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Diab RA, Eltobgy A, Adelhamied H, Alabdallat Y. A Case Report of Comprehensive Diagnostic Approach on a Complex Left Adnexal Mass in a Young Female: Endometrioma or Complicated Ovarian Serous Cystadenofibroma. Cureus 2024; 16:e61798. [PMID: 38975375 PMCID: PMC11227433 DOI: 10.7759/cureus.61798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
This case report presents a young female who was clinically, radiologically, and intraoperatively misdiagnosed as an ovarian endometrioma and was only diagnosed by histopathological biopsy as complicated serous cystadenofibroma, a rare benign tumor composed of both glandular and fibrous tissue. The diagnosis of adenofibroma typically involves a combination of imaging studies, such as ultrasound or magnetic resonance imaging (MRI) scan, and a histopathological biopsy to confirm the presence of the tumor. This case underscores the significance of utilizing various diagnostic methods and histopathological biopsies to diagnose and treat complex adnexal masses in females accurately.
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Affiliation(s)
- Rehab A Diab
- Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Asmaa Eltobgy
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Hala Adelhamied
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
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Dabi Y, Rockall A, Sadowski E, Touboul C, Razakamanantsoa L, Thomassin-Naggara I. O-RADS MRI to classify adnexal tumors: from clinical problem to daily use. Insights Imaging 2024; 15:29. [PMID: 38289563 PMCID: PMC10828223 DOI: 10.1186/s13244-023-01598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/25/2023] [Indexed: 02/02/2024] Open
Abstract
Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the conclusion that ultrasonography was insufficient to accurately assess adnexal masses and that a standardized MRI criteria could improve these patients' management. The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. The different steps were the following: (1) preliminary work to formalize the issue, (2) physiopathological analysis and finding dynamic parameters relevant to increase MRI performances, (3) construction and internal validation of a score to predict the nature of the lesion, (4) external multicentric validation (the EURAD study) of the score named O-RADS MRI, and (5) communication and education work to spread its use and inclusion in guidelines. Future steps will include studies at patients' levels and a cost-efficiency analysis. Critical relevance statement We present translating radiological research into a clinical application based on a step-by-step structured and systematic approach methodology to validate MR imaging for the characterization of adnexal mass with the ultimate step of incorporation in the latest worldwide guidelines of the O-RADS MRI reporting system that allows to distinguish benign from malignant ovarian masses with a sensitivity and specificity higher than 90%. Key points • The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography.• The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management.• The first developing score named ADNEX MR Score was constructed using multiple easily assessed criteria on MRI to classify indeterminate adnexal lesions following ultrasonography.• The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.
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Affiliation(s)
- Yohann Dabi
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Cyril Touboul
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Leo Razakamanantsoa
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Isabelle Thomassin-Naggara
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
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3
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Mangla M, Ramavath K, Kumar N, Roy S, Srirambhatla A, Palo S. Ovarian Cystadenofibroma: An Innocent Tumor Causing Early Postoperative Small Bowel Obstruction and Perforation Peritonitis. J Midlife Health 2024; 15:43-47. [PMID: 38764931 PMCID: PMC11100640 DOI: 10.4103/jmh.jmh_5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 05/21/2024] Open
Abstract
Ovarian serous cystadenofibroma (CAF) is a relatively uncommon variant of benign epithelial tumors of the ovary. It is frequently misdiagnosed as malignant ovarian mass, on both ultrasound (USG) and computed tomography (CT). Although most cases are easily treatable by surgery, some cases can present with life-threatening complications increasing patient morbidity and mortality. The present case report briefs about a 69-year-old female, P4 L4, who presented to the gynecology outpatient department with a complaint of pain in the lower abdomen for 2-3 months. USG and CT were suggestive of a suspicious-looking ovarian mass favoring malignancy. A staging laparotomy with pelvic and para-aortic lymphadenectomy with omental biopsy was done. Although the tumor was benign, extensive surgery, due to the suspicion of malignancy led to the patient developing early postoperative small bowel obstruction, mandating a re-exploration. CAF is a specific type of ovarian tumor that exhibits a combination of benign characteristics. This tumor presents as a partly cystic (containing fluid-filled sacs) and partly solid (composed of fibrous tissue) growth within the ovary, displaying a diverse architectural pattern. Mostly the diagnosis is incidental, on USG done for some other indication. CAF of the ovary needs a very high index of suspicion for diagnosis as these are frequently misdiagnosed as malignant ovarian masses. Although an innocent tumor, extensive surgery done for CAF, under suspicion for malignancy, can sometimes lead to serious complications.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Krishna Ramavath
