Fig. 4

Example of the application of the #Enzian (m) classification, with MR images and coding. 38-year-old patient with abdominal wall endometriosis in the C-section scar and pelvic endometriosis. a Sagittal T2W image depicts an anteverted-retroflexed uterus. The posterior junctional zone of the uterus is thickened, in keeping with focal adenomyosis (arrow). b Axial T2W image demonstrate a plaque-like retrocervical endometriotic lesion, with low signal intensity, measuring about 3.6 cm in the axial plane (arrows). c Sagittal T2W image. The exact measurement of the retrocervical involvement on the sagittal plane, is challenging, due to the millimetric thickness of the lesion (about 0.4 cm). Elevation of the posterior vaginal fornix is seen (arrow). d Axial T2W image and e axial fat-saturated T1W image depict a nodular lesion (circles) in the left rectus abdominis muscle, showing high signal intensity foci on both sequences, suggestive of blood products. An US guided biopsy was performed and the histopathological examination confirmed an endometriotic nodule. Disease classification according to #Enzian (m): A1, FA, F (abdominal wall)