Elsayes et al.

A b d o m i n a l I m ag i n g • P i c t o r i a l E s s ay
MRI of the
Peritoneum
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A C E N T U
R Y O F

MRI of the Peritoneum:

MEDICAL IMAGING
Spectrum of Abnormalities
Khaled M. Elsayes1,2 OBJECTIVE. Our objective was to detail peritoneal anatomy, techniques for optimizing
Paul T. Staveteig1 peritoneal MRI, and the MRI characteristics of several disease processes that frequently in-
Vamsidhar R. Narra1 volve the peritoneum.
John R. Leyendecker3 CONCLUSION. Homogeneous fat suppression and dynamic contrast-enhanced imag-
James S. Lewis, Jr.4 ing, including delayed imaging, are critical technical factors for successful lesion detection and
characterization on peritoneal MRI.
Jeffrey J. Brown1
Elsayes KM, Staveteig PT, Narra VR, iseases involving the peritoneum
Leyendecker JR, Lewis JS Jr, Brown JJ
D are frequently encountered in
medical practice. Primary abnor-
malities of the peritoneum are
rare. However, involvement of the peritoneal
cavity and its specialized folds secondary to
infectious, neoplastic, and traumatic condi-
tions that originate at other sites within the ab-
domen and pelvis is frequent.
MRI, because of its excellent tissue charac-
terization and multiplanar abilities, is a pow-
erful tool for disease characterization and an-
atomic delineation. This article details
peritoneal anatomy, techniques for optimiz-
ing peritoneal MRI, and the MRI characteris-
tics of several disease processes that fre-
quently involve the peritoneum.
Keywords: abdominal imaging, MRI, peritoneum
Peritoneal Anatomy
DOI:10.2214/AJR.04.1522
The peritoneum is a serous sac consisting
Received September 27, 2004; accepted after revision of a thin mesothelial membrane that lines the
March 14, 2005. abdominal and pelvic cavities and covers
most of the abdominal organs contained
1Mallinckrodt Institute of Radiology, Washington University
therein [1]. Although the peritoneum is a sin-
School of Medicine, 510 S Kingshighway Blvd., St. Louis,
gle continuous sheet, it is divided arbitrarily
MO 63110. Address correspondence to: K. M. Elsayes
(elsayesk@mir.wustl.edu). into two types, the visceral peritoneum and
the parietal peritoneum.
2Present address: Theodore Bilharz Institute, Giza, Egypt.
The parietal peritoneum lines the abdom-
3Department
inal and pelvic cavities. The visceral perito-
of Radiology, Wake Forest University School
of Medicine, Winston-Salem, NC.
neum covers the external surface of most ab-
dominal organs, or viscera. The small and
4Department of Surgical Pathology, Washington University large intestines are suspended from the pos-
School of Medicine, St. Louis, MO. terior aspect of the peritoneal cavity by the
AJR 2006; 186:1368–1379
mesentery, a double layer of parietal perito-
neum that has fused during embryologic de-
0361–803X/06/1865–1368
velopment. The mesentery serves as a con-
© American Roentgen Ray Society duit for the blood vessels, nerves, and
lymphatic vessels going to and from the ab-
dominal organs.
The omentum is a double-layer extension
of visceral peritoneum that extends from the
stomach. The lesser omentum, also known
as the gastrohepatic ligament, arises from
the lesser curvature of the stomach and ex-
tends to the liver. The greater omentum
arises from the greater curvature of the stom-
ach and extends inferiorly in the peritoneal
cavity. Other peritoneal ligaments, such as
the gastrosplenic ligament and splenorenal
ligament, are also formed by fused double
layers of peritoneum.
The peritoneal cavity consists of several
communicating spaces [2]. Fused layers of
peritoneum form the transverse mesocolon,
which is the mesentery suspending the trans-
verse colon. The transverse mesocolon di-
vides the peritoneal cavity into suprameso-
colic and inframesocolic components, as
seen in Figure 1A. As depicted, the trans-
verse mesocolon acts as the floor of the
lesser sac. The transverse mesocolon pro-
vides a pathway of spread for pancreatic dis-
ease to the transverse colon.
Supramesolic Compartment
The supramesocolic compartment (Fig. 1B)
is divided into right and left peritoneal spaces
by the falciform ligament.
The left supramesocolic peritoneal space is
bound on the right by the hepatic falciform
ligament and consists of anterior and poste-
rior perihepatic components. The anterior and
posterior perihepatic spaces communicate
freely below the lower border of the liver.

