mri features of malignant transformation of pelvic endometriosis: a systematic review

Background: endometriosis is a benign gynecologic condition that is estrogen-dependent. malignant transformation is one of the complications of endometriosis; it can affect the woman`s ovarian and extra-ovarian regions. diagnosing endometriosis-associated cancers has an essential role in treatment. purpose: our study aimed to review magnetic resonance imaging (mri) features of malignant transformation of pelvic endometriosis. material and methods: we searched three online databases including web of science, scopus, and pubmed, applying relevant keywords up to may 2022. we included english observational studies using mri for endometriosis patients and comparing the mri features of malignant pelvic endometriosis with non-malignant ones or studies reporting the mri features of malignant pelvic endometriosis. finally, a comprehensive systematic review of the included studies was conducted. the small number of qualifying studies was the most significant limitation. also, the eligible studies were insufficient for conducting a meta-analysis. results: a total of eight papers were included as they matched our inclusion requirements. eighty-seven individuals were included finally. studies were published between 1992 and 2021. the larger size of the lesion, loss of t2-weighted images shading, mural nodules, mural nodules contrast enhancement, and mural nodules protruding from the cyst wall at acute angles were the main mri features suggesting potential malignant transformation of pelvic endometriosis. conclusion: the endometriosis›s malignant changes can be observed on mri. the predominant mri findings are a large cyst, loss of shading on t2-weighted imaging, mural nodules enhancement, and acutely angled protrusion of mural nodules from the cyst wall.