scholar 

  9. Motamedi M, Mousavinia F, Naser Moghadasi A, Talebpoor M, Hajimirzabeigi A (2015) Endometriosis of the lumbosacral plexus: report of a case with foot drop and chronic pelvic pain. Acta Neurol Belg. 115(4):851–852

    Article  Google Scholar 

  10. Possover M, Chiantera V (2007) Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril. 87(2):417.e17–417.e19

    Article  Google Scholar 

  11. Possover M, Baekelandt J, Flaskamp C, Li D, Chiantera V (2007) Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. Minim Invasive Neurosurg. 50(1):33–36

    Article  CAS  Google Scholar 

  12. Reddy S, Porter D, Patton JT, Al-Nafussi A, Beggs I (2007) Endometriosis of the superior gluteal nerve. Skeletal Radiol. 36(9):879–883

    Article  CAS  Google Scholar 

  13. Siquara de Sousa AC, Capek S, Howe BM, Jentoft ME, Amrami KK, Spinner RJ (2015) Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurg Focus. 39(3):E15

    Article  Google Scholar 

  14. Vercellini P, Chapron C, Fedele L, Frontino G, Zaina B, Crosignani PG (2003) Evidence for asymmetric distribution of sciatic nerve endometriosis. Obstet Gynecol. 102(2):383–387

    PubMed  Google Scholar 

  15. Siquara De Sousa AC, Capek S, Amrami KK, Spinner RJ (2015) Neural involvement in endometriosis: review of anatomic distribution and mechanisms. Clin Anat. 28(8):1029–1038

    Article  Google Scholar 

  16. Gebarski KS, Gebarski SS, Glazer GM, Samuels BI, Francis IR (1986) The lumbosacral plexus: anatomic-radiologic-pathologic correlation using CT. Radiographics. 6(3):401–425

    Article  CAS  Google Scholar 

  17. Rv L, Dt A, Pvp H, Lcz R, Mb R (2017) Magnetic resonance imaging of hip neuropathies beyond the sciatica: a practical approach. Curr Radiol Rep. 5:36

    Article  Google Scholar 

  18. Neufeld EA, Shen PY, Nidecker AE, Runner G, Bateni C, Tse G, et al. (2015) MR imaging of the lumbosacral plexus: a review of techniques and pathologies. J Neuroimaging. 25(5):691–703

    Article  Google Scholar 

  19. Chhabra A, Faridian-Aragh N (2012) High-resolution 3-T MR neurography of femoral neuropathy. AJR Am J Roentgenol. 198(1):3–10

    Article  Google Scholar 

  20. Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A (2013) Imaging of neuropathies about the hip. Eur J Radiol. 82(1):17–26

    Article  Google Scholar 

  21. Mannan K, Altaf F, Maniar S, Tirabosco R, Sinisi M, Carlstedt T (2008) Cyclical sciatica: endometriosis of the sciatic nerve. J Bone Joint Surg Br. 90(1):98–101

    Article  CAS  Google Scholar 

  22. Schlicke CP (1946) Ectopic endometrial tissue in the thigh. J Am Med Assoc. 132:445

    Article  CAS  Google Scholar 

  23. Papapietro N, Gulino G, Zobel BB, Di Martino A, Denaro V (2002) Cyclic sciatica related to an extrapelvic endometriosis of the sciatic nerve: new concepts in surgical therapy. J Spinal Disord Tech. 15(5):436–439

    Article  CAS  Google Scholar 

  24. Zhang Z, Song L, Meng Q, Li Z, Pan B, Yang Z, et al. (2009) Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusion-weighted magnetic resonance neurography techniques. Spine (Phila Pa 1976). 34(7):E245–E250

    Article  Google Scholar 

  25. Yekeler E, Kumbasar B, Tunaci A, Barman A, Bengisu E, Yavuz E, et al. (2004) Cyclic sciatica caused by infiltrative endometriosis: mRI findings. Skeletal Radiol. 33(3):165–168

    Article  Google Scholar 

  26. Cottier JP, Descamps P, Sonier CB, Rosset P (1995) Sciatic endometriosis: MR evaluation. AJNR Am J Neuroradiol. 16(7):1399–1401

    CAS  PubMed  Google Scholar 

  27. Gougoutas CA, Siegelman ES, Hunt J, Outwater EK (2000) Pelvic endometriosis: various manifestations and MR imaging findings. AJR Am J Roentgenol. 175(2):353–358

    Article  CAS  Google Scholar 

  28. Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics. 32(6):1675–1691

    Article  Google Scholar 

  29. Choudhary S, Fasih N, Papadatos D, Surabhi VR (2009) Unusual imaging appearances of endometriosis. AJR Am J Roentgenol. 192(6):1632–1644

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to express their deepest gratitude to Abdalla Youssef Skaf MD, Nucélio Luiz de Barros Moreira Lemos MD, and Luis Pecci Neto MD for providing cases to this manuscript.

Funding

Funding

This research received no funding.

Author information

Author notes

  1. Jucélio Pereira Moura Filho and Renata Vidal Leão have contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil

    Jucélio Pereira Moura Filho, Renata Vidal Leão, Natally Horvat, Paulo Victor Partezani Helito, Denise Tokechi Amaral, Publio Cesar Cavalcanti Viana, Isabel Curcio Felix Louza & Marcelo Bordalo-Rodrigues

Authors
  1. Jucélio Pereira Moura Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renata Vidal Leão
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natally Horvat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paulo Victor Partezani Helito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Denise Tokechi Amaral
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Publio Cesar Cavalcanti Viana
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Isabel Curcio Felix Louza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marcelo Bordalo-Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natally Horvat.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moura Filho, J.P., Leão, R.V., Horvat, N. et al. What abdominal radiologists should know about extragenital endometriosis-associated neuropathy. Abdom Radiol 45, 1818–1828 (2020). https://doi.org/10.1007/s00261-018-1864-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-018-1864-x

Keywords

Search

Navigation