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MDCT of the Gonadal Veins in Females with Large Pelvic Masses: Value in Differentiating Ovarian Versus Uterine Origin

¹ Department of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
² Department of Anatomic Pathology, Kyushu University, Fukuoka 812-8582, Japan.

View larger version (18K): [in a new window]   Fig. 1 —Graph shows receiver operating characteristic (ROC) curves of two observers for determination of origin of lesion. Area under ROC curve (Az) values of both observers had good diagnostic accuracy: 0.90 for observer 1 () and 0.92 for observer 2 (), with good interobserver correlation ( = 0.48).

View larger version (141K): [in a new window]   Fig. 2A —53-year-old woman with uterine carcinosarcoma. CT image at level of left renal vein.

View larger version (139K): [in a new window]   Fig. 2B —53-year-old woman with uterine carcinosarcoma. CT image shows joining point of left gonadal vein (arrow) into left renal vein.

View larger version (116K): [in a new window]   Fig. 2C —53-year-old woman with uterine carcinosarcoma. CT image shows right gonadal vein (white arrow) joining to inferior vena cava. Black arrow = left gonadal vein.

View larger version (123K): [in a new window]   Fig. 2D —53-year-old woman with uterine carcinosarcoma. CT image of upper level of pelvis shows right (white arrow) and left (black arrow) gonadal veins.

View larger version (107K): [in a new window]   Fig. 2E —53-year-old woman with uterine carcinosarcoma. CT images at level of pelvic mass show that gonadal veins continue to bilateral ovarian cystic structures. Bilateral gonadal veins arise from normal ovary (thin black arrows and thin white arrows, F) and are totally detectable to inferior vena cava or left renal vein, respectively. Detectability scores of both bilateral gonadal veins were 5. Score of origin determination was judged by both observers to be 1. Thick white arrows = right gonadal vein, thick black arrows = left gonadal vein.

View larger version (103K): [in a new window]   Fig. 2F —53-year-old woman with uterine carcinosarcoma. CT images at level of pelvic mass show that gonadal veins continue to bilateral ovarian cystic structures. Bilateral gonadal veins arise from normal ovary (thin black arrows and thin white arrows, F) and are totally detectable to inferior vena cava or left renal vein, respectively. Detectability scores of both bilateral gonadal veins were 5. Score of origin determination was judged by both observers to be 1. Thick white arrows = right gonadal vein, thick black arrows = left gonadal vein.

View larger version (124K): [in a new window]   Fig. 2G —53-year-old woman with uterine carcinosarcoma. Continuity of gonadal veins and normal ovaries is most easily visualized on curved multiplanar reconstruction, such as this image, which was not shown to either observer. Thick white and black arrows = right and left gonadal veins, thin white and black arrows = normal ovary.

View larger version (116K): [in a new window]   Fig. 3A —59-year-old woman with right ovarian carcinoma. CT image shows large solid mass with central necrosis located in pelvis.

View larger version (125K): [in a new window]   Fig. 3B —59-year-old woman with right ovarian carcinoma. CT images show right gonadal vein (arrow, B and C) arises from solid component of large mass. Score of origin determination was 5—that is, this mass was considered to be right ovarian mass. In addition, stretched venous branches are seen around mass (wraparound phenomenon, arrowheads, C and D). Uterus is not seen in these images.

View larger version (121K): [in a new window]   Fig. 3C —59-year-old woman with right ovarian carcinoma. CT images show right gonadal vein (arrow, B and C) arises from solid component of large mass. Score of origin determination was 5—that is, this mass was considered to be right ovarian mass. In addition, stretched venous branches are seen around mass (wraparound phenomenon, arrowheads, C and D). Uterus is not seen in these images.

View larger version (121K): [in a new window]   Fig. 3D —59-year-old woman with right ovarian carcinoma. CT images show right gonadal vein (arrow, B and C) arises from solid component of large mass. Score of origin determination was 5—that is, this mass was considered to be right ovarian mass. In addition, stretched venous branches are seen around mass (wraparound phenomenon, arrowheads, C and D). Uterus is not seen in these images.

View larger version (113K): [in a new window]   Fig. 4A —49-year-old woman with subserosal pedunculated uterine myoma. CT images show large mass was located adjacent to uterus (U, C). Both gonadal veins (thick black and white arrows) are joined to normal ovarian structures (thin black and white arrows, C). Score of origin determination was 2, of probable nonovarian origin.

View larger version (111K): [in a new window]   Fig. 4B —49-year-old woman with subserosal pedunculated uterine myoma. CT images show large mass was located adjacent to uterus (U, C). Both gonadal veins (thick black and white arrows) are joined to normal ovarian structures (thin black and white arrows, C). Score of origin determination was 2, of probable nonovarian origin.

View larger version (118K): [in a new window]   Fig. 4C —49-year-old woman with subserosal pedunculated uterine myoma. CT images show large mass was located adjacent to uterus (U, C). Both gonadal veins (thick black and white arrows) are joined to normal ovarian structures (thin black and white arrows, C). Score of origin determination was 2, of probable nonovarian origin.

View larger version (134K): [in a new window]   Fig. 5A —45-year-old woman with uterine myoma. CT images show right gonadal vein (arrow) looks as if it continues directly to mass. Both observers diagnosed this lesion as ovarian tumor. Surgery disclosed leiomyoma of uterus. In this case, normal ovary is not visualized, causing misdiagnosis. However, wraparound appearance is not seen, but abrupt interruption of gonadal vein is recognized at lateral edge of mass, which indicates this mass originates from uterus rather than ovary.

View larger version (133K): [in a new window]   Fig. 5B —45-year-old woman with uterine myoma. CT images show right gonadal vein (arrow) looks as if it continues directly to mass. Both observers diagnosed this lesion as ovarian tumor. Surgery disclosed leiomyoma of uterus. In this case, normal ovary is not visualized, causing misdiagnosis. However, wraparound appearance is not seen, but abrupt interruption of gonadal vein is recognized at lateral edge of mass, which indicates this mass originates from uterus rather than ovary.

View larger version (129K): [in a new window]   Fig. 5C —45-year-old woman with uterine myoma. CT images show right gonadal vein (arrow) looks as if it continues directly to mass. Both observers diagnosed this lesion as ovarian tumor. Surgery disclosed leiomyoma of uterus. In this case, normal ovary is not visualized, causing misdiagnosis. However, wraparound appearance is not seen, but abrupt interruption of gonadal vein is recognized at lateral edge of mass, which indicates this mass originates from uterus rather than ovary.

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