1368 AJR:186, May 2006

 MRI of the Peritoneum

Fig. 1—Schematics of liver and right kidney. Fluid collections in the

peritoneal anatomy. right perihepatic space are usually explained
A–C, In these sagittal (A), Stomach
axial (B), and coronal (C) by abnormalities involving the right hepatic
views, pouch of Douglas lobe, gallbladder, and duodenum.
and lateral paravesicular Supramesocolic
spaces are seen to
communicate (green
Peritoneum Inframesocolic Compartment
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arrows) with peritoneal The inframesocolic compartment, depicted

cavity. Peritoneum is in Figure 1C, is divided into two spaces by the
shown in red. Ao = aorta, Greater obliquely oriented small-bowel mesentery.
IVC = inferior vena cava, Peritoneal
Spl = spleen. The right inframesocolic space is to the right of
Space the small-bowel mesentery but medial to the
ascending colon. The left inframesocolic space
Inframesocolic is to the left of the small-bowel mesentery.
Peritoneum The right and left paracolic gutters run lat-
Duodenum erally to the ascending and descending co-
lonic reflections, respectively. The right para-
colic gutter is continuous superiorly with the
Transverse Mesocolon Transverse Colon
right perihepatic space. On the left, the
A phrenicocolic ligament represents a barrier
between the left paracolic gutter and the left
Falciform Ligament
supramesocolic peritoneal space. Finally, the
Gastrohepatic Ligament
midline pouch of Douglas and the lateral
paravesicular spaces form the most dependent
portions of the peritoneal cavity, where in-
fected fluid and malignant ascites usually
Gastrosplenic Ligament
pool by means of gravity.

Foramen of Winslow
Transverse
Mesocolon
Ascending Colon
This space can be affected by abnormalities
involving the left hepatic lobe, lesser gastric
curvature, anterior gastric and duodenal
walls, and anterior wall of the gallbladder.
The right supramesocolic peritoneal space
comprises an anterior perihepatic region,
Splenorenal Ligament
Right Supramesocolic Space
Left Supramesocolic Space
Lesser Sac
B tinely used, can improve image quality.
Phrenocolic Ligament
Small-Bowel Mesentery
Descending Colon
Right Inframesocolic Space
Left Inframesocolic Space
Dependent Pelvis
C
bound medially by the falciform ligament,
and a posterior component, known as the
lesser sac. The two right supramesocolic
spaces communicate via the foramen of Win-
slow. Morison’s pouch (also known as the
hepatorenal fossa) is a recess between the
MRI Technique
MRI evaluation of the peritoneal cavity re-
quires meticulous attention to technique. Ap-
propriate coil placement and homogeneous
fat suppression are essential. Oral contrast
material and IV glucagon, although not rou-
Pulse sequences used for MRI examination
of the peritoneum are similar to those of stan-
dard abdominal MRI. Our standard protocol
comprises four types of sequences: a coronal
T2-weighted single-shot fast spin-echo or
HASTE sequence; a turbo or fast spin-echo
T2-weighted or long-TE inversion-recovery
breath-hold sequence in the axial plane (STIR
eliminates field artifacts and is usually
performed as a fat-saturated T2-weighted
pulse sequence); a gradient-recalled-echo T1-
weighted chemical-shift in-phase and out-of-
phase breath-hold sequence in the axial plane;
and a 3D gradient-echo breath-hold sequence,
such as a volumetric interpolated breath-hold
examination, which is fat suppressed.
Dynamic gadolinium-enhanced images
must be included, because peritoneal disease
typically enhances slowly after contrast ad-
ministration [3]. The arterial phase images are
acquired at 15–20 sec, the portal phase im-
ages at 60–90 sec, and the delayed phase
images at 5 min after IV contrast injection.
Homogeneous fat suppression is a critical

AJR:186, May 2006 1369

 Elsayes et al.

Fig. 2—45-year-old man feature of the sequence to eliminate compet-

with right indirect ing signal from fat adjacent to the peritoneum.
inguinal hernia (arrows).
A and B, Axial gradient-
refocused-echo in- Disorders of Peritoneal Confinement
phase image (A) and Hernias are abnormal protrusions of in-
axial fast spin-echo T2-
weighted image (B) show
traabdominal contents through a defect in the
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bowel loops and fat abdominal wall, usually as the result of a con-
herniating through right genital defect, a loss of tissue strength, or
external inguinal ring. trauma. Hernias are typically described by an-
atomic location. MRI characterizes hernias
well on the basis of its ability to differentiate
tissue planes.

