Learning objectives
Recognizing features and findings of benign adnexal masses on multiple imaging modalities,
enabling their diagnosis when possible or narrowing their differential,
and allowing for a more focused clinical approach.
Background
Benign adnexal masses are a common finding (incidental or otherwise) in pre and post-menopausal women,
and present an important diagnostic challenge that,
while not always possible through imaging findings alone,
can most of the time provide invaluable clues as to the benign/malignant probability and help guide the patient’s management.
Findings and procedure details
A pictorial review aiming to address theoretical concepts and illustrate some of the imaging findings and differential diagnosis of the most common types of benign adnexal masses based on ultrasound,
CT and MRI scans performed at our institution,
and discussing features pointing towards benign or malignant etiology such as solid components,
vascularity,
accompanying ascites and others.
General approach principles
The first line,
go-to examination for pelvic mass diagnosis and characterization is transvaginal ultrasound.
Advancements in the field and hardware have allowed this radiation free,
low...
Conclusion
Even when a specific diagnosis is not possible based exclusively on imaging findings there are still important clues that may contribute to narrowing the differential and influence patient management.
Transvaginal ultrasound excels at lesion characterization and should allow adequate study of most adnexal masses.
Undetermined lesions should undergo aditional cross-sectional imaging,
such as MRI when available and/or not contra-indicated,
or otherwise MDCT for further study and characterization.
References
Hiller N,Appelbaum L,
et al.
CT Features of Adnexal Torsion.
American Journal of Roentgenology.
2007;189: 124-129.
Laing FC,
Allison SJ.
US of the Ovary and Adnexa: To Worry or Not to Worry.
Radiographics 2012; 32:1621–1639
Izumi Imaoka I,
Wada A,
et al. Developing an MR Imaging Strategy for Diagnosis of Ovarian Masses.
RadioGraphics 2006; 26:1431–1448
Tsili AC,Tsampoulas C,
et al. Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexalmasses.
Eur Radiol.2008 May;18(5):1049-57
Tsili AC,et al. Multi-detector CT features of benignadnexallesions.
Acad...