DOI:10.2214/AJR.04.1417
AJR 2006; 186:440-448
© American Roentgen Ray Society
MDCT of the Gonadal Veins in Females with Large Pelvic Masses: Value in Differentiating Ovarian Versus Uterine Origin
Yoshiki Asayama1,
Kengo Yoshimitsu1,
Hitoshi Aibe1,
Akihiro Nishie1,
Daisuke Kakihira1,
Hiroyuki Irie1,
Tsuyoshi Tajima1,
Kunishige Matake1,
Tomohiro Nakayama1,
Yoshihiro Ohishi2,
Eisuke Kaneki2 and
Hiroshi Honda1
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.
Received September 12, 2004;
accepted after revision January 28, 2005.
Address correspondence to Y. Asayama
(asayama{at}radiol.med.kyushu-u.ac.jp).
Abstract
OBJECTIVE. The objective of our study was to determine the
usefulness of recognizing the continuity of the gonadal veins to the pelvic
mass to differentiate ovarian versus uterine origin on MDCT in females with a
large pelvic mass.
MATERIALS AND METHODS. Two radiologists interpreted the MDCT images
obtained on a monitor, using paging methods, in 86 female patients with a
large pelvic mass (> 8 cm) and 40 patients without an abdominopelvic mass
as control subjects. The following issues were recorded using a 5-point scale:
visualization of gonadal veins and origin determination based on anatomic
continuity. Receiver operating characteristic (ROC) curve analysis was
performed, and the interobserver differences were checked with kappa
statistics. The maximum diameters of the gonadal veins were also measured.
With consensus interpretations, the sensitivity, specificity, and accuracy of
ovarian origin determination were calculated.
RESULTS. Gonadal veins were shown in more than 70% of the subjects
in both the control group and the patients with a mass (hereafter referred to
as the "mass group"). There was no significant difference in the
diameter of the gonadal veins between the control and mass groups and between
patients with an ovarian mass and those with a uterine mass. The values for
the area under the ROC curve (Az) of the two observers for
ovarian origin determination were 0.90 and 0.92. The kappa value was 0.48. The
sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.9%,
respectively.
CONCLUSION. Gonadal veins can be shown on MDCT with high
consistency; MDCT provides useful information for determining the origin of
relatively large pelvic tumors arising in females.
Keywords: CT • genitourinary tract imaging • gonadal veins • pelvic imaging • pelvic mass • women's imaging
Introduction
To help narrow the differential diagnosis of a pelvic mass in females, it
is important to determine the site of origin. Some researchers
[1-5]
have proposed that the analysis of MRI or sonographic features of the
tumor—including its content, architecture, pattern of degeneration, and
the relationship of the uterine serosa to the mass—allows
differentiation of an ovarian mass from a uterine mass. In routine practice,
however, it may not always be possible to determine the site of the origin of
a large pelvic tumor [6].
On the other hand, the relationship of a pelvic mass and the gonadal veins
on CT when determining the origin of masses has drawn little attention. The
purpose of this study, therefore, was to describe the detectability of gonadal
veins on routine CT examination and the utility of detecting anatomic
continuity of the gonadal veins to pelvic masses to define the organ of origin
of pelvic masses, especially masses with an ovarian origin versus those with a
uterine origin.
Materials and Methods
Patient Population
There were 130 consecutive patients who had a large pelvic mass (> 8 cm)
that was surgically resected. Of these 130 patients, 86 underwent preoperative
MDCT of the abdomen and pelvis with a consistent protocol: 54 had an ovarian
tumor (47 epithelial tumors, two metastases, and five others) and 32 had a
uterine tumor (28 leiomyomas, one leiomyosarcoma, and three others). These
cases were ultimately selected for this study. The patients ranged in age from
19 to 81 years (mean, 52.0 years), and tumor size ranged from 8 to 26 cm
(mean, 10.5 cm). An additional 40 females who underwent MDCT during the same
period and were found to be free of disease in the abdomen and pelvis were
selected as control subjects. They ranged in age from 16 to 81 years (mean,
47.9 years), which is almost exactly equivalent to the age range of the 86
patients with a pelvic mass (p =0.33, Student's t test). Our
institutional review board did not require its approval or informed consent
for retrospective evaluation of the patients' records and images.
