CT and MRI of Adnexal Masses in Patients with Primary Nonovarian Malignancy
Department of Radiology, University of California San Francisco, Box 0628, M-372 505 Parnassus Ave., San Francisco, CA 94143-0628, USA.American Journal of Roentgenology (Impact Factor: 2.73). 05/2006; 186(4):1039-45. DOI: 10.2214/AJR.04.0997
OBJECTIVE: The purpose of this pictorial essay is to review the differential considerations when an adnexal mass is detected on CT or MRI in a patient with a primary nonovarian malignancy. CONCLUSION: Such adnexal masses may be metastases to the ovaries, primary ovarian malignancy, or incidental benign disorders. Solid masses are more likely metastases, but metastases can be predominantly cystic and primary ovarian cancers can be solid. MRI may help characterize incidental benign entities such as endometriosis, fibroma, and peritoneal inclusion cysts.
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ABSTRACT: Die Diagnose „Ovarialkarzinom“ wird in 75% der Fälle erst im Stadium FIGOIII/IV gestellt, und die 5-Jahres-Überlebensrate konnte trotz medizinischer Fortschritte nur mäßig auf 44% verbessert werden. Die Bildgebung erfolgt initial mittels transvaginalem Ultraschall (Sensitivität 90–96%, Spezifität 98–99% für ovarielle Läsionen). Benigne Befunde werden sonographisch im Verlauf kontrolliert oder laparoskopisch entfernt. Bei sonographisch unklaren Läsionen erlaubt die MRT in mehr als 90% eine definitive Diagnose. Sonographisch malignomsuspekte Läsionen sollten einem CT-Staging unterzogen werden. Diese Information ist entscheidend für die Therapiestratifizierung, die idealerweise in gynäkoonkologischen Zentren in multidisziplinärer Zusammenarbeit erfolgt. Bei peritonealer Karzinose werden Implantationen über 1cm in der CT und MRT vergleichbar gut detektiert. Ein Aszites, der beim Ovarialkarzinom in bis zu 80% der Fälle mit einer peritonealen Karzinose assoziiert ist, lässt sich gleichermaßen mit Ultraschall, CT und MRT nachweisen. Ovarian cancer is diagnosed in stages FIGO III/IV in up to 75% of cases. Despite medical advances the 5-year survival rate has only been moderately increased to 44% during recent years. The initial evaluation is performed using transvaginal ultrasound (US) (sensitivity 90–96%, specificity 98–99% for detection of ovarian lesions). Probably benign findings will be followed-up sonographically or will be laparoscopically excised. Magnetic resonance imaging (MRI) allows a definitive diagnosis in more than 90% of sonographically indeterminate lesions. Malignant lesions require computer tomography (CT) staging and treatment in gynecooncology centers in a multidisciplinary setting. Peritoneal implants larger than 1cm are detected equally by CT and MRI. Detection of ascites which is associated with peritoneal carcinomatosis in up to 80% of cases is equally feasible by US, CT and MRI. SchlüsselwörterOvarielle Neoplasie–Magnetresonanztomographie (MRT)–Computertomographie (CT)–Ultraschall (US)–Staging KeywordsOvarian neoplasms–Magnetic resonance imaging–Computed tomography–Ultrasonography–StagingDer Radiologe 07/2011; 51(7):581-588. DOI:10.1007/s00117-010-2120-8 · 0.43 Impact Factor
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ABSTRACT: Adnexal masses are common in women of all ages. A range of physiological and benign ovarian conditions that develop in women, especially in the reproductive age, and adnexal malignancies can be evaluated with magnetic resonance imaging (MRI). Management of women with adnexal masses is frequently guided by imaging findings; therefore, precise characterization of adnexal pathology should be performed whenever possible. Magnetic resonance imaging is useful in characterization of adnexal masses that are not completely evaluated by ultrasound because it can provide additional information on soft tissue composition of adnexal masses based on specific tissue relaxation times and allows multiplanar imaging at large field of view to define the origin and extent of pelvic pathology. The patients most likely to benefit from MRI are pregnant women and those who are premenopausal and have masses that have complex features on ultrasound but do not have raised cancer antigen 125 tumor marker levels. The overlap in imaging appearance among different cell type malignancies makes it difficult to predict exact histology based on MRI appearance; however, MRI has a high accuracy in differentiating benign from malignant masses. Teratomas, endometriomas, simple and hemorrhagic cysts, fibromas, exophytic or extrauterine fibroids, and hydrosalpinges can be diagnosed with high confidence. In this article, the authors review the histopathologic background and MRI features of adnexal masses and discuss the role of MRI in the differentiation of benign from malignant adnexal pathologies.Topics in Magnetic Resonance Imaging 01/2007; 17(6):379-97. DOI:10.1097/RMR.0b013e3180417d8e
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ABSTRACT: Advances in technology and improved availability have led to increased use of computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate women presenting to the emergency department or to their primary care provider with abdominal and/or pelvic pain. Computed tomographic examinations are often performed to evaluate the presence of appendicitis or renal stone disease. However, gynecologic abnormalities are frequently identified on these examinations. Although ultrasound remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT and MRI imaging occurs before sonographic evaluation.Historically, because of cost, radiation exposure, and relative ease of use, ultrasound examinations have preceded all other imaging modalities when evaluating pelvic disorders. However, as CT and MRI technology have improved, their use in diagnosing causes of pelvic pain has become equal to that of ultrasound. In some cases, primarily because of historic comfort with sonographic evaluation, gynecologic abnormalities originally diagnosed on CT or MRI may be immediately and unnecessarily reevaluated by ultrasound. For a woman in her reproductive years, the most common adnexal masses are physiological cysts, endometriomas, and cystic teratomas. Although lesions are often asymptomatic and incidentally detected, they can present with pain, and they increase the risk of ovarian torsion. Common causes of chronic pelvic pain in this population include leiomyomata and adenomyosis. In postmenopausal women, ovarian carcinoma, which often does not present clinically until a late stage, has to be included in the differential diagnosis of adnexal masses. If a gynecologic pathology is discovered on CT or MRI, an immediate follow-up ultrasound need not be pursued if the lesion can be characterized as benign, needing immediate surgical intervention, or a variant of normal anatomy. If, on the other hand, findings demonstrate a mass that either is uncharacteristic of a benign lesion, has an indeterminate risk for malignancy, or demonstrates suspicious characteristics for malignancy (such as enhancing mural nodules), further evaluation by serial ultrasound, biochemical marker, and/or CT or MRI is warranted. The purpose of this review is to present a series of commonly encountered gynecologic abnormalities with either CT or MR to make radiologists more familiar with gynecologic pathology on CT and MRI.Ultrasound Quarterly 10/2007; 23(3):167-75. DOI:10.1097/RUQ.0b013e31815202df · 1.19 Impact Factor
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