- Department of General Surgery, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Naina Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Subhrajyoti Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Annapurna Srirambhatla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Seetu Palo
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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4
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Avesani G, Elia L, Anghelone AG, Perazzolo A, Panico C, Paola VD, Gui B, Rodolfino E, Moro F, Testa AC, Manfredi R. Features of cystadenofibroma on magneticresonance images: An update using the O-RADS lexicon and considering diffusion-weighted and perfusion imaging. Eur J Radiol 2022; 154:110429. [DOI: 10.1016/j.ejrad.2022.110429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/31/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
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5
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Ultrasound Characteristics of Cystadenofibromas: A Retrospective Multicenter Study. Ultrasound Q 2021; 37:349-356. [PMID: 34855711 DOI: 10.1097/ruq.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cystadenofibromas (CAFs) are relatively rare benign ovarian tumors. This study was to describe the ultrasound (US) findings of CAFs. Preoperative US information of 86 CAFs was retrospectively collected. To better illustrate their characteristic, 173 cystadenomas (CADs), 103 borderline ovarian tumors (BOTs), and 129 cystadenocarcinomas (CACs) were recruited as match groups. Besides morphology evaluation, tumors were categorized by the Ovarian-Adnexal Reporting and Data System US system. Higher-risk stratification in CAFs was more often being seen than CADs (63% of CAFs classified as Ovarian-Adnexal Reporting and Data System 4 or 5 vs 35% in CADs). Cystadenofibromas more commonly appeared as unilocular or multilocular solid than CADs. Solid components presented in 59% of CAFs and papillary projections presented in 45%. More CAFs contained solid components and papillary projections than CADs (P < 0.0001). When compared with BOTs and CACs, less CAFs contained solid components (P < 0.017 and P < 0.0001). However, no significant difference was found in CAFs versus BOTs or CACs about the presence of papillary projections. Shadowing was identified in 58% of CAFs; however, in CADs, BOTs, and CACs, the proportion was 2%, 11%, and 11%, respectively. Presence of shadowing in CAFs was noticeably more than CADs, BOTs, and CACs (P < 0.017 or P < 0.0001). Similar to CADs, most CAFs were avascular (76%) and without ascites (99%), which were significantly different from BOTs and CACs. We concluded that the sonographic markers for CAFs that differ from malignant were presence of shadowing, avascular, and absence of ascites.
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Avesani G, Caliolo G, Gui B, Petta F, Panico C, Manna VL, Moro F, Testa AC, Scambia G, Manfredi R. Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay. Korean J Radiol 2021; 22:1809-1821. [PMID: 34668348 PMCID: PMC8546138 DOI: 10.3348/kjr.2020.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/20/2021] [Accepted: 07/03/2021] [Indexed: 12/28/2022] Open
Abstract
Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called "dark-dark appearance") and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Gianluca Caliolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Federica Petta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Camilla Panico
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Viviana La Manna
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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7
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Shanbhogue KP, Prasad AS, Ucisik-Keser FE, Katabathina VS, Morani AC. Hereditary ovarian tumour syndromes: current update on genetics and imaging. Clin Radiol 2021; 76:313.e15-313.e26. [PMID: 33353730 DOI: 10.1016/j.crad.2020.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
Hereditary ovarian tumour syndromes are a diverse group of hereditary syndromes characterised by the development of specific histotypes of ovarian neoplasms. While BRCA syndromes are exclusively associated with high-grade serous carcinomas, patients with Lynch syndrome show a preponderance of endometrioid subtype of ovarian and endometrial carcinomas. Distinct non-epithelial phenotypes, such as sex cord stromal tumours with annular tubules, Sertoli-Leydig cell tumours, and small cell carcinoma of the hypercalcaemic type occur in patients with Peutz-Jeghers, DICER1, and rhabdoid tumour predisposition syndromes, respectively. Gorlin-Goltz syndrome is characterised by the development of bilateral, multiple ovarian fibromas in 14-24% of patients. Ovarian steroid cell tumours and broad ligament papillary cystadenomas are characteristically found in women with von Hippel-Lindau syndrome. Recent studies have allowed the characterisation of tumour genetics and associated oncological pathways that contribute to tumourigenesis. Implications of the diagnosis of these syndromes on screening, management, and prognosis are discussed.
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Affiliation(s)
- K P Shanbhogue
- Department of Radiology at NYU Grossman School of Medicine, NY 10016, USA
| | - A S Prasad
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX 77030, USA
| | - F E Ucisik-Keser
- Department of Radiology, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX 77030, USA
| | - V S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - A C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX 77030, USA.
