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MRI of Sonographically Indeterminate Adnexal Masses

Saroja Adusumilli1, Hero K. Hussain1, Elaine M. Caoili1, William J. Weadock1, John P. Murray1, Timothy D. Johnson2, Qixuan Chen2 and Benoit Desjardins1

1 Department of Radiology, University of Michigan Health System, UH B2 A-209-R, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030.
2 Department of Biostatistics, School of Public Health, University of Michigan Health System, Ann Arbor, MI.


Figure 1
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  		Fig. 1A —30-year-old woman with unicornuate uterus and rudimentary horn in right pelvis that was diagnosed as possible solid right ovarian neoplasm on sonography. Longitudinal transvaginal sonogram reveals 2.4-cm solid adnexal mass (asterisk) that appears to arise from right ovary (arrow).

 

Figure 2
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  		Fig. 1B —30-year-old woman with unicornuate uterus and rudimentary horn in right pelvis that was diagnosed as possible solid right ovarian neoplasm on sonography. Axial T2-weighted image (TR/TE, 3,750/98) reveals classic banana-shaped unicornuate uterus (white arrows) in left pelvis and rudimentary horn (black arrows) in right pelvis adjacent to right ovary (arrowhead).

 

Figure 3
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  		Fig. 1C —30-year-old woman with unicornuate uterus and rudimentary horn in right pelvis that was diagnosed as possible solid right ovarian neoplasm on sonography. Coronal T2-weighted image (3,750/98) also shows that solid mass seen in A is a small rudimentary horn (arrow) located adjacent to a normal right ovary.

 

Figure 4
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  		Fig. 2A —48-year-old woman with right ovarian endometrioma. Longitudinal transvaginal sonogram reveals solid right ovarian mass (asterisk) that is nonspecific in appearance and could have benign or malignant diagnosis.

 

Figure 5
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  		Fig. 2B —48-year-old woman with right ovarian endometrioma. Axial fat-suppressed T1-weighted gradient-echo image (TR/TE, 190/1.8; flip angle, 70°) (B) shows that right ovarian mass (arrow) has homogeneous high signal intensity and (C) relative loss of signal intensity on axial T2-weighted image (5,300/96) from hemorrhagic content of endometrioma with intracellular methemoglobin causing typical T2 shading (arrow). Contrast-enhanced imaging (not shown) confirmed absence of enhancement.

 

Figure 6
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  		Fig. 2C —48-year-old woman with right ovarian endometrioma. Axial fat-suppressed T1-weighted gradient-echo image (TR/TE, 190/1.8; flip angle, 70°) (B) shows that right ovarian mass (arrow) has homogeneous high signal intensity and (C) relative loss of signal intensity on axial T2-weighted image (5,300/96) from hemorrhagic content of endometrioma with intracellular methemoglobin causing typical T2 shading (arrow). Contrast-enhanced imaging (not shown) confirmed absence of enhancement.

 

Figure 7
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  		Fig. 3A —42-year-old woman with left ovarian dermoid. Transverse transvaginal sonogram reveals heterogeneous complex-appearing mass (arrows) in left ovary.

 

Figure 8
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  		Fig. 3B —42-year-old woman with left ovarian dermoid. Axial T1-weighted (TR/TE, 650/14) (B) and T2-weighted (4,050/86) (C) images show high-signal-intensity mass (arrow) that homogeneously loses signal intensity on fat-suppressed axial T1-weighted spoiled gradient-echo image (240/2.0; flip angle, 70°) (D), confirming fat content of mature dermoid.

 

Figure 9
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  		Fig. 3C —42-year-old woman with left ovarian dermoid. Axial T1-weighted (TR/TE, 650/14) (B) and T2-weighted (4,050/86) (C) images show high-signal-intensity mass (arrow) that homogeneously loses signal intensity on fat-suppressed axial T1-weighted spoiled gradient-echo image (240/2.0; flip angle, 70°) (D), confirming fat content of mature dermoid.

 

Figure 10
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  		Fig. 3D —42-year-old woman with left ovarian dermoid. Axial T1-weighted (TR/TE, 650/14) (B) and T2-weighted (4,050/86) (C) images show high-signal-intensity mass (arrow) that homogeneously loses signal intensity on fat-suppressed axial T1-weighted spoiled gradient-echo image (240/2.0; flip angle, 70°) (D), confirming fat content of mature dermoid.

 

Figure 11
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  		Fig. 4A —33-year-old woman with 8-cm serous cystadenoma of left ovary that was diagnosed as follicular ovarian cyst versus ovarian cystadenoma on sonography and MRI. Transverse transabdominal sonogram of pelvis reveals unilocular cystic mass (arrow) immediately adjacent to uterus (asterisk).

 

Figure 12
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  		Fig. 4B —33-year-old woman with 8-cm serous cystadenoma of left ovary that was diagnosed as follicular ovarian cyst versus ovarian cystadenoma on sonography and MRI. Axial unenhanced T2-weighted (TR/TE, 4,200/90) (B) and gadolinium-enhanced spoiled gradient-echo T1-weighted (190/1.7; flip angle, 70°) (C) images reveal cystic mass in left ovary (arrow) without septations, mural nodules, or abnormal enhancement to definitively diagnose as ovarian cystic neoplasm.

 

Figure 13
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  		Fig. 4C —33-year-old woman with 8-cm serous cystadenoma of left ovary that was diagnosed as follicular ovarian cyst versus ovarian cystadenoma on sonography and MRI. Axial unenhanced T2-weighted (TR/TE, 4,200/90) (B) and gadolinium-enhanced spoiled gradient-echo T1-weighted (190/1.7; flip angle, 70°) (C) images reveal cystic mass in left ovary (arrow) without septations, mural nodules, or abnormal enhancement to definitively diagnose as ovarian cystic neoplasm.

 

Figure 14
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  		Fig. 5A —64-year-old woman with pedunculated uterine fibroid that was diagnosed as either solid ovarian neoplasm or pedunculated leiomyoma on sonography. Transverse transvaginal sonogram reveals that solid left adnexal mass (asterisk) located immediately adjacent to uterus is indeterminate as to uterine or ovarian origin.

 

Figure 15
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  		Fig. 5B —64-year-old woman with pedunculated uterine fibroid that was diagnosed as either solid ovarian neoplasm or pedunculated leiomyoma on sonography. T2-weighted image through short axis of uterus (TR/TE, 3,500/90) shows stalk (arrows) between mass (asterisk) and uterus, which confirms diagnosis of leiomyoma.

 

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