Diagnostic work-up Step 1 If a cystic pelvic mass is present, the first step is to find out if it is ovarian or non-ovarian in origin. Step 2 The next step is to determine if the lesion can be categorized as one of the common, benign ovarian masses (simple cyst, hemorrhagic cyst, endometrioma or mature cystic teratoma), or is indeterminate. Step 3 To aid in selecting the proper work-up, the final
Look For First
Role of imaging Role of Ultrasound For characterization of ovarian masses, ultrasound is often the first-line method of choice, especially for distinguishing cystic from complex cystic-solid and solid lesions.
Role of CT CT is useful for the N- and M-staging of proven malignant lesions.
Role of MRI For complex lesions, primary evaluation with ultrasound is often followed by further evaluation with MRI.
Key MRI Findings
Role of imaging Role of Ultrasound For characterization of ovarian masses, ultrasound is often the first-line method of choice, especially for distinguishing cystic from complex cystic-solid and solid lesions.
Role of CT CT is useful for the N- and M-staging of proven malignant lesions.
Role of MRI For complex lesions, primary evaluation with ultrasound is often followed by further evaluation with MRI.
Even with MRI it is often not possible to make an accurate diagnosis of neoplastic subtype.
By using MRI as an adjunct to sonography a delay in the treatment of potentially malignant ovarian lesions is prevented.
This is not only beneficial to the small number of women who do have ovarian cancer, but also a proven cost-effective approach to the management of sonographically indeterminate adnexal lesions.
Differential Diagnosis
differential diagnosis for possible cystic ovarian masses.
Enable Scroll Disable Scroll Scroll through the images Enable Scroll Disable Scroll Scroll through the images A helpful tool to identify the ovaries is to follow the ovarian veins caudally.
Scroll through the CT-images and follow the right ovarian vein from where it joins the inferior vena cava, and the left ovarian vein where it joins the left renal vein, until you identify the ovaries.
Ultrasound pattern recognition Pattern recognition on ultrasound often allows a fairly confident diagnosis of common cystic ovarian masses.
Discussion
- Variations in FOV, with a larger FOV to cover the whole pelvis and a smaller FOV centered on the lesion of interest.
Post-contrast images in 2 or even 3 planes.
Sagittal T2W cine acquisition for recording uterine wall contractions.
MR imaging is a valuable adjunct to US, as it allows identification of blood products within hemorrhagic masses that may mimic solid tumor at US.
Prenuvo Reporting Pearl
Edit this pearl for how you want to report ovaries in your screening MRI workflow.