1576 Preoperative MRI is a Must If You Are Planning Sclerotherapy for Ovarian Endometrioma

Video Objective To evaluate the effect of preoperative MRI before sclerotherapy for ovarian endometrioma. Setting An academic teaching hospital. Interventions Ultrasound-guided aspiration followed by ethanol sclerotherapy was done for premenopausal women who are anticipating pregnancy or who are planning any kind of assisted reproductive technique. With the bladder completely emptied, the cystic lesion is localized using a transvaginal ultrasound. The 18 gauge ovum aspiration needle is penetrated into the cystic cavity under ultrasound guidance. Constant negative pressure is indirectly applied with a syringe. Once the cyst is adequately drained, normal saline is flushed into the cystic cavity for irrigation until the irrigated fluid becomes clear. Then the cystic cavity is irrigated with 95% ethanol and another ethanol is instillated in the cyst. Although variable according to size and duration, the majority of endometrioma present as a classic homogeneous hypoechoic cyst with diffuse ground glass appearance on ultrasound. However, even if preoperative ultrasound strongly suggests endometrioma, differential diagnosis must be made to rule out the possibility of other kind of ovarian cysts like dermoid cyst or mucinous cyst if one is planning sclerotherapy. Magnetic resonance imaging (MRI) is known to have greater specificity for the diagnosis of endometriomas. They appear bright on T1 weighted image due to hemorrhagic contents and will remain bright on T1 fat suppressed images. It shows shading on T2 weighted image secondary to high concentration of protein and degraded blood products. Conclusion We suggest that MRI should be performed in all women in whom sclerotherapy is being considered as a treatment for ovarian endometrioma to rule out other cystic ovarian lesions which might mimic the ultrasound findings of an endometrioma.