Indirect Inguinal Hernia

In indirect inguinal hernias (Fig. 2), intra-
peritoneal contents herniate through the in-
ternal inguinal ring lateral to the inferior epi-
A gastric vessels and into the inguinal canal.
Bowel strangulation, incarceration, and ob-
struction may result from these and other
types of hernias.

Spigelian Hernia
A spigelian hernia is a hernia through the
lateral ventral abdominal wall at the point
where the semilunar and semicircular lines
intersect at the lateral border of the rectus ab-
dominus, also known as the spigelian apo-
neurosis. Classic spigelian hernias are cranial
to the junction of the inferior epigastric ves-
sels and the spigelian aponeurosis. Visualiza-
tion of a spigelian hernia on physical exami-
nation can be difficult, particularly in obese
patients. Bowel may herniate through the
spigelian hernia and become incarcerated or
strangulated. Omentum may also herniate
B through the spigelian aponeurosis. Abdomi-
nal pain may result from omental infarction
within a spigelian hernia.

Incisional Hernia
An incisional hernia results during or af-
ter closure of anterior abdominal wall inci-
sions (Fig. 3). Imaging may be useful for
showing the size and location of the abdom-
inal defect, particularly in obese patients,
and for differentiating hernia from he-
matoma early after surgery. MRI provides
excellent multiplanar tissue resolution for
hernia characterization [4].
Fig. 3—51-year-old
woman with left ventral
Peritoneal Inflammation and
incisional hernia. Axial
T1-weighted 3D Intraperitoneal Fluid
volumetric interpolated Inflammatory peritoneal disease may re-
breath-hold image sult in acute or chronic peritonitis. Peritonitis
shows left incisional
hernia containing may be infectious and is typically seen in the
mesenteric fat and small- setting of bowel perforation, diverticulitis,
bowel loops (arrow). appendicitis, or severe cholecystitis. Bacterial

1370 AJR:186, May 2006

 MRI of the Peritoneum

peritonitis may also result from peritoneal in-
strumentation, such as peritoneal dialysis,
surgery, or penetrating abdominal trauma.
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Noninfectious causes of peritonitis include
pancreatitis and systemic diseases such as
systemic lupus erythematosus.
A dynamic, enhanced gradient-echo pulse
sequence is particularly pertinent for the diag-
nosis of peritonitis. The administration of IV
contrast material produces peritoneal en-
hancement in cases of peritonitis. The perito-
neal contour may remain smooth, in contrast

Fig. 4—36-year-old man to the nodular peritoneal contour more typical

with acute peritonitis. of neoplastic disease [5] (Fig. 4).
A and B, Axial T1
gradient-refocused- Sarcoidosis is a granulomatous systemic
echo volumetric disease of unknown cause that infrequently
interpolated breath-hold involves the peritoneum [6]. MRI characteris-
images before (A) and
after (B) contrast tics typical of sarcoid peritonitis include re-
administration show gions of enhancing peritoneum, with soft-tis-
smooth linear sue infiltration of the omentum and
enhancement of
peritoneum (arrows, B)
mesentery (Fig. 5).
with unenhanced
intraperitoneal fluid, Hemoperitoneum
representing acute Hemoperitoneum usually occurs second-
peritonitis.
ary to abdominal trauma or tumor rupture.
Blood products evolve over time into deox-
yhemoglobin, methemoglobin, and other
A degradation products, with concomitant sig-
nal changes (Fig. 6). The appearance of
blood products on MRI varies with their
stage of evolution. Acute blood in the form
of deoxyhemoglobin is isointense on T1-
weighted images and dark on T2-weighted
images. Subacute blood in the form of meth-
emoglobin is hyperintense on T1-weighted
images. Initially, methemoglobin is intrac-
ellular and appears dark on T2-weighted im-
ages. Subsequently, it becomes bright on
T2-weighted images as the red cells lyse and
the methemoglobin becomes extracellular.
An old hemorrhage is dark on both T1- and
T2-weighted images because of the pres-
ence of hemosiderin. T1-weighted images
B with fat saturation are quite sensitive in de-
tecting methemoglobin. Gradient-echo im-
ages can magnify the susceptibility effects
of decreased signal intensity seen with he-
mosiderin and deoxyhemoglobin, thereby
increasing their conspicuity. Similarly, a le-
sion that loses significant signal intensity on
in-phase images compared with out-of-
phase images of shorter TE may contain
blood products. Smooth peritoneal wall en-
hancement is sometimes noted, likely from
reactive inflammation (Fig. 7).
Fig. 5—42-year-old man
with sarcoidosis. Axial Pneumoperitoneum
enhanced T1-weighted Pneumoperitoneum (intraperitoneal air)
gradient-refocused-
echo volumetric usually results from instrumentation or vis-
interpolated breath-hold cus perforation and is characterized by re-
image shows irregularly gions of signal absence on T1- and T2-
enhancing omental soft
tissue (arrows) weighted images. Free intraperitoneal air
secondary to can be a subtle MRI finding, requiring a
sarcoidosis. thorough search pattern. Gradient-refo-

