I-41: Imaging Strategy for Diagnosis of Adnexal Masses Including US,CT Scan and MRI

Adnexal masses are spectrum of diseases from benign non neoplastic and neoplastic masses to malignant neoplasms. Endovaginal ultrasonography (US) is the fisrt and invaluable modality for assessment of adnexal masses because it is available and has a high negative predictive value. Important morphologic features are solid (vascularized) tissue, vascular and thick septations, and papillary projections on gray scale and color doppler US. Spectral Doppler analysis parameters (RI and PI and S/D ratio) correlate well with malignancy but generally add little information. CT scan can help in staging malignant ovarian cancers but some indeterminate adnexal masses need more detailed imaging by Magnetic resonance (MR) imaging. Using MR imaging for diagnosis of adnexal masses includes morphologic characteristics and signal intensity on T1- and T2-weighted images. Cystic masses are probably benign tumors, whereas complex masses are strongly associated with malignancy. Cysts, mature cystic teratomas, leiomyomas, endometriomas and fibromas, can be accurately determined on the basis of T1, T2 and fat-saturated T1-weighted sequences. New MRI protocols such as dynamic enhanced MRI (DCE-MRI) and MRspectroscopy can be used as adjuant to simple MRI to increase diagnostic accuracy for characterizing adnexal masses.