CT Protocol
All patients were examined with a 4-MDCT scanner (Aquilion, Toshiba; or
Somatom Volume Zoom, Siemens Medical Solutions). The parameters for scanning
were a 2.5- or 3-mm collimation, 5-mm reconstruction, and 5.5 pitch. Scanning
from the top of the liver to the pubis was begun 60 and 240 sec after IV
injection of 100 mL of a contrast medium containing 300 mg I /mL; the
injection rate was 2 mL/sec.
Image Interpretation
Two abdominal radiologists with 10 and 16 years of experience with CT of
the abdomen, respectively, were blinded to the surgical results and MRI or
sonographic findings; they interpreted independently the axial CT images on a
monitor (Coronis 3MP, Barco) using paging methods (the scroll function on a
PACS workstation). Visualization of the gonadal veins was scored using the
following 5-point scale in both the patients with a mass (hereafter referred
to as the "mass group") and the control subjects: 1, not detected;
2, about a quarter detectable; 3, about half the length detectable; 4, about
three quarters detectable; and 5, totally detectable. The gonadal veins were
tracked backward from the draining point at the inferior vena cava (IVC) or
left renal veins in a caudal direction to the pelvis.
The maximum diameters of the gonadal veins were measured on the console by
the two observers at the time of interpretation. We measured the gonadal veins
in the image at the point where they looked the biggest. Actually, we measured
two or three points when the biggest point was uncertain, and the averaged
values were compared among the three age groups (
30, 31-59, 
60
years), between patients with and without a pelvic mass, between patients with
a mass of ovarian origin and those with a mass of uterine origin, between
patients with an ovarian mass and those without a pelvic mass, and between
patients with a uterine mass and those without pelvic mass. We also compared
the diameters of the gonadal vein between the right and left side in the mass
group and control group, respectively, and the mass side and contralateral
side in the patients with an ovarian mass.
The origin of the tumors was determined as follows. The mass was considered
to be ovarian in origin when the gonadal vein was observed to be continuous to
the mass. When the gonadal vein continued to the ovaries, the mass was
considered uterine in origin. The diagnostic confidence in determining the
origin of the mass, based on the continuity of the gonadal vein and the pelvic
mass, was also scored using a 5-point ordinal scale. In this scale, 1 meant
the origin was definitely uterine; 2, probably uterine; 3, uncertain; 4,
probably ovarian; and 5, definitely ovarian. When the observer rated the mass
4 or 5, the laterality of the gonadal vein that the observer focused on (in
other words, the laterality of the mass) was also recorded.
Data Analysis and Statistics
For detection of the gonadal veins, the interobserver difference was
evaluated with kappa statistics, and the detectability was then calculated by
defining confidence level ratings of 4 and 5 as positive and 3 or less as
negative after resolving discrepancies between the two observers by consensus.
The degree of interobserver agreement was characterized as slight (0-0.20),
fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), or almost
perfect (0.81-1.00). The chi-square test was used for a comparison of gonadal
vein detection between the control group and the mass group; visualization of
the gonadal vein in correlation with patient age was tested by Fisher's exact
test. For comparison of the diameter of the gonadal vein, the unpaired
Student's t test was used. All p values were calculated
using statistical software (StatView, Hulinks).
For determination of the origin of each pelvic mass, the receiver operating
characteristic (ROC) curve was fitted to each observer, and the area under the
ROC curve (Az value) was evaluated for diagnostic
accuracy. The computer program ROC-KIT 0.9B (C. E. Metz) was used
[7,
8]. Factors with
Az values greater than 0.80 were considered to have good
diagnostic accuracy [8]. The
interobserver difference was evaluated with kappa statistics. The sensitivity,
specificity, and accuracy for detecting ovarian origin were calculated by
defining confidence level ratings of 4 and 5 as positive and 3 or less as
negative; discrepancies between the two observers were resolved by
consensus.