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8
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Chung SH, Woldenberg N, Roth AR, Masamed R, Conlon W, Cohen JG, Joines MM, Patel MK. BRCA and Beyond: Comprehensive Image-rich Review of Hereditary Breast and Gynecologic Cancer Syndromes. Radiographics 2020; 40:306-325. [DOI: 10.1148/rg.2020190084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie Histed Chung
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Nina Woldenberg
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Antoinette R. Roth
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Rinat Masamed
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Wendy Conlon
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Joshua G. Cohen
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Melissa M. Joines
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Maitraya K. Patel
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
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9
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Stein EB, Hansen JM, Maturen KE. Fertility-Sparing Approaches in Gynecologic Oncology. Radiol Clin North Am 2020; 58:401-412. [DOI: 10.1016/j.rcl.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Ali A, Beckett K, Flink C. Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance. Emerg Radiol 2020; 27:205-214. [PMID: 31902010 DOI: 10.1007/s10140-019-01747-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
Abstract
Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging (MRI) is increasingly favored in this setting. The purpose of this review is to familiarize the reader with common pathologies which may be encountered in pregnant females presenting with acute abdominal pain requiring emergent MRI.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267, USA.
| | - Katrina Beckett
- Department of Radiology, University of California Los Angeles Medical Center, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Carl Flink
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267, USA
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11
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Rockall AG, Qureshi M, Papadopoulou I, Saso S, Butterfield N, Thomassin-Naggara I, Farthing A, Smith JR, Bharwani N. Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies. Radiographics 2017; 36:2214-2233. [PMID: 27831834 DOI: 10.1148/rg.2016150254] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Treatments for gynecologic cancer usually result in loss of fertility due to surgery or radical radiation therapy in the pelvis. In countries with an established screening program for cervical cancer, the majority of gynecologic malignancies occur in postmenopausal women. However, a substantial number of affected women are of childbearing age and have not completed their families. In these younger women, consideration of fertility preservation may be important. This article describes the fertility-sparing treatment options that are currently available and outlines the role of imaging in the selection of eligible patients on the basis of a review of the literature. In the setting of cervical cancer, magnetic resonance (MR) imaging is used to delineate the size, position, and stage of the tumor for selection of patients who are suitable for radical trachelectomy. In patients with solitary complex adnexal masses, diffusion- and perfusion-weighted MR imaging sequences are used to categorize the likelihood of invasive or borderline malignancy for consideration of unilateral ovarian resection, with fertility preservation when possible. In patients with endometrial cancer, MR imaging is used to rule out signs of invasive disease before hormone therapy is considered. Imaging is also used at patient follow-up to detect recurrent disease; however, evidence to support this application is limited. In conclusion, imaging is an essential tool in the care of patients with gynecologic malignancies who are considering fertility-preserving treatment options. ©RSNA, 2016.
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Affiliation(s)
- Andrea G Rockall
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Mahrukh Qureshi
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Ioanna Papadopoulou
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Srdjan Saso
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nicholas Butterfield
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Isabelle Thomassin-Naggara
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Alan Farthing
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - J Richard Smith
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nishat Bharwani
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
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Chen H, Liu Y, Shen LF, Jiang MJ, Yang ZF, Fang GP. Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison. J Ovarian Res 2016; 9:81. [PMID: 27876070 PMCID: PMC5120502 DOI: 10.1186/s13048-016-0291-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background Ovarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. The objective of the study was to demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology. Methods A total of 61 patients with surgically proven OTFG were enrolled in this retrospective study to demonstrate its clinical and sonographic features and to compare with pathological findings. Gray scale and color Doppler sonography were performed presurgically with either transabdominal or transvaginal approach to image pelvic structures and lesions. The clinical findings and sonographic appearances were compared with the types of the OTFG tumors based on the histopathological diagnosis. Results The mean patient age was 53.57 (range, 26–86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi’s syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level (p < 0.01) and the amount of ascites fluid (p < 0.05). Conclusions The typical sonographic features of OTFG include adnexal hypoechoic masses with clear border and acoustic attenuation as well as minimal Doppler flow signals. All the aforementioned features could make ultrasound imaging as a assistent tool improve the preoperative diagnostic accuracy.
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Affiliation(s)
- Hui Chen
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Li-Fei Shen
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Mei-Jiao Jiang
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhi-Fang Yang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Guo-Ping Fang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
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Cystadenofibroma: A Benign Epithelial Ovarian Tumor in Pregnancy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Jalaguier-Coudray A, Jacquemier J, Villard-Mahjoub R, Delarbre B, Thomassin-Piana J. Pourquoi la macroscopie est-elle essentielle pour comprendre et analyser les tumeurs ovariennes ? IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Singh AK, Lopez-Araujo A, Katabathina VS. Gorlin syndrome. J Pediatr 2014; 164:1501-1501.e1. [PMID: 24602407 DOI: 10.1016/j.jpeds.2014.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Achint K Singh
- Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Alejandro Lopez-Araujo
- Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
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16
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A case of mucinous cystadenofibroma of the ovary. Case Rep Obstet Gynecol 2014; 2014:130530. [PMID: 24772358 PMCID: PMC3977110 DOI: 10.1155/2014/130530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022] Open
Abstract
Ovarian adenofibroma is a rare benign tumour originating from the germinal lining and stroma of the ovary. We describe here the case of a 36-year-old woman with an ovarian mucinous cystadenofibroma that was diagnosed as a benign cystic mass of the ovary before surgery. The tumour was a cystic lesion composed of 2 regions: one filled with mucinous fluid and the other with yellowish solid components. The patient successfully underwent a left oophorectomy.