AJR:186, May 2006 1371

 Elsayes et al.

cused-echo sequences are the most sensitive
in depicting dephasing artifacts from free
air due to “blooming” associated with mag-
netic field inhomogeneities at air–tissue in-
terfaces [7] (Fig. 8).
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Intraperitoneal Bile Leak
A bile leak usually results from surgery and is
clinically occult when the leakage is present in
small amounts. An active bile leak can be eluci-
dated by administration of mangafodipir triso-
dium (Teslascan, GE Healthcare), which results
in increased intraperitoneal T1 signal intensity
on delayed enhanced images (Fig. 9). This in-
creased signal results from biliary excretion of
the contrast agent, which usually collects in the
right upper quadrant. Formation of a pseudocap-

sule results in biloma formation. Other findings,

such as peritoneal inflammation, likely related to
Fig. 6—55-year-old both recent surgery and inflammation secondary
woman with to bile leakage, are visualized as smooth perito-
intraperitoneal subacute
hematoma. neal contrast enhancement. Bilomas are typi-
A and B, Axial T2- cally cystic, heterogeneously hypointense on
weighted inversion- T1-weighted images, homogeneously hyperin-
recovery image (A) and
axial gradient- tense on T2-weighted images, and lacking inter-
refocused-echo image nal enhancement (Fig. 10) [8].
(B) show subacute blood, Mangafodipir trisodium is a hepatocyte-se-
best seen in perihepatic
space (arrows). Use of
lective contrast agent that is partially eliminated
inversion recovery via biliary excretion. Maximal hepatic paren-
eliminates near-field chymal enhancement occurs during the first 20
artifact. min after intravenous injection of this agent. De-
layed images acquired at about 60 min after in-
jection can be used to assess possible bile leaks.
Unfortunately, Mangafodipir trisodium is no
longer available in the United States. Multi-
Hance (Gadobenate dimeglumine, Bracco Di-
agnostics) is also partially excreted by the biliary
system, however, further experience is needed to
determine its efficacy in assessing bile leaks.

Peritoneal Neoplasms
Benign Tumors
A variety of benign tumors of the perito-
A neum can manifest as soft-tissue masses.
These lesions include lipomas, neurofibromas,
and other mesenchymal tumors. Peritoneal and
mesenteric neurofibromatosis is uncommon,
seen most often in patients with a diagnosis of
neurofibromatosis type 1 (von Reckling-
hausen’s disease). Peritoneal and mesenteric
neurofibromas have MRI characteristics simi-
lar to those of neurofibromas in other anatomic
locations. Typically, neurofibromas are hypo-
to isointense to muscle on T1-weighted im-
ages, are hyperintense to muscle on T2-
weighted images, and show moderate to brisk
gadolinium enhancement [9] (Fig. 11). Both
T2-weighted and gadolinium-enhanced T1-
weighted gradient-echo pulse sequences are
useful for the diagnosis of neurofibromatosis.
Cystic mesothelioma of the peritoneum is a
rare benign neoplasm that occurs predomi-
nantly in women and tends to recur locally. It
is seen as a multilocular mass that can be con-
fused with other intraperitoneal cystic lesions.

Malignant Tumors
Peritoneal mesothelioma—Primary peri-
B toneal mesothelioma is a rare neoplastic

1372 AJR:186, May 2006

 MRI of the Peritoneum

Fig. 7—48-year-old man with infected intraperitoneal hematoma.

