The prevalence of retroverted uterus in patients with endometriosis was 36%. This value is derived from the ratio of patients belonging to the first group of women with a retroverted-flexed uterus, or rather those with a diagnosis or strong clinical suspicion of endometriosis (38 patients) and the total number of women with endometriosis (105 patients). Women with a retroverted/retroflexed uterus were a total of 97 patients, because 23 patients (19,17%) were discarded from the study, due to menopause in 56.52% and for technical examination reasons in 43.48%.

The results in these 97 patients obtained, were

Fig 2: 2. Prevalence of retroverted-flexed uterus in different groups.

- group 1 (39.2%): women with previous confirmed/suspected endometriosis: (38 patients, mean age 37).

- group 2 (47.4%): women without previous diagnosis or suspicion: the occasional finding of retroverted uterus was attributable to a possible diagnosis of endometriosis (46 patients, mean age 35).

- group 3 (13.4%): women whose finding of retroverted uterus was likely related to another cause: 13 patients.

Group 1 (39.2%), on the other hand, encompasses all those women already diagnosed with endometriosis who performed pelvic studies in follow-up or different types of examinations in which the retroverted-flexed uterus was found

Fig 3: 3. (A) Sagittal T2 weighted images show a retroverted-flexed uterus, increased in volume due to the presence of multiple intramural leiomyomas, with the serosa of the posterior wall of the body adhered to the posterior wall of the isthmus due to the presence of small endometriotic implants. (B) Sagittal T2, (C) oblique axial T2 and (D) axial T1 show in the right ovary two cystic formations (arrows) with blood content attributable to endometriotic cysts. (E) and (F) oblique axial T2 show respectively thickening of the uterosacral ligament and the round ligament (arrows) as a possible endometriotic involvement.

Analysis of these data shows that the largest group was the second, that is those women who performed an MRI examination for a clinical question other than suspected endometriosis, a finding that confirms the course of our study. These (47,4 % of patients) were performing an MRI examination for a variety of reasons and in particular 8 were suffering from Crohn's disease (17%), 5 were suspected demyelinating disease for which they were performing a spine study (10.8%)

Fig 4: 4. 23-year-old woman undergoing MRI scan for suspected demyelinating disease. (A) Sagittal T2, (B) sagittal T2 STIR and (C) sagittal T1 weighted images show the presence of a retroverted-flexed uterus with the serosa of the posterior wall of the body appearing to adhere to the posterior wall of the isthmus.

Fig 5: 5. Percentage of various endometriosis findings found in groups 1 and 2.

The remaining part of the patients analyzed (13,4 %) represents all those women who present with retroverted-flexed uterus for reasons other than endometriosis, such as previous cesarean delivery (30.76%)

Fig 6: 6. (A) Sagittal T2, (B) sagittal T2 fat-sat, (C) oblique coronal T2 and (D) oblique axial T2 show the presence of a retroverted-flexed uterus whose fundal surface adheres to the anterior abdominal wall in a patient who had undergone a previous cesarean section.

Fig 7: 7. (A) Sagittal T2 and (B) oblique axial T2 show the presence of a large, heterogeneously hypointense, subserosal leiomyoma on the posterior wall of the uterine body which is likely the cause of uterine retroflexion.