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17
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Diffusion-weighted MR imaging findings of ovarian adenocarcinofibromas and adenofibromas. Clin Imaging 2014; 38:483-489. [PMID: 24685607 DOI: 10.1016/j.clinimag.2014.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/11/2014] [Accepted: 01/22/2014] [Indexed: 11/20/2022]
Abstract
We retrospectively evaluated pelvic magnetic resonance imaging including diffusion-weighted imaging (DWI) of 16 ovarian lesions (5 adenocarcinofibromas, 2 borderline adenofibromas, and 9 benign adenofibromas). All adenocarcinofibromas were detected as large solid areas of strong high signal on DWI, and seven of nine benign adenofibromas and both borderline adenofibromas demonstrated no areas of high signal or small areas of weak high signal. Solid components that appear as areas of strong high signal on DWI might represent a characteristic finding of adenocarcinofibromas.
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Ulker V, Tunca AF, Akbayir O, Numanoglu C, Yesil S, Bakir B. Serous surface papillary adenofibroma of the ovary: impersonator of ovarian malignancy. J OBSTET GYNAECOL 2014; 34:365-6. [PMID: 24484475 DOI: 10.3109/01443615.2013.868421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V Ulker
- Department of Obstetrics and Gynecology, Oncology Unit
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19
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Singh N, Tripathi R, Mala YM, Khurana N, Khan M. Large functional benign endometroid cystadenofibroma of the ovary leading to endometrial cystic glandular hyperplasia and postmenopausal bleeding. BMJ Case Rep 2013; 2013:bcr-2013-010323. [PMID: 23761571 DOI: 10.1136/bcr-2013-010323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Benign endometroid cystadenofibroma of the ovary is a rare tumour with few reported cases. The association of endometroid cystadenofibroma with endometrial cystic glandular hyperplasia has not been previously reported to authors' knowledge. We are reporting a 75-year-old postmenopausal woman who presented with a large abdominopelvic mass corresponding to 30 weeks size gravid uterus and postmenopausal bleeding. She has a well-oestrogenised vagina. Ultrasound pelvis revealed a large cystic mass extending from pelvis to epigastrium with no solid component and few incomplete septations and no internal echoes. MRI findings showed mainly cystic component with few moderately enhancing, fine, incomplete septa. Endometrial aspiration reported histopathology of cystic glandular hyperplasia without atypia. Serum oestrogen level reported to be high (210 pg/mL). Hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology of the specimen revealed benign endometroid cystadenofibroma. She remained asymptomatic and disease free during her 6-month follow-up.
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Affiliation(s)
- Nilanchali Singh
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India.
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20
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Kato H, Kanematsu M, Ono H, Yano R, Furui T, Morishige KI, Hatano Y. Ovarian fibromas: MR imaging findings with emphasis on intratumoral cyst formation. Eur J Radiol 2013; 82:e417-21. [PMID: 23684385 DOI: 10.1016/j.ejrad.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to assess MR imaging findings of ovarian fibromas with emphasis on intratumoral cyst formation. MATERIALS AND METHODS MR images with a 1.5-T unit obtained in 17 consecutive patients (age range, 18-87 years; mean age, 58 years) with 17 histologically proven ovarian fibromas were retrospectively reviewed for the size, configuration, signal intensity of solid components, and presence of cystic degeneration and edema within tumor. Size, number, and location of intratumoral cysts were also assessed. RESULTS The maximum diameter of tumors ranged from 3.3 to 19.1cm (mean, 10.9 cm). Seven (41%) tumors were multinodular. On T2-weighted images, solid components of tumors were heterogeneously mixed hypo- and hyperintensity in 16 (94%) tumors. Nine (53%) tumors demonstrated cysts and 16 (94%) demonstrated edema within tumor. The maximum diameter of the largest cysts ranged from 1.0 to 13.2 cm (mean, 6.4 cm), and the number of cysts per tumor ranged from 1 to 60 (mean, 15.6). Of the nine tumors with cystic formation, the predominant location of the cysts was peripheral in five (56%), exophytic in two (22%), central (11%) in one, and diffuse in one (11%). CONCLUSION Peripheral or exophytic cyst formation may be characteristic MR imaging features with ovarian fibromas.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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21