A–C, Axial T2-weighted image (A) and axial T1-weighted gradient-refocused-echo
volumetric interpolated breath-hold images before (B) and after (C) IV administration
of contrast material show linear smooth peritoneal enhancement, with presence of
intraperitoneal blood-intensity signal.
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B C

A B
Fig. 8—54-year-old man with pneumoperitoneum.
A and B, Axial in-phase (A) and out-of-phase (B) images show small amount of free air (arrows). Conspicuity is increased on in-phase images because of longer TE, resulting
in greater susceptibility artifact.

AJR:186, May 2006 1373

 Elsayes et al.

Fig. 9—48-year-old condition of the peritoneum, often associ-

woman with bile leak. ated with asbestos exposure. Peritoneal me-
A–C, Axial fat-
suppressed T1-weighted sothelioma spreads along the serosal surface
image (A) and axial (B) and may invade solid and hollow viscera di-
and coronal (C) fat- rectly. MRI of the peritoneum typically re-
suppressed T1-weighted
images 1 hr after IV
veals a peritoneal mass with delayed con-
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administration of trast enhancement, often in association with

mangafodipir trisodium sheets of enhancing peritoneal disease.
show hyperintense Small nodules may be seen in the early
perihepatic fluid
denoting bile leak stages. Later, these nodules may coalesce to
(arrow, C). form large, confluent masses or omental
caking [10] (Fig. 12).
Peritoneal metastases—Metastatic disease
is the most commonly encountered neoplas-
tic process involving the peritoneum. Peri-
toneal carcinomatosis is typically mani-
fested by enhancing peritoneal nodules
A (Figs. 13 and 14) or a rind of enhancing
perihepatic soft tissue. In patients with ova-
rian neoplasms, gastrointestinal malignan-
cies, or pseudomyxoma peritonei, the peri-
toneal surfaces, including the perihepatic
ligaments and transverse mesocolon, are
frequent sites of tumor deposition [11].
These neoplastic peritoneal nodules and
sheets enhance gradually after gadolinium
administration. Distinguishing between
simple perihepatic ascites and perihepatic
peritoneal neoplastic disease can be difficult
with CT because peritoneal disease may not
enhance significantly with iodinated con-
trast material. Gadolinium-enhanced MR
images, on the other hand, are sensitive to
peritoneal enhancement, which is seen with
inflammatory or malignant peritoneal dis-
ease but not with simple ascites [12]. The
B
most common locations of peritoneal me-
tastases are the pouch of Douglas, ileocecal
region, right paracolic gutter, sigmoid
mesocolon, greater omentum, and right sub-
diaphragmatic parietal peritoneum [13].
Mesenteric carcinoid—Intraabdominal
carcinoid tumors, although often arising from
the foregut, midgut, and hindgut, may also
arise from neuroendocrine cells within
Meckel’s diverticulum, within cystic duplica-
tions, and within the mesentery and perito-
neum. Mesenteric carcinoid tumors are usu-
ally seen as nodular masses associated with
mesenteric stranding. Ninety-four percent of
carcinoid tumors are hypervascular and ex-
hibit low T1 signal intensity, high T2 signal
intensity, and moderately intense gadolinium
enhancement [14] (Fig. 15). Independent of
site of origin, aggressive carcinoid tumors
typically spread to the mesentery, mesenteric
lymph nodes, liver, ovaries, and spleen. Bone
C metastases are not rare.

