Abstract:PurposeOvarian torsion is the twisting of the ovary on its vascular pedicle resulting in vascular compromise. Diagnosis of ovarian torsion is challenging in patients who have atypical clinical or ultrasound (US) findings. The objective of our study was to demonstrate the magnetic resonance imaging (MRI) features of ovarian torsion to help radiologists make a conclusive diagnosis when the clinical and US findings are unclear.Material and methodsWe retrospectively reviewed the clinical and MRI features in 10 fem… Show more
“…Despite those findings are not specific to dysgerminomas, it may be a critical indicator for determination of the ovarian origin and narrow the differential diagnosis. Twisted ovarian vascular pedicle has been previously described as an important CT and MRI imaging feature of ovarian torsion [15]. In agreement with previous study, twisted ovarian vascular pedicle was also recognized in the two cases complicated with a torsion of ipsilateral adnexa in the present study.…”
Background: To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary. Methods: CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients , ages ranged from 6~27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of "ovarian vascular pedicle" sign. We also noted the extent or stage of the tumors. Results: 75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10 − 3 mm 2 /s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. "Ovarian vascular pedicle" sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas' cul-de-sac were present in one patient respectively. Conclusion: On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and "ovarian vascular pedicle" sign may narrow the differential diagnosis.
“…Despite those findings are not specific to dysgerminomas, it may be a critical indicator for determination of the ovarian origin and narrow the differential diagnosis. Twisted ovarian vascular pedicle has been previously described as an important CT and MRI imaging feature of ovarian torsion [15]. In agreement with previous study, twisted ovarian vascular pedicle was also recognized in the two cases complicated with a torsion of ipsilateral adnexa in the present study.…”
Background: To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary. Methods: CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients , ages ranged from 6~27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of "ovarian vascular pedicle" sign. We also noted the extent or stage of the tumors. Results: 75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10 − 3 mm 2 /s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. "Ovarian vascular pedicle" sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas' cul-de-sac were present in one patient respectively. Conclusion: On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and "ovarian vascular pedicle" sign may narrow the differential diagnosis.
“…Subacute haemorrhage shows high signal intensity on fat-saturated T1-weighted images and may involve the periphery of the enlarged ovary, as T1-hyperintense rim, or the central stroma. In this stage, heterogeneous, minimal or absent enhancement on gadolinium-enhanced subtraction of fat-saturated T1-weighted images confirm the evolution towards infarction [9, 42, 45, 47–50]. .…”
Section: Adnexal Torsionmentioning
confidence: 72%
“…19). In this early stage, ovarian stroma shows enhancement after contrast agent administration [9, 42, 45, 47–50]. Fig.…”
Section: Adnexal Torsionmentioning
confidence: 99%
“…MRI usually shows a distended dilated fallopian tube with thickened walls; the tube may demonstrate a vortex-like appearance (due to more twists) distant from the ipsilateral ovary, and the latter appears normal. Thick and twisted pedicle can also be observed (whirlpool sign) [19, 50].…”
Section: Adnexal Torsionmentioning
confidence: 99%
“…It should also be remembered that enlarged hyperstimulated ovaries are themselves at risk for torsion [61]. If torsion occurs in hyperstimulated ovaries, the latter may demonstrate asymmetrical augmentation, abnormal enhancement, twisted pedicle and eventually haemorrhage [50].…”
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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