Adnexal Masses Caused by Pelvic Inflammatory Disease: MR Appearance

Ueda, Hiroyuki; Togashi, Kaori; Kataoka, Milliam L.; Koyama, Takashi; Fujiwara, Toru; Fujii, Shingo; Konishi, Junji

doi:10.2463/mrms.1.207

Cited by 16 publications

(5 citation statements)

References 21 publications

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“…The present study found that only a proportion of TOAs present with typical MRI findings, while the majority showed mixed cystic and solid mass. TOAs with obvious solid component mostly presented striking rim-enhancement on post-contrast images, pathologically proven to be the abundant granulation tissue and fibrous tissue hyperplasia peripherally [ 21 ]. Moreover, the signal intensities in abscess cavity varied from low signal intensity to intermediate or high signal intensity on T1/T2-weighted images with 82.4% of TOAs showing similar signal intensity to those of soft-tissue or mucinous components of adnexal masses.…”

Section: Discussionmentioning

confidence: 99%

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Wang

et al. 2016

PLoS ONE

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ObjectiveTo assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy.Materials and MethodsPatients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis.ResultsThe mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10−3 mm2/s vs. 2.42 ± 0.38 × 10−3 mm2/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10−3mm2/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10−3 mm2/s vs.1.18 ± 0.36 × 10−3 mm2/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively.ConclusionsDW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.

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Section: Discussionmentioning

confidence: 99%

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Wang

et al. 2016

PLoS ONE

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“…The signal intensity of the abscess content depends on its viscosity and protein content [18][19][20]. Tukeva et al [12] showed the superior sensitivity and specificity of MRI for TOA of 100% and 90% respectively, compared with transvaginal ultrasound (sensitivity of 56% and specificity of 86%).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT

Rakheja

Makis

Hickeson

2011

Nucl Med Mol Imaging

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A 20-year-old woman, who presented with a several-week history of abdominal pain, was referred for magnetic resonance imaging (MRI) and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after an ultrasound showed complex cystic masses arising from both ovaries. The MRI and 18 F-FDG PET/CT imaging characteristics of the ovarian masses were strongly suspicious for malignancy, and the masses were surgically removed. Histopathological evaluation revealed a bilateral tubo-ovarian abscess, with no evidence of malignancy. This case highlights a potentially serious pitfall in the evaluation of suspicious pelvic masses by 18 F-FDG PET/CT, whereby a complex bilateral tubo-ovarian abscess may mimic the PET/CT imaging characteristics of an ovarian or pelvic malignancy.

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“…With disease progression, TOAs show enhancing solid tissue, wall or septal thickening, and even papillary projections due to the formation of abundant granulation tissue and fibrous tissue hyperplasia [ 4 , 30 ]. It is known that tissue cellularity, interstitial oedema, and the fibrous component can influence the diffusion signal and ADC values [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The role of “penumbra sign” and diffusion-weighted imaging in adnexal masses: do they provide a clue in differentiating tubo-ovarian abscess from ovarian malignancy?

Patel¹,

Garg²,

Dixit³

et al. 2021

Pol J Radiol

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Purpose: To evaluate the role of "penumbra sign", diffusion-weighted imaging (DWI), and the apparent diffusion coefficient (ADC) value in differentiating tubo-ovarian abscess (TOA) from ovarian malignancy. Material and methods:Thirty-six patients with 50 adnexal masses (tubo-ovarian abscess, n = 24; ovarian malignancy, n = 26), who underwent magnetic resonance imaging (MRI) with DWI, were retrospectively evaluated. "Penumbra sign" (hyperintense rim on T1W images), diffusion restriction, and mean apparent diffusion coefficient (ADC) values from cystic (c-ADC) and solid (s-ADC) components were evaluated for all the masses. Results: "Penumbra sign" on T1W images was significantly more common in the TOA group (n = 21, 87.5%) than in the ovarian malignancy group (n = 2, 7.7%) (p < 0.001). Similarly, diffusion restriction in the cystic component was more frequent in the TOA group (n = 24, 100% vs. n = 2, 10.5%; p < 0.001). In contrast, diffusion restriction in the solid component was more common in the ovarian malignancy group (n = 5, 20.8% vs. n = 26, 100%; p < 0.001). The mean c-ADC value was significantly lower in TOAs (p < 0.001). A c-ADC value of 1.31 × 10 -3 mm 2 /s may be an optimal cut-off in distinguishing TOAs from ovarian malignancies. Conversely, the mean s-ADC value was significantly lower in the ovarian malignancy group (p < 0.001). An s-ADC value of 0.869 × 10 -3 mm 2 /s may be an optimal cut-off in differentiating ovarian malignancies from TOAs (p < 0.001). ROC curve analysis showed that c-ADC values had a higher diagnostic accuracy than s-ADC values.Conclusions: "Penumbra sign" on T1W images, diffusion characteristics, and ADC values provide important clues in addition to conventional MR imaging features in differentiating TOA from ovarian malignancy.

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Adnexal Masses Caused by Pelvic Inflammatory Disease: MR Appearance

Abstract: MR imaging findings well reflect the basic pathological process of inflammation, and inflammatory adnexal masses are associated with relatively specific appearances in MR images. MR imaging can be a problem-solving alternative in the diagnosis of inflammatory adnexal masses.

Cited by 16 publications

References 21 publications

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values

Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT

The role of “penumbra sign” and diffusion-weighted imaging in adnexal masses: do they provide a clue in differentiating tubo-ovarian abscess from ovarian malignancy?

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