1374 AJR:186, May 2006


Miscellaneous Diseases
Mesenteric Cysts
Mesenteric cysts are composed of a di-
verse group of fluid-filled lesions, usually
serous, sanguineous, or mixed. They are
classified on the basis of the tissue of origin
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and can be divided into lymphatic, mesothe-
lial, enteric, or urogenital types or may be
related to prior infection or trauma. The typ-
ical MRI appearance of mesenteric cysts is
Fig. 10—52-year-old man with biloma.
A and B, Axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image (A) and axial T2-weighted inversion recovery image (B) show lambda-
shaped fluid collection (arrows) adjacent to caudate lobe, representing biloma.
AJR:186, May 2006
MRI of the Peritoneum
a multiloculated or uniloculated well-de- Endometrial Implants
fined abdominal mass, usually in the mesen- Endometrial implants, the hallmark of en-
tery of the small bowel [15]. The MRI signal dometriosis, are focal deposits of functioning
intensity of mesenteric cysts varies depend- endometrial tissue outside the uterus
ing on the cyst contents. Serous cysts tend to (Fig. 17) [16]. Endometriosis is a common
have a low T1 signal, whereas proteinaceous disorder of women of reproductive age. The
and hemorrhagic cysts have an intermediate ectopic endometrium is responsive to ovarian
to high T1 signal. Mesenteric cysts show no hormones, resulting in a typical cyclic pat-
internal enhancement with gadolinium che- tern of symptoms. Endometrial implants
lates (Fig. 16). commonly involve the serosal surface of the
A B
Fig. 11—39-year-old woman with neurofibromatosis type 1. Axial T1-weighted
volumetric interpolated breath-hold image obtained after IV administration of
gadolinium chelate shows heterogeneously enhancing mass (arrow) involving
small-bowel mesentery, representing neurofibromatosis.
1375
 Elsayes et al.
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A B
Fig. 12—58-year-old man with mesothelioma.
A–C, Gradient-refocused-echo out-of-phase image (A) and enhanced axial T1-
weighted 3D gradient-refocused-echo volumetric interpolated breath-hold images
(B and C) show enhancing large mass (arrows, A and B), representing mesothelioma,
which is entangling bowel loops.

Fig. 13—44-year-old woman with metastases from ovarian cancer. Axial enhanced Fig. 14—41-year-old woman with ovarian cancer. Axial fat-suppressed gradient-
T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image refocused-echo T1-weighted enhanced image shows peritoneal tumor implants in
shows nodular enhancement of peritoneum over liver surface (arrows), representing perihepatic space (white arrow) and Morison’s pouch (black arrow).
metastases in patient with history of ovarian cancer.

1376 AJR:186, May 2006

 MRI of the Peritoneum
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A B
Fig. 15—48-year-old woman with mesenteric
carcinoid tumor.
A, Three-dimensional subvolume maximum-intensity
projection shows narrowing of ileocolic artery (arrow).
B and C, Enhancing mass (arrows) is seen on portal
venous phase images, with involvement of draining veins.

ovary, where they can be cystic and are re-
ferred to as endometriomas or chocolate
cysts. The implants can incite an inflamma-
tory reaction resulting in adhesions and fi-
brosis. Because of cyclic hormonal stimula-
tion, endometriomas often exhibit varying
stages of hemorrhage (most commonly in-
creased T1 and T2 signal or increased T1 and
decreased T2 signal). Chronic hemorrhage or
fibrosis can result in focal areas of signal
void on both T1- and T2-weighted images
[17]. Fat-suppressed T1-weighted imaging is
the most sensitive MRI technique for depict-
ing endometriomas [18]. The use of fat satu-
ration helps to distinguish endometrial im-
plants from fatty lesions, such as ovarian
teratomas. Common locations for endome-
trial implants, in addition to the ovaries, in-
clude the peritoneal lining around the rec-
tovaginal pouch and the abdominal wall [16].
Conclusion
The peritoneum, including peritoneal re-
flections and spaces, is difficult to visualize

AJR:186, May 2006 1377

 Elsayes et al.
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A B
Fig. 16—51-year-old man with mesenteric cyst.
A, Axial enhanced T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image shows large, nonenhancing extrahepatic cystic structure (arrow)
posterior to portal vein and anterior to hepatic artery, representing mesenteric cyst.
B, T2-weighted image shows homogeneously bright signal (arrow).

Fig. 17—48-year-old woman with cystic liver lesion incidentally discovered on CT.
A, Coronal T2-weighted HASTE image shows high-signal-intensity lesion (arrow)
posterior to right hepatic lobe.
B and C, Unsubtracted (B) and subtracted (C) axial T1-weighted gadolinium-
enhanced images show capsule-based lesion (arrows) secondary to endometriosis.

B C

1378 AJR:186, May 2006


when it is healthy. However, knowledge of
these peritoneal reflections improves our in-
terpretation of imaging studies of patients
with peritoneal disease, including hernias,
peritonitis, and neoplasia.
Successful MRI of the peritoneum de-
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pends critically on imaging technique. Ho-
mogeneous fat suppression and dynamic
contrast-enhanced imaging, including de-
layed imaging, are important technical fac-
tors for successful detection and character-
ization of lesions.
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