When the origin of a mass was misdiagnosed, the reasons for the
misdiagnosis were evaluated by the study coordinator. We investigated the
reasons of misdiagnosis in cases of ovarian tumors rated 1 or 2 and in cases
of uterine tumors rated 4 or 5.
Results
The detectability of the gonadal veins in both the control group and mass
group was more than 70% with kappa values between 0.41 and 0.52, which shows
good correlation. No significant difference was found in detection of gonadal
veins on both sides between the control group and the mass group. There was no
statistically significant difference in detection of gonadal veins on both
sides among the three age groups in either the control or mass group. Details
are shown in Tables 1 and
2.
There was no significant difference between the two observers' measurements
of maximum diameter of gonadal veins (p = 0.682, paired Student's
t test). The mean diameters of the gonadal veins for the three age
groups are shown in Table 3.
From the data presented in Table
3, it can be seen that the younger patients had gonadal veins of
smaller caliber than did the elderly patients, with statistical significance
(p < 0.05). There were no significant differences in the diameter
of both gonadal veins between the control group and mass group in each of the
three age groups. The diameter of the right gonadal vein in the ovarian mass
group (mean ± SD, 4.4 ± 2.1 mm) was significantly smaller than
that in the uterine mass group (5.6 ± 4.8 mm) (p = 0.0028).
The diameter of the left gonadal vein in the ovarian mass group (4.5 ±
2.3 mm) was smaller than that in the uterine mass group (5.3 ± 2.7 mm),
also showing a significant difference (p = 0.039).
There were no significant differences in gonadal vein diameter between the
ovarian mass group and the control group on either side (right: ovarian mass
group vs control group, 4.4 ± 2.1 mm vs 4.0 ± 1.7 mm,
respectively, p = 0.24; left: ovarian mass group vs control group,
4.5 ± 2.3 mm vs 4.2 ± 2.7 mm, respectively, p = 0.32).
There were significant differences in the diameter of the gonadal vein on both
sides between the uterine mass group and control group (right: uterine mass
group vs control group, 5.6 ± 4.8 mm vs 4.0 ± 1.7 mm,
respectively, p = 0.0004; left: uterine mass group vs control group,
5.3 ± 2.7 mm vs 4.2 ± 2.7 mm, respectively, p =
0.0084). There were no significant differences in size between right and left
in the control group (right vs left, 4.0 ± 1.7 mm vs 4.3 ± 2.6
mm, p = 0.43) and mass group (right vs left, 4.8 ± 2.5 mm vs
4.8 ± 3.4 mm, p = 0.99). In the ovarian mass group, there was
no significant difference in gonadal vein size between the mass side and the
contralateral side (mass side vs contralateral side, 4.4 ± 2.2 mm vs
4.0 ± 1.5 mm, respectively; p = 0.28).
For determination of the origin of the pelvic masses, the
Az values of the two observers were 0.90 and 0.92,
respectively (Fig. 1). The
interobserver kappa value was 0.48, showing moderate agreement. For observer
1, sensitivity, specificity, and accuracy were 77.8%, 90.6%, and 82.6%,
respectively. For observer 2, sensitivity, specificity, and accuracy were
87.0%, 84.4%, and 86.0%, respectively. Disagreement was resolved by consensus,
which was needed for 12 cases (eight right and four left), and sensitivity,
specificity, and accuracy values of 83.3%, 87.5%, and 84.9%, respectively,
were obtained. In the 45 ovarian tumor cases in which the origin was correctly
diagnosed—namely, rated 4 or 5—the laterality of the tumor was
also correctly diagnosed in all 45 cases.
The number of misdiagnoses was 10 and eight for observers 1 and 2,
respectively. The major reason for incorrect origin determination was small
ovaries, which were considered to obscure the relationship between the gonadal
vein and the mass (six and four cases for observers 1 and 2, respectively).
Other possible reasons included small gonadal veins (five and four cases for
observer 1 and 2, respectively) and little retroperitoneal fat (three and two
cases for observers 1 and 2, respectively).