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Takeuchi M, Matsuzaki K, Harada M. Ovarian adenofibromas and cystadenofibromas: magnetic resonance imaging findings including diffusion-weighted imaging. Acta Radiol 2013; 54:231-6. [PMID: 23171527 DOI: 10.1258/ar.2012.120516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ovarian adenofibromas (AF) and cystadenofibromas (CAF) belong to the surface epithelial-stromal tumors, and may appear as solid, or solid and cystic masses mimicking ovarian cancers. PURPOSE To evaluate the capability of magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement for the diagnosis of ovarian AF/CAF. MATERIAL AND METHODS Magnetic resonance manifestations of 13 cases of ovarian AF/CAF were retrospectively evaluated. DWI was obtained in all 13 lesions, and mean ADC values in 11 lesions were compared with those in solid portions of 27 ovarian cancers. Results Neither case with AF/CAF revealed high signal intensity on DWI, whereas all ovarian cancers showed high signal intensity on DWI. The ADC values in the solid portions of AF/CAF were significantly higher than those of ovarian cancers (P < 0.001). A cut-off value of 1.20 × 10(-3) mm(2)/s for AF/CAF had a sensitivity of 82%, specificity of 93%, positive predictive value of 82%, and negative predictive value of 93%. CONCLUSION DWI with ADC measurement may be helpful in differentiating AF/CAF from ovarian cancers.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, University of Tokushima, Tokushima, Japan
| | - Kenji Matsuzaki
- Department of Radiology, University of Tokushima, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, University of Tokushima, Tokushima, Japan
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22
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Cho YJ, Lee HS, Kim JM, Joo KY, Kim ML. Clinical Characteristics and Surgical Management Options for Ovarian Fibroma/Fibrothecoma: A Study of 97 Cases. Gynecol Obstet Invest 2013; 76:182-7. [DOI: 10.1159/000354555] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/23/2013] [Indexed: 01/13/2023]
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23
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TAKEUCHI M, MATSUZAKI K, UEHARA H, FURUMOTO H, HARADA M. Clear Cell Adenocarcinoma Arising from Clear Cell Adenofibroma of the Ovary: Value of DWI and DCE-MRI. Magn Reson Med Sci 2013; 12:305-8. [DOI: 10.2463/mrms.2013-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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24
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Deshmukh SP, Gonsalves CF, Guglielmo FF, Mitchell DG. Role of MR Imaging of Uterine Leiomyomas before and after Embolization. Radiographics 2012; 32:E251-81. [DOI: 10.1148/rg.326125517] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Jalaguier-Coudray A, Thomassin-Naggara I, Perrot N, Sarran A, Bazot M. Masses pelviennes : comment je raisonne ? IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Tang YZ, Liyanage S, Narayanan P, Sahdev A, Sohaib A, Singh N, Rockall A. The MRI features of histologically proven ovarian cystadenofibromas-an assessment of the morphological and enhancement patterns. Eur Radiol 2012; 23:48-56. [PMID: 22814827 DOI: 10.1007/s00330-012-2568-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the morphological and enhancement features of histologically proven cystadenofibromas (CAFs) on magnetic resonance imaging (MRI). METHODS Forty-seven histologically proven CAFs (42 benign, five borderline) were retrospectively reviewed. One benign CAF had a synchronous adenocarcinoma in the same ovary. The morphological, signal and enhancement characteristics on MRI were recorded. RESULTS The mean long axis diameter of the CAFs was 80 mm. The contralateral ovary was abnormal in 45 % of cases. A solid component was seen in 85 %, which returned low T2-weighted signal in 75 % of CAFs. Septa were seen in 74 % and one CAF was purely cystic. The majority of solid components and septa demonstrated enhancement that was less than the myometrium. Wash-in rates (WIR) of the solid tissue were available for measurement in nine patients with an average WIR of 3.2 l/s. CONCLUSION This is the largest series describing MRI appearances of histologically proven CAFs. They are typically complex adnexal lesions containing septa, cystic components and solid tissue. The majority of solid components demonstrate low T2 signal and minimal enhancement. Almost half of the cases have an abnormal contralateral ovary.
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Affiliation(s)
- Yen Zhi Tang
- Imaging Department, Barts and the London NHS Trust, London, UK.
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27
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Imai A, Ichigo S, Takagi H, Matsunami K, Watanabe S, Murase T, Ikeda T. Pelvic tumors with normal-appearing shapes of ovaries and uterus presenting as an emergency (Review). Oncol Lett 2012; 4:10-14. [PMID: 22807951 DOI: 10.3892/ol.2012.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 04/18/2012] [Indexed: 12/11/2022] Open
Abstract
Abdominal pain with an associated pelvic mass is a common problem in everyday practice. Concerns about ectopic pregnancy, torsion of an enlarged ovary or malignancy usually dominate the diagnostic evaluation. On physical and imaging examination, when a palpable painful mass is present in the pelvis and the two ovaries and uterus are detected in their normal anatomical locations, the content and origin of the lesions may be significant in narrowing the pre-operative differential diagnosis. Thus, the emergent pelvic indications discussed in this review should be considered. The causes of acute abdominal pain are few in number and therefore an accurate diagnosis may be most frequently made at the time of exploratory laparotomy.
