Characterization of Adnexal Mass Lesions on MR Imaging
S. A. Aslam Sohaib1,2,
Ahju Sahdev1,
Philippe Van Trappen3,
Ian J. Jacobs3 and
Rodney H. Reznek1
1 Department of Diagnostic Imaging, St. Bartholomew's Hospital, West Smithfield,
London, EC1A 7BE, England, United Kingdom.
2 Academic Department of Diagnostic Radiology, Royal Marsden Hospital, Downs
Rd., Sutton, Surrey SM2 5PT, United Kingdom.
3 Department of Gynaecological Oncology, St. Bartholomew's Hospital, London,
EC1A 7BE, England, United Kingdom.
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Fig. 1 .—86-year-old woman with bilateral borderline mucinous ovarian tumor.
Axial T2-weighted fast spin-echo MR image shows large left cystic lesion
(black arrows) with small septum and small right cystic lesion
(white arrow). Because no features on MR imaging suggested
malignancy, lesions were thought to be benign.
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Fig. 2. —40-year-old woman with large endometriotic cyst
(arrow) in left ovary. Axial T1-weighted fast spin-echo MR image
shows large thick-walled cystic lesion containing high signal intensity and
thick nodular septa that enhanced after IV administration of gadolinium (not
shown). On MR imaging, this lesion was incorrectly interpreted as
malignancy.
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Fig. 3A. —48-year-old woman with large endometriotic cyst. Axial
T1-weighted spin-echo MR images obtained with frequency-selective fat
saturation before (A) and after (B) IV administration of
gadolinium shows cystic lesion (arrows) with high signal intensity
and thick wall with enhancing nodule (arrowhead, B) seen
posteriorly. Lesion was incorrectly interpreted as malignancy on MR
imaging.
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Fig. 3B. —48-year-old woman with large endometriotic cyst. Axial
T1-weighted spin-echo MR images obtained with frequency-selective fat
saturation before (A) and after (B) IV administration of
gadolinium shows cystic lesion (arrows) with high signal intensity
and thick wall with enhancing nodule (arrowhead, B) seen
posteriorly. Lesion was incorrectly interpreted as malignancy on MR
imaging.
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Fig. 4. —79-year-old woman with granulomatous salpingo-oophoritis.
Axial T2-weighted fast spin-echo MR image shows cystic lesion
(arrows). Note septum with nodule (arrowhead). On MR
imaging, lesion was incorrectly interpreted as malignancy.
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Fig. 5. —62-year-old woman with poorly differentiated serous
cystadenocarcinoma. Axial T2-weighted fast spin-echo MR image shows cystic
lesion (white arrow). Note vegetation on lesion wall (black
arrow) and thick irregular septa (arrowhead) within lesion.
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Fig. 7A. —61-year-old woman with cystic teratoma in left ovary. Axial
T1-weighted spin-echo MR image shows well-defined thick-walled adnexal mass
(arrows) with extremely high signal intensity.
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Fig. 7B. —61-year-old woman with cystic teratoma in left ovary. Axial
T1-weighted spin-echo MR image obtained with frequency-selective fat
saturation shows central portion of mass (arrows) with low signal
intensity confirming presence of fat. Appearance is typical of teratoma, which
was confirmed at histopathology.
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Fig. 8A. —78-year-old woman with clear cell cancer of ovary. Sagittal
T2-weighted fast-spin echo MR image shows solid–cystic mass
(arrow). Note thick irregular septum (arrowhead).
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Fig. 8B. —78-year-old woman with clear cell cancer of ovary. Unenhanced
(B) and contrast-enhanced (C) sagittal T1-weighted spin-echo MR
images obtained with frequency-selective fat saturation show enhancing soft
tissue (arrowhead, C). High signal intensity in cystic
component of mass (arrow) was due to blood related products.
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Fig. 8C. —78-year-old woman with clear cell cancer of ovary. Unenhanced
(B) and contrast-enhanced (C) sagittal T1-weighted spin-echo MR
images obtained with frequency-selective fat saturation show enhancing soft
tissue (arrowhead, C). High signal intensity in cystic
component of mass (arrow) was due to blood related products.
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Fig. 9A. —82-year-old woman who had benign ovarian fibroma with central
necrosis. Sagittal T2-weighted fast spin-echo MR image shows large
heterogeneous mass (arrows) with areas of low signal intensity.
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Fig. 9B. —82-year-old woman who had benign ovarian fibroma with central
necrosis. Contrast-enhanced T1-weighted spin-echo MR image obtained with
frequency-selective fat saturation shows areas of nonenhancement
(arrowheads) in keeping with necrosis within mass (arrows).
At histopathology, nonenhancing areas corresponded to areas of myxoid
degeneration.
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Fig. 10A. —66-year-old woman with poorly differentiated adenocarcinoma
of ovary. Axial T2-weighted fast spin-echo MR image shows large heterogeneous
mass (arrow).
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Fig. 10B. —66-year-old woman with poorly differentiated adenocarcinoma
of ovary. Contrast-enhanced T1-weighted spin-echo MR image obtained with
frequency-selective fat saturation shows areas of necrosis
(arrowhead) within mass (arrow).
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Fig. 11. —58-year-old woman with right ovarian fibroma
(arrow). Axial T2-weighted fast spin-echo MR image shows well-defined
solid lesion with low signal intensity.
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Copyright © 2003 by the American Roentgen Ray Society.
;
Az = 0.96 ± 0.02), regression model based on MR
imaging features (
;Az = 0.86 ± 0.03),
percentage of enhancement seen within 60 sec of rapid bolus injection of IV
gadolinium (
; Az = 0.74 ± 0.1), and volume
of lesions (—; Az = 0.68 ± 0.04).
Radiologists' interpretations had largest area under curve and thus was best
discriminator between benign and malignant adnexal masses.