Discussion
Sonograms and MR images are generally capable of helping determine whether
a pelvic mass is uterine or adnexal in origin
[1-3,
5,
9]. However, the larger the
pelvic mass, the more difficult it is to determine tumor location. The
characteristics of the tumor, such as its content, architecture, and pattern
of degeneration, are not always helpful in determining the origin of a large
pelvic mass [6,
10-14].
Kim et al. [15] reported
that the "bridging vascular" sign on MR images—which they
described as curvilinear, tortuous vascular signal-void structures crossing,
between, or crossing and between the uterus and the mass—was a useful
finding for differentiating exophytic subserosal uterine myomas from
extrauterine tumors. Mittl et al.
[16] also reported that a
high-signal-intensity rim surrounding uterine myomas on T2-weighted MR images
was a useful sign.
Recently, the use of a high-resolution CT scanner combined with IV contrast
medium injection and thinner sections has substantially improved imaging of
the female genital tract anatomy and facilitated precise identification of the
vascular structures [17]. To
our knowledge, however, only one report has been published about a sign on CT
that contributes to determining the origin of pelvic masses
[18]. The "vascular
pedicle" sign, named by Lee et al.
[18], is a sign that can be
used to indicate ovarian origin of the pelvic mass when the gonadal veins are
observed directly joining the mass. That study was performed using a
single-detector helical CT scanner, and Lee et al. did not evaluate how often
gonadal veins are detectable in patients with or without pelvic masses. We
designed the present study to evaluate the detectability of gonadal veins in
patients with and in those without a pelvic mass and the diagnostic accuracy
of MDCT in determining the origin of pelvic masses using ROC curve
analysis.
The normal anatomy of the gonadal vein, as imaged by CT, has been described
[17,
19,
20]. The right gonadal vein
arises from the right ovarian plexus and lies lateral to the right ureter. It
ascends and parallels the right ureter, crossing anteromedially to it
approximately halfway between the right gonadal vein-IVC union and the IVC
bifurcation. The right gonadal vein then joins the IVC laterally or
anterolaterally [19]. The left
gonadal vein arises and ascends similarly and drains into the left renal vein
instead of the IVC [17].
In healthy patients, we can trace the gonadal veins on MDCT backward from
the draining point into the IVC or left renal vein to the adnexal region in
approximately 80% of the patients. Although there is no statistically
significant difference in the detection of gonadal veins among the three age
groups on MDCT, the gonadal veins tended to be less detectable in younger
females ( 30 years old) than in elderly women ( 60 years old) in both
the control and mass groups. This was supported by the fact that the diameter
of the gonadal veins in the younger population ( 30 years old) was
significantly smaller than that in the elderly population ( 60 years old)
when measured on MDCT. This may be related to the parous status of the women.
Rozenblit et al. [21] reported
that incompetent and dilated ovarian veins were present in 63% of parous
women, which was significantly more frequent than the rate in nulliparous
women (10%). However, in this study, we did not check the parous status of any
of our patients.
The diameter of the gonadal veins in patients with a uterine tumor was
significantly larger than that in the patients with an ovarian tumor, whereas
there was no significant difference between patients with and without pelvic
masses. The diameter of the gonadal vein may be affected by various factors:
The gonadal vein conveys venous blood not only from the ovaries, but also from
the uterus, and there may even be bidirectional flow, particularly on the left
side, where the gonadal vein drains into the left renal vein. Because venous
blood volume may be related to the volume of the solid part of the mass,
uterine masses (most of which are solid) may drain a larger volume of venous
blood than ovarian masses (most of which are cystic), which may explain why
the gonadal veins in patients with uterine masses are larger in caliber than
in those with ovarian masses
[22]. Therefore, we would like
to emphasize that what is important in determining the origin of the pelvic
mass is the anatomic continuity of the gonadal veins to the pelvic mass, not
the diameter or size of the gonadal veins. Another tendency we observed,
although it was not statistically significant, was that gonadal veins were
less likely to be detected in patients with pelvic masses than in those
without. This may be attributable to the fact that the gonadal veins may be
compressed by the mass, most typically at the level of the pelvic inlet.
