|Technique||Endometrioma Image||Suspicion of malignant transformation|
|US||Unilocular or multilocular (less than 5 locules) cysts.|
Homogenous low-level echogenicity (ground glass echogenicity).
Poor or no vascularization.
Presence of diffuse low-level echoes.
Multilocularity of hyperechoic foci in the wall.
Blot clots or fibrin adjacent to the cyst wall forming papillations (no vascularisation inside).
Thin septa in large endometriomas.
|Anechoic thin-walled cyst with echogenic vegetation or focal wall nodularity (blood clots or fibrosis due to recurrent hemorrhage can mimick these findings).|
|MRI||Specific sign – shading (caused by old blood products containing high levels of iron and protein).|
Higher T1, lower T2 signal intensities than in hemorrhagic cysts.
Shortening of T1 and T2 secondary to high protein concentration and increased viscosity.
Bilateral and multifocal lesions.
|Cystic mass containing mural nodules and hemorrhagic fluid.|
Enhancing mural nodules within endometrioma on T1 W1 is highly suggestive of malignancy.
Absence of characteristic T2-weighted “shading” which disappears in malignant tumor.