MR diagnostics of adnexal masses

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

Congress:

ECR 2017

Poster Number:

C-1499

Type:

Educational Exhibit

Keywords:

Pelvis, MR, Imaging sequences, Neoplasia, Metastases, Cancer

Authors:

O. Nikolic, J. Ostojic, M. Basta Nikolic, A. Spasic, D. Donat, S. Stojanovic; Novi Sad/RS

DOI:

10.1594/ecr2017/C-1499

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-1499

Fig. 15: T2: cystic-solid mass of the right ovary.

Fig. 16: T1FSC+: enchancement of the solid component of right ovarian mass.

Fig. 17: DWI: diffusion restriction in the solid component of right ovarian mass.

Fig. 18: Perfusion DCE base image: ROI placed on 2. myometrium, 3. mass on the right.

Learning objectives

This lecture will cover: 1. MRI indications, 2. patient preparation, 3. protocol and 4. categorization of adnexal masses. Variety of selected cases will be discussed.

Background

Based on US examination all adnexal masses can be divided into three cathegories: 1. benign 2. malignant 3. indeterminate. Indeterminate adnexal mass is the complex one which even after including color doppler cannot be placed into either cathegory or for which the site of origin cannnot be established. For women with indeterminate adnexal masses MR imaging is the method of choice. In these women MRI imaging can reduce the number of unnecessary surgery for benign lesions and the risk of missing malignant lesions.

Findings and procedure details

For evaluation of adnexal masses we used the following MRI protocol: T2W Sag pelvis T2W, T1W covering the mass in the same ortogonal plane (ax, cor or oblique) with identical slice thickness. DWI Ax T1W DCE Option 1: mass has high signal on T1W Ax FSE, then T1W FS Option 2: if doubts whether mass belongs to ovary or uterus (axial plane of the ovary FSE T1WFS, axial plane of the ovary FSE T2W, axial plane of the ovary 3DT1WFS). According to signal characteristics obtained...

Conclusion

MRI allows identification of blood products within adnexal masses that may mimic solid tumors at US. T1WFS images may reveal small amounts of fat, which allows the diagnosis of mature hematoma. T1WCE imaging best depicts features of malignancy. Perfusion curve types are useful tool for analysis of epithelial ovarian tumors.

Personal information

References

Spencer JA, Forstner R, Cunha TM, Kinkel K. ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithimic approach. Eur Radiol 2010; 20: 25-35. Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology 2010; 256: 677-94. Thomassin-Nagarra I et al. Characterization of complex adnexal masses: value of adding perfusion and diffusion-weighted MR imaging to conventional MR imaging. Radiology 2011; 258; 3: 793-803. AIUM, ACR, ACOG, SPR, SRU. AIUM practice guideline for the performance of ultrasound of the female...