In our study of origin determination, the Az values of
the two observers were high (0.90 and 0.92), and the interobserver kappa value
of 0.48 showed moderate agreement. The sensitivity, specificity, and accuracy
were all approximately 85%, and the organ of origin did not influence whether
the observers were correct in consensus or not. We presume that these
excellent diagnostic performances were at least partially attributable to the
use of an MDCT scanner. MDCT provides substantial improvement in volume
coverage and z-axis resolution
[23]. In addition, image
interpretation with paging methods on the monitor substantially helped the
observers trace the gonadal veins in a cephalocaudad direction. On the other
hand, despite the high Az value, the intraobserver kappa
value showed relatively low agreement. The reason was thought to be that the
two observers missed different cases.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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According to our observations, in ovarian tumors, gonadal veins frequently
coursed along the lateral and dorsal aspect of a large ovarian mass and their
branches continued to the surface of the mass, typically in a wraparound
fashion (Figs. 2A,
2B,
2C,
2D,
2E,
2F,
2G,
3A,
3B,
3C, and
3D). We thus recognized the
stretched gonadal venous branches at the periphery of the mass (in a
wraparound fashion) in 38 (70.4%) of 54 cases of ovarian tumors in the current
study. The wraparound appearance was seen in only three (9.4%) of the 32
uterine masses. In contrast, in patients with uterine masses, the gonadal
veins tended to show abrupt interruption at the lateral edge of the uterine
mass, continuing to the normal ovary (Figs.
4A,
4B,
4C,
5A,
5B, and
5C); this was seen in 23
(71.9%) of the 32 uterine masses. This abrupt interruption of the gonadal vein
was observed even in three patients with undetectable small ovaries adjacent
to the uterine masses. Although these observations were not formally studied
in an unblinded fashion, the observation was made during the course of the
study. In addition to the information about the continuity of the mass and the
gonadal veins, with this sign used as an indicator of uterine origin of the
mass, the sensitivity, specificity, and accuracy of the origin determination
reached 87.0%, 96.9%, and 93.0%.
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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.
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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.
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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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There are some limitations of this present study. First, large masses in
the female pelvis arise not only from reproductive organs, but also from the
gastrointestinal system, urinary system, adjacent soft tissues, peritoneum, or
retroperitoneum. Our study did not include cases in which lesions had arisen
from nonreproductive organs. In diagnosing those lesions, meticulous
evaluation of other venous systems—such as the inferior mesenteric veins
for rectosigmoid lesions, the superior mesenteric veins for small intestinal
or mesenteric lesions, and the internal iliac veins for retroperitoneal
lesions—may be of use in determining the origin of the mass. Additional
studies with a larger number of cases that include pelvic masses of both
reproductive and nonreproductive origins may clarify this issue.
Second, because this study was retrospective, some patients who had a large
pelvic mass did not undergo preoperative CT. This study might not include the
patients in whom CT was thought to be unnecessary after a usual sonographic
examination. Third, the numbers of patients younger than 30 were small in both
the control and mass groups. Fourth, no multivariate analysis was done
including age, size of the mass, and so on as possible predictors or to
increase accuracy.
In conclusion, gonadal veins were consistently shown on MDCT as observed
with paging methods on the console. Differentiation of large pelvic masses
with an ovarian origin and those with a uterine origin is possible with an
accuracy of approximately 85% by detecting the anatomic continuity of gonadal
veins to the masses. This CT sign is a new indicator for determination of the
organ of the large pelvic mass.
References
- Dooms GC, Hricak H, Tscholakoff D. Adnexal structures: MR imaging.
Radiology 1986;158
: 639-646[Abstract/Free Full Text]
- Mitchell DG, Mintz MC, Spritzer CE, et al. Adnexal masses: MR
imaging observations at 1.5 T, with US and CT correlation.