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Affiliation(s)
- Atsushi Imai
- Department of Obstetrics and Gynecology, Matsunami General Hospital, Kasamatsu, Gifu 501-6062, Japan
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28
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Khashper A, Addley HC, Abourokbah N, Nougaret S, Sala E, Reinhold C. T2-Hypointense Adnexal Lesions: An Imaging Algorithm. Radiographics 2012; 32:1047-64. [DOI: 10.1148/rg.324115180] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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29
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MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation. AJR Am J Roentgenol 2012; 198:W296-303. [PMID: 22358029 DOI: 10.2214/ajr.11.7221] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation. MATERIALS AND METHODS In this retrospective study, preoperative MRI examinations of 35 women (mean age, 49 years; range, 24-86 years) with pathologically proven ovarian fibroma (n = 25) or fibrothecoma (n = 10) were reviewed by two radiologists in consensus. MRI features, including visibility of ovaries, presence of capsule, degeneration, T1 and T2 signal, and enhancement pattern, were recorded and correlated with histopathologic features. After administration of gadopentetate dimeglumine, the maximum percentages of enhancement of fibroma or fibrothecoma, myometrium, and, if present, uterine fibroids (11/35 patients) were compared. RESULTS All fibromas and fibrothecomas appeared well defined, with a mean size of 6.36 × 4.81 cm. Ipsilateral and contralateral ovaries were each seen in 89% (31/35) of patients. Most fibromas and fibrothecomas were isointense to hypointense compared with myometrium on T1-weighted (91% [32/35]) and T2-weighted (77% [27/35]) images. Capsule was noted in 63% (22/35) and degenerative changes were noted in 66% (23/35) of patients. Fibromas and fibrothecomas larger than 6 cm more likely showed capsule (p < 0.0001, Fisher exact probability test), degenerative changes (p = 0.003), peripheral subcapsular cystic areas (p < 0.0001), heterogeneous T2 signal (p = 0.001), and heterogeneous enhancement (p = 0.005). At least four of the above five characteristics were present in 93% (14/15) of fibromas and fibrothecomas larger than 6 cm (p < 0.0001). The maximum percentage of enhancement for fibromas and fibrothecomas (63%) was significantly lower than those for myometrium (131%; p < 0.0001) and fibroids (103%; p < 0.0001), without a statistically significant difference between the maximum percentage enhancement of myometrium and fibroids. A maximum percentage of enhancement less than 75% yielded 92% positive predictive value in differentiating fibromas and fibrothecomas from fibroids. Fibrothecomas had a higher maximum percentage of enhancement than did fibromas (p = 0.01). CONCLUSION MRI features of ovarian fibromas and fibrothecomas depend on size, with capsule and degenerative changes common with fibromas and fibrothecomas larger than 6 cm. Fibromas and fibrothecomas enhance less than myometrium and fibroids do, and less than 75% maximum percentage enhancement can help in differentiating fibromas and fibrothecomas from fibroids.
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Xie L, Cianciolo RE, Hulette B, Lee HW, Qi Y, Cofer G, Johnson GA. Magnetic resonance histology of age-related nephropathy in the Sprague Dawley rat. Toxicol Pathol 2012; 40:764-78. [PMID: 22504322 DOI: 10.1177/0192623312441408] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Magnetic resonance histology (MRH) has become a valuable tool in evaluating drug-induced toxicity in preclinical models. However, its application in renal injury has been limited. This study tested the hypothesis that MRH could detect image-based biomarkers of chronic disease, inflammation, or age-related degeneration in the kidney, laying the foundation for more extensive use in evaluating drug toxicity. We examined the entire intact kidney in a spontaneous model of chronic progressive nephropathy. Kidneys from male Sprague Dawley rats were imaged at 8 weeks (n = 4) and 52 weeks (n =4) on a 9.4 T system dedicated to MR microscopy. Several potential contrast mechanisms were explored to optimize the scanning protocols. Full coverage of the entire kidney was achieved with isotropic spatial resolution at 31 microns (voxel volume = 30 pL) using a gradient recalled echo sequence. Isotropic spatial resolution of 15 microns (voxel volume < 4 pL) was achieved in a biopsy core specimen. Qualitative age-related structural changes, such as renal cortical microvasculature, tubular dilation, interstitial fibrosis, and glomerular architecture, were apparent. The nondestructive 3D images allowed measurement of quantitative differences of kidney volume, pelvis volume, main vessel volume, glomerular size, as well as thickness of the cortex, outer medulla, and inner medulla.
