Differential diagnosis of cystic masses in the female pelvis based on the conventional MRI findings and the added value of advanced MRI techniques

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2014

Poster Number:

C-1245

Type:

Educational Exhibit

Keywords:

Genital / Reproductive system female, Pelvis, MR, MR-Diffusion/Perfusion, MR-Spectroscopy, Diagnostic procedure, Cysts, Cancer, Inflammation

Authors:

M. Takeuchi, K. Matsuzaki, M. Harada; Tokushima/JP

DOI:

10.1594/ecr2014/C-1245

DOI-Link:

https://dx.doi.org/10.1594/ecr2014/C-1245

Fig. 10: MR Spectroscopy (MRS)

Fig. 25: Step 3: Morphologic appearances of the cyst

Fig. 29: Decision Tree of Ovarian cystic mass

Fig. 13: Step 1: Adnexal, Uterine, or Non-gynecologic origin? Demonstrating...

Learning objectives

To demonstrate diagnostic strategy of cystic masses in the female pelvis by using conventional and advanced MRI. To describe the clinical and imaging features of various benign and malignant tumors and tumor-like lesions exhibiting cystic masses in the female pelvis.

Background

Various benign and malignant tumors and tumor-like lesions in the female pelvis may appear as cystic masses. We describe the optimized MR protocol for evaluating cystic masses and the added value of advanced MR techniques: DWI; Fat/Water separation techniques; SWI; High-resolution MRI at 3T; 3D-DCE MRI; MR Spectroscopy, in identifying the tumor origin, in distinguishing benign and malignant lesions, and in determining specific histological subtypes. We describe 5 steps to the diagnosis. Step 1 is the lesion localization by ovary detection, extra-peritoneal or intra-peritoneal localization,...

Findings and procedure details

[Conventional and advanced MRI for the differential diagnosis] - Conventional MRI (T1-/T2WI) (Fig. 1) -Water shows T2-very high and T1-low signal pattern -Serous fluid shows water-like signal pattern -Thin mucinous fluid may also show water-like intensities, however, thick mucinous material may show T1-increase / T2-decrease pattern -Fat shows high signal intensity on both T1- and T2WI -Hemorrhagic fluid may show various signal patterns: -Acute hemorrhage may show T2-decrease due to deoxyhemoglobin -Subacute to chronic hemorrhage may show T1/T2 increase due to methemoglobin -Hematocrit effect may...

Conclusion

Systemic evaluation by using conventional MRI and advanced MR techniques may lead to the correct diagnosis of cystic masses in the female pelvis for the appropriate treatment.

Personal information

Mayumi Takeuchi, MD, PhD Associate professor Department of Radiology, University of Tokushima 3-18-15, Kuramoto-cho, Tokushima zip: 770-8503, JAPAN tel: 81-88-633-9283 fax: 81-88-633-7468 e-mail: [email protected]

References

1) Kurman RJ ed. Blaustein's Pathologiy of the Female Genital Tract 6th ed. Springer, 2010. 2) Hricak H ed. Diagnostic Imaging: Gynecology. AMIRSYS, 2007. 3) Outwater EK et al. Normal ovaries and functional cysts: MR appearance. Radiology. 1996;198:397-402. 4) Tamai K et al. MR features of physiologic and benign conditions of the ovary. Eur Radiol. 2006;16:2700-11. 5) Takeuchi M et al. Manifestations of the female reproductive organs on MR images: changes induced by various physiologic states. Radiographics. 2010;30:1147. doi: 10.1148/rg.e39. 6) Kanso HN et al....