Abstract
Background: Imaging plays a major role in the detection, diagnosis, and ultimate treatment strategies of adnexal masses. As high as 10% of women in the United States undergo surgical evaluation for a suspected adnexal neoplasm.
Objective: To understand the advantages and disadvantages of each imaging modality used in the evaluation of adnexal masses.
Results: Ultrasound is frequently the imaging modality of choice for initial characterization. Computed tomography, magnetic resonance imaging, and positron emission tomography – computed tomography are frequently employed if malignancy is suspected to assess for metastasis.
Conclusion: A basic understanding of adnexal imaging modalities will be of benefit to care providers and, in turn, be of benefit to patients.
Keywords: Adnexal mass, computed tomography, magnetic resonance imaging, malignancy, ovarian cancer, ovarian cysts, ultrasound.
Graphical Abstract
[3]
Lentz GM, Lobo RA, Gershenson DM, Katz VL. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby 2012. Chapter 13.
[4]
Utrilla-Layna J, Alcázar JL, Aubá M, et al. Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses. Ultrasound Obstet Gynecol 2015; 45(5): 613-7.
[5]
Middleton WD, Kurtz AB, Hertzberg BS. Ultrasound: the
requisites, chapter 9 2nd ed St Louis: Mosby. 2004; pp. 220-43.
[6]
Sample WF, Lippe BM, Gyepes MT. Gray-scale ultrasonography of the normal female pelvis. Radiology 1977; 125(2): 477.
[7]
Pavlik EJ, DePriest PD, Gallion HH, et al. Ovarian volume related to age. Gynecol Oncol 2000; 77(3): 410.
[8]
Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169(22): 2071.
[9]
Smith-Bindman R. Environmental causes of breast cancer and radiation from medical imaging: findings from the Institute of Medicine report. Arch Intern Med 2012; 172(13): 1023.
[10]
Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007; 357(22): 2277.
[11]
Yeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics 2000; 20: 1445-70.
[12]
Lauterbur PC. Progress in N.M.R. zeugmatography imaging. Philos Trans R Soc Lond B Biol Sci 1980; 289(1037): 483.
[13]
Andrew ER. The Welcome Foundation lecture, 1981. Nuclear magnetic resonance imaging in medicine: physical principles. Proc R Soc Lond B Biol Sci 1985; 225(1241): 399.
[15]
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016; 316(9): 952-61.
[16]
Pannu HK, Bristow RE, Cohade C, Fishman EK, Wahl RL. PET-CT in recurrent ovarian cancer: initial observations. Radiographics 2004; 24(1): 209-23.
[17]
Abbas AM, Sheha AM, Salem MN, Altraigey A. Three-dimensional power doppler ultrasonography in evaluation of adnexal masses. Middle East Fertil Soc J 2017; 22(4): 241-5.
[18]
Levine D, Brown D, Andreotti R, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement. Radiology 2010; 256(3): 121-31.
[19]
Modesitt SC, Pavlik EJ, Ueland FR, DePriest PD, Kryscio RJ, van Nagell JR Jr. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol 2003; 102(3): 594-9.
[20]
Patel MD, Ascher SM, Paspulati RM, et al. Managing Incidental Findings on Abdominal and Pelvic CT and MRI part 1, white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol 2013; 10(9): 675-81.
[21]
Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy Index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990; 97: 922-9.
[22]
Kurjak A, Kupesic S, Sparac V, Kosuta D. Three-dimensional ultrasonographic and power doppler characterization of ovarian lesions. Ultrasound Obstet Gynecol 2000; 16: 365-71.
[23]
Abbas AM, Amin MT, Tolba SM, Ali MK. Hemorrhagic ovarian cysts: Clinical and sonographic correlation with the management options. Middle East Fertil Soc J 2016; 21: 41-5.
[24]
Patel MD, Feldstein VA, Filly RA. The likelihood ratio of sonographic findings for the diagnosis of hemorrhagic ovarian cysts. J Ultrasound Med 2005; 24(5): 607-14.
[25]
Jermy K, Luise C, Bourne T. The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol 2001; 17(2): 140.
[26]
Brawn J, Morotti M, Zondervan KT, Becker CM, Vincent K. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update 2014; 20(5): 737-47.
[27]
Patel MD, Feldstein VA, Chen DC, Lipson SD, Filly RA. Endometriomas: diagnostic performance of US. Radiology 1999; 210(3): 739.
[29]
Mansour GM, El-Lamie IK, El-Sayed H, et al. Adnexal mass vascularity assessed by 3-dimensional power doppler: does it add to the risk of malignancy index in prediction of ovarian malignancy? four hundred-case study. Int J Gynecol Cancer 2009; 19(5): 867-72.
[30]
Van Holsbeke C, Van Calster B, Guerriero S, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol 2010; 35(6): 730.
[31]
Tanaka YO, Yoshizako T, Nishida M, et al. Ovarian carcinoma in patients with endometriosis: MR imaging findings. Am J Reoentgenol 2000; 175: 1423-30.