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Affiliation(s)
- Luke Xie
- Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, USA
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31
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Tanaka YO, Okada S, Satoh T, Matsumoto K, Saida T, Oki A, Yoshikawa H, Minami M. Solid non-invasive ovarian masses on MR: Histopathology and a diagnostic approach. Eur J Radiol 2011; 80:e91-7. [DOI: 10.1016/j.ejrad.2010.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 11/16/2022]
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32
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Epelman M, Chikwava KR, Chauvin N, Servaes S. Imaging of pediatric ovarian neoplasms. Pediatr Radiol 2011; 41:1085-99. [PMID: 21567140 DOI: 10.1007/s00247-011-2128-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/03/2011] [Accepted: 04/08/2011] [Indexed: 11/28/2022]
Abstract
We review the clinical and imaging characteristics of the most common ovarian neoplasms in children and adolescents. Because of the widespread use of diagnostic imaging, incidental ovarian neoplasms might be encountered during the evaluation of abdominal pain, trauma or other indications and might pose a diagnostic dilemma. Conducting adequate imaging studies under these conditions is important, as management strategies differ according to the size and appearance of the lesion as well as the age of the patient. US dominates in gynecological imaging because of its excellent visualization, absence of ionizing radiation and sedation risks and comparatively low cost. For further examination of indeterminate lesions found using US, MRI is being used more progressively in this field, particularly for the evaluation of complex pelvic masses with the aim of distinguishing benign and malignant conditions and conditions requiring surgical intervention. CT is reserved primarily for tumor staging and follow-up and for emergency situations.
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Affiliation(s)
- Monica Epelman
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Millet I, Rathat G, Perrochia H, Hoa D, Mérigeaud S, Curros-Doyon F, Taourel P. [Imaging features of granulosa cell tumors of the ovary: about three cases]. ACTA ACUST UNITED AC 2011; 92:236-42. [PMID: 21501762 DOI: 10.1016/j.jradio.2011.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 01/13/2011] [Accepted: 02/04/2011] [Indexed: 11/28/2022]
Abstract
Granulosa cell tumors of the ovary are rare, and included in the sex cord-stromal tumor category. They have a low malignancy potential and generally have a good prognosis. They are the most frequent hormone-secreting tumors of the ovary and may lead to suggestive clinical symptoms. Some biological markers (serum inhibin B and AMH) may be helpful for diagnosis, though their sensitivity is not perfect. Preoperative imaging diagnosis remains challenging due to the wide variability in morphology and lack of epidemiological data in the imaging literature (small patient populations). From a review of the clinical and MR imaging features of three cases of granulosa cell tumor of the adult and a review of the literature, we will describe a few imaging features that may suggest the correct diagnosis.
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Affiliation(s)
- I Millet
- Service de radiologie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
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Pérez-López FR, Chedraui P, Troyano-Luque JM. Peri- and post-menopausal incidental adnexal masses and the risk of sporadic ovarian malignancy: new insights and clinical management. Gynecol Endocrinol 2010; 26:631-43. [PMID: 20500106 DOI: 10.3109/09513590.2010.487611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adnexal masses are common among peri- and post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. Despite this, the appearance of an adnexal mass is a concern for the patient and an insight exercise for physicians. In most cases, an adnexal enlargement is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. Exceptionally an ovarian tumour may be malignant and should be treated as early as possible. When conventional ultrasound renders complex morphology other diagnostic tools must be used such as: colour Doppler and functional tumour vessel properties, serum CA 125 levels, nuclear magnetic resonance imaging and in some cases laparoscopy. Several new tumour markers are being studied for clinical application, although there are presently no clear recommendations. Adnexal masses with benign morphological and functional properties must be periodically monitored as an alternative to surgery since malignant transformation is exceptional.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad de Zaragoza, Hospital Clínico de Zaragoza, Zaragoza 50009, Spain.
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Spencer JA, Ghattamaneni S. MR Imaging of the Sonographically Indeterminate Adnexal Mass. Radiology 2010; 256:677-94. [DOI: 10.1148/radiol.10090397] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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36
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IRM de diffusion et tumeurs annexielles. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2010.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 2010; 194:311-21. [PMID: 20093590 DOI: 10.2214/ajr.09.3522] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions. CONCLUSION The goal of imaging in ovarian cancer detection is to expeditiously distinguish benign adnexal lesions from those requiring further pathologic evaluation for malignancy. For lesions indeterminate on ultrasound, MRI increases the specificity of imaging evaluation, thus decreasing benign resections. CT is useful in diagnosis and treatment planning of advanced cancer. Although (18)F-FDG-avid ovarian lesions in postmenopausal women are considered suspicious for malignancy, PET/CT is not recommended for primary cancer detection because of high false-positive rates.
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Zampolin RL, Shi A. Radiologic Evaluation of Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:581-602. [PMID: 26838772 DOI: 10.1016/j.path.2009.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mesenchymal neoplasms of the female genital tract are a diverse group of tumors, of which the most common are smooth muscle tumors. There is a significant overlap in the imaging characteristics of benign and malignant tumors and final diagnosis often requires pathologic correlation. However, familiarity with typical radiologic features, common imaging pitfalls, and the utility of different imaging modalities can be valuable in the evaluation of mesenchymal tumors. This article highlights the imaging features of the most commonly encountered mesenchymal tumors in the female genital tract.