Radiology 1987;162
: 319-324[Abstract/Free Full Text]
- Weinreb JC, Barkoff ND, Megibow A, Demopoulos R. The value of MR
imaging in distinguishing leiomyomas from other solid pelvic masses when
sonography is indeterminate. AJR 1990;154
: 295-299[Abstract/Free Full Text]
- Fried AM, Kenney CM 3rd, Stigers KB, Kacki MH, Buckley SL. Benign
pelvic masses: sonographic spectrum. RadioGraphics1996; 16:321
-334[Abstract]
- Olson MC, Posniak HV, Tempany CM, Dudiak CM. MR imaging of the
female pelvic region. RadioGraphics 1992;12
: 445-465[Abstract]
- Szklaruk J, Tamm EP, Choi H, Varavithya V. MR imaging of common and
uncommon large pelvic masses. RadioGraphics2003; 23:403
-424[Abstract/Free Full Text]
- Metz CE. ROC methodology in radiologic imaging. Invest
Radiol 1986; 21:720
-733[Medline]
- Metz CE. Some practical issues of experimental design and data
analysis in radiological ROC studies. Invest Radiol1989; 24:234
-245[Medline]
- Scoutt LM, McCarthy SM, Lange R, Bourque A, Schwartz PE. MR
evaluation of clinically suspected adnexal masses. J Comput Assist
Tomogr 1994; 18:609
-618[Medline]
- Troiano RN, Lazzarini KM, Scoutt LM, Lange RC, Flynn SD, McCarthy
S. Fibroma and fibrothecoma of the ovary: MR imaging findings.
Radiology 1997;204
: 795-798[Abstract/Free Full Text]
- Ha HK, Baek SY, Kim SH, Kim HH, Chung EC, Yeon KM. Krukenberg's
tumor of the ovary: MR imaging features. AJR1995; 164:1435
-1439[Abstract/Free Full Text]
- Outwater EK, Siegelman ES, Kim B, Chiowanich P, Blasbalg R, Kilger
A. Ovarian Brenner tumors: MR imaging characteristics. Magn Reson
Imaging 1998; 16:1147
-1153[CrossRef][Medline]
- Togashi K, Nishimura K, Nakano Y, et al. Cystic pedunculated
leiomyomas of the uterus with unusual CT manifestations. J Comput
Assist Tomogr 1986; 10:642
-644[Medline]
- Yoshitake T, Asayama Y, Yoshimitsu K, et al. Bilateral ovarian
leiomyomas: CT and MRI features. Abdom Imaging2005; 30:117
-119[Medline]
- Kim JC, Kim SS, Park JY. "Bridging vascular sign" in
the MR diagnosis of exophytic uterine leiomyoma. J Comput Assist
Tomogr 2000; 24:57
-60[CrossRef][Medline]
- Mittl RL Jr, Yeh IT, Kressel HY. High-signal-intensity rim
surrounding uterine leiomyomas on MR images: pathologic correlation.
Radiology 1991;180
: 81-83[Abstract/Free Full Text]
- Foshager MC, Walsh JW. CT anatomy of the female pelvis: a second
look. RadioGraphics 1994;14
: 51-64[Abstract]
- Lee JH, Jeong YK, Park JK, Hwang JC. "Ovarian vascular
pedicle" sign revealing organ of origin of a pelvic mass lesion on
helical CT. AJR 2003;181
: 131-137[Abstract/Free Full Text]
- Rebner M, Gross BH, Korobkin M, Ruiz J. CT appearance of right
gonadal vein. J Comput Assist Tomogr1989; 13:460
-462[Medline]
- Moncada R, Reynes C, Churchill R, Love L. Normal vascular anatomy
of the abdomen on computed tomography. Radiol Clin North
Am 1979; 17:25
-37[Medline]
- Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES Jr. Incompetent and
dilated ovarian veins: a common CT finding in asymptomatic parous women.
AJR 2001; 176:119
-122[Abstract/Free Full Text]
- Umeoka S, Koyama T, Togashi K, Kobayashi H, Akuta K. Vascular
dilatation in the pelvis: identification with CT and MR imaging.
RadioGraphics 2004;24
: 193-208[Abstract/Free Full Text]
- Hu H, He HD, Foley WD, Fox SH. Four multidetector-row helical CT:
image quality and volume coverage speed. Radiology2000; 215:55
-62[Abstract/Free Full Text]
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Abstract
Introduction
) and 0.92 for observer 2 (
), with
good interobserver correlation (
= 0.48).
