MR Imaging in Ovarian Cancer

Abstract

Magnetic resonance (MR) imaging is increasingly being used in patients with gynaecological disorders due to its high contrast resolution compared to computed tomography (CT) and ultrasound. In women presenting with an adnexal mass, ultrasound remains the primary imaging modality in the detection and characterisation of such lesions. However, in recent years overwhelming evidence has accumulated for the use of MR imaging in patients with indeterminate adnexal masses particularly in younger women and where disease markers are unhelpful. In staging ovarian cancer and for evaluating therapeutic response MR imaging is as accurate as CT but CT remains the imaging modality of choice because it is more widely available and quicker. This article reviews that evidence and outlines a place for the use of MR imaging in ovarian cancer.

Two cases of Wolffian tumor with novel magnetic resonance imaging findings reflecting characteristic pathology

“…A high intensity on DWI and strong enhancement are also typical signs of ovarian cancer; however, low‐intensity rims in the periphery on T2 weighted images, as seen in the present Wolffian tumor cases, are not reported. On the other hand, minimal enhancement and predominantly or uniformly low T2 signal intensity within a lesion is a typical feature of benign solid adnexal tumors, such as fibroma, thecoma, Brenner tumor and leiomyoma . Collectively, we propose that a solid round or lobulated mass with a black rim on T2 weighted images showing restriction of diffusion might be predictive of a Wolffian tumor.…”

Role of MRI in Differentiating benign Versus Malignant Ovarian Lesions

“…In our study, internal characteristics of ovarian lesion in MRI which pointed to a malignant pathology were thick enhancing septations, solid areas, heterogenous enhancement of the wall, mural nodules and masses (Fig 1). Sohaib SA et al in 2007 5 has described that MRI findings suggestive of malignancy include the demonstration of solid masses, solid/cystic masses and the presence of papillary projections (vegetations)and thick septa in a cystic lesion. MRI was able to detect the presence of fat in all 4 cases of dermoid which showed hyper intense signal on T1 and T2 weighted images which were suppressed on STIR sequences.…”

“…4 Most important morphological features of high risk ovarian masses include (a) solid/cystic or solid lesions with a maximum diameter greater than 4 cm; (b) the presence of irregular, nonfatty, solid vascularized areas greater than 28 mm in diameter (c) the presence of papillary projection (vegetation) and thick wall and septa greater than 3 mm in a cystic lesion. 5 Ancillary findings of pelvic organ invasion, implants (peritoneal, omental, mesenteric), ascites, and adenopathy increase diagnostic confidence for malignancy. Features such as wall thickening, septa, and multilocularity are less reliable indicators of malignancy because they are frequently seen in benign neoplasms, particularly cystadenoma-fibromas, mucinous cystadenomas, and endometriomas.…”

Importance of Surgical Treatment in Ovarian Neoplasm

“…The paraclinical criteria for determining the inoperable stage of the disease may vary from one clinic to another, also taking into account the individual surgical aggressiveness of each surgeon individually [1].…”

“…Such a score <25 correlates with a risk of <3% malignancy, while a score> 250 shows a 75% risk of malignancy. Objective imaging of neoplastic invasion at the Vlevel gates, liver, diaphragm, gastro-splenic ligament, extraperitoneal space correlates with advanced staging of the disease, most likely inoperable optimally [1].…”