[32]
Vegetti W, Alagna F. FSH and follucogenesis: from physiology to ovarian stimulation. Reprod Biomed Online 2006; 12(6): 684-94.
[33]
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188(1): 100.
[34]
Kim SH, Sim JS, Seong CK. Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors. J Comput Assist Tomogr 2001; 25(1): 36.
[35]
Kim JS, Lee HJ, Woo SK, Lee TS. Peritoneal inclusion cysts and their relationship to the ovaries: evaluation with sonography. Radiology 1997; 204(2): 481.
[36]
Singh A, Sehgal A, Mohan H. Multilocular peritoneal inclusion cyst mimicking an ovarian tumor: A case report. J Midlife Health 2015; 6(1): 39-40.
[38]
McWilliams GD, Hill MJ, Dietrich CS 3rd. Gynecologic emergencies. Surg Clin North Am 2008; 88(2): 265-83.
[39]
Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion: A 15-year review. J Pediatr Surg 2009; 44(6): 1212.
[40]
Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med 2011; 30(9): 1205-10.
[41]
Wilkinson C, Sanderson A. Adnexal torsion: A multimodality imaging review. Clin Radiol 2012; 67(5): 476-83.
[42]
Bar-On S, Mashiach R, Stockheim D, et al. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010; 93(6): 2012-5.
[43]
Nizar K, Deutsch M, Filmer S, Weizman B, Beloosesky R, Weiner Z. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. J Clin Ultrasound 2009; 37(8): 436.
[44]
Rha SE, Byun JY, Jung SE, et al. CT and MR Imaging features of adnexal torsion. Radiographics 2002; 22: 282-94.
[45]
Timor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol 1998; 12(1): 56.
[46]
Patel MD, Acord DL, Young SW. Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses. Am J Roentgenol 2006; 186(4): 1033.
[47]
Peipert JF, Boardman LA, Sung CJ. Performance of clinical and laparoscopic criteria for the diagnosis of upper genital tract infection. Infect Dis Obstet Gynecol 1997; 5(4): 291.
[48]
Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23(5): 667.
[49]
Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol 1993; 36(2): 433.
[50]
Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am 2008; 22(4): 693.
[51]
Hiller N, Sella T, Lev-Sagi A, Fields S, Lieberman S. Computed tomographic features of tuboovarian abscess. J Reprod Med 2005; 50(3): 203.
[52]
Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: A 10 year population-based study of 1800 cases. Hum Reprod 2002; 17(12): 3224.
[54]
Dogra V, Paspulati RM, Bhatt S. First trimester bleeding evaluation. Ultrasound Q 2005; 21(2): 69.
[55]
Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369(15): 1443-51.
[56]
Lee K, Tavassoli FA, Prat J, et al. Tumors of the ovary and
peritoneum. In: World Health Organization Classification of
Tumours: Pathology and Genetics of Tumours of the Breast and
Female Genital Organs, IARC Press, Lyon, France 2003; p. 117.
[57]
Kurman RJ, Ellenson LH, Ronnett B. Blaustein’s Pathology of the Female Genital Tract. 6th ed. Springer 2011.
[58]
Killackey MA, Neuwirth RS. Evaluation and management of the pelvic mass: A review of 540 cases. Obstet Gynecol 1988; 71(3 Pt 1): 319.
[59]
Guerriero S, Alcazar JL, Pascual MA, et al. Diagnosis of the most frequent benign ovarian cysts: Is ultrasonography accurate and reproducible? J Womens Health 2009; 18(4): 519-27.
[60]
Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. Am J Roentgenol 1998; 171(4): 1061.
[61]
Jermy K, Luise C, Bourne T. The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol 2001; 17(2): 140.
[62]
Malde HM, Kedar RP, Chadha D, Nayak S. Dermoid mesh: a sonographic sign of ovarian teratoma. Am J Roentgenol 1992; 159(6): 1349.
[63]
Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: imagining types and tumor characteristics. Radiographics 2001; 21: 475-90.
[64]
Jung SE, Lee JM, Rha SE, et al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics 2002; 22: 1305-25.
[65]
Kido A, Togashi K, Konishi I, et al. Dermoid cysts of the ovary with malignant transforamation: MR appearance. Am J Roentgenol 1999; 172: 445-9.
[66]
Jung SE, Rha SE, Lee JM, et al. CT and MR findings of sex-cord stromal tumor of the ovary. Am J Roentgenol 2005; 185: 207-15.
[68]
Timmerman D, Van Calster B, Testa A, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol 2016; 214(4): 424-37.
[69]
Brown DL, Doubilet PM, Miller FH, et al. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology 1998; 208(1): 103.
[70]
Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicenter diagnostic study. International Ovarian Tumour Analysis Group. BMJ 2014; 349: 5920.
[71]
Sohaib SA, Mills TD, Sahdev A, et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005; 60: 340-8.
[72]
Mohaghegh P, Rockall AG. Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques. Radiographics 2012; 32: 1751-73.
[73]
Kawamoto S, Urban BA, Fishman EK. CT of epithelial ovarian tumors. Radiographics 1999; 19: S85-S102.
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