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Affiliation(s)
- Richard L Zampolin
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA
| | - Ann Shi
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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Bouic-Pagès E, Perrochia H, Mérigeaud S, Giacalone PY, Taourel P. [MR Imaging of primary ovarian tumors with pathologic correlation]. ACTA ACUST UNITED AC 2009; 90:787-802. [PMID: 19752784 DOI: 10.1016/s0221-0363(09)73210-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ovarian tumors are classified based on the cell of origin into epithelial tumors, germ cell tumors and sex cord-stromal tumors. This pictorial essay illustrates the MR imaging features of the main ovarian tumors with pathologic correlation. These key features are helpful to suggest a specific diagnosis or narrow the differential diagnosis, in order to optimize the surgical approach.
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Affiliation(s)
- E Bouic-Pagès
- Service d'Imagerie médicale, Hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5
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Roussel A, Thomassin-Naggara I, Darai E, Marsault C, Bazot M. Évaluation de la séquence de diffusion pour l’étude des tumeurs annexielles. ACTA ACUST UNITED AC 2009; 90:589-96. [DOI: 10.1016/s0221-0363(09)74025-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Thomassin-Naggara I, Cuenod CA, Darai E, Marsault C, Bazot M. Dynamic contrast-enhanced MR imaging of ovarian neoplasms: current status and future perspectives. Magn Reson Imaging Clin N Am 2008; 16:661-72, ix. [PMID: 18926429 DOI: 10.1016/j.mric.2008.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MR imaging is useful for characterizing ovarian tumors. Dynamic contrast-enhanced MR imaging is a promising new technique useful for characterizing perfusion and angiogenesis of ovarian masses. This article describes the dynamic contrast-enhanced MR imaging technique examines the current and future applications of this technique in patients with ovarian tumors.
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43
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Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr 2008; 32:712-23. [PMID: 18830100 DOI: 10.1097/rct.0b013e31815881ef] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews the value of magnetic resonance imaging (MRI) for the diagnosis of ovarian tumors especially when ultrasonography is indeterminate. Although ultrasonography is the first imaging technique used to investigate suspected pelvic masses, it has a limited capacity for tissue characterization. In addition to morphological characteristics, many tissue parameters such as T1, T2, perfusion, and diffusion contribute to signal intensity, so MRI is able to identify various types of tissue contained in pelvic masses. Magnetic resonance imaging helps to locate large solid masses and to distinguish benign from malignant ovarian tumors, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. The aims of this review are 3-fold. First, we review state-of-the-art and usual MRI techniques and published findings. Second, we recall the MR features most useful for assessing the main ovarian tumors. Finally, we discuss the relevance of various features for distinguishing between benign, borderline, and invasive ovarian tumors.
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Kitajima K, Kaji Y, Sugimura K. Usual and unusual MRI findings of ovarian fibroma: correlation with pathologic findings. Magn Reson Med Sci 2008; 7:43-8. [PMID: 18460848 DOI: 10.2463/mrms.7.43] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Ovarian fibromas typically exhibit low signal intensity on T(2)-weighted images, which reflects their abundant fibrocollagenous stroma. However, the mass of larger tumors often demonstrates high signal intensity on T(2)-weighted images, which reflects varied degenerative changes, such as cystic degeneration, edematous change, hemorrhagic infarction, or necrosis caused by torsion and myxomatous change. We illustrate typical and atypical magnetic resonance (MR) imaging findings of ovarian fibromas and correlate them with histopathologic findings.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Dokkyo Medical University School of Medicine, Shimotuka-Gun, Tochigi, Japan.
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Shimizu S, Okano H, Ishitani K, Nomura H, Nishikawa T, Ohta H. Ovarian cystadenofibroma with solid nodular components masqueraded as ovarian cancer. Arch Gynecol Obstet 2008; 279:709-11. [DOI: 10.1007/s00404-008-0785-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 08/21/2008] [Indexed: 02/05/2023]
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Oh S, Rha S, Byun J, Lee Y, Jung S, Jung C, Kim M. MRI features of ovarian fibromas: emphasis on their relationship to the ovary. Clin Radiol 2008; 63:529-35. [DOI: 10.1016/j.crad.2007.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 10/15/2007] [Accepted: 10/17/2007] [Indexed: 11/29/2022]
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48
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Tsili AC, Tsampoulas C, Argyropoulou M, Navrozoglou I, Alamanos Y, Paraskevaidis E, Efremidis SC. Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses. Eur Radiol 2008; 18:1049-57. [DOI: 10.1007/s00330-007-0842-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 11/05/2007] [Accepted: 12/10/2007] [Indexed: 01/22/2023]
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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.
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Affiliation(s)
- S A A Sohaib
- Department of Radiology, Royal Marsden Hospital, Fulham Road, London, UK
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50
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Tanaka YO, Saida TS, Minami R, Yagi T, Tsunoda H, Yoshikawa H, Minami M. MR findings of ovarian tumors with hormonal activity, with emphasis on tumors other than sex cord-stromal tumors. Eur J Radiol 2007; 62:317-27. [PMID: 17403591 DOI: 10.1016/j.ejrad.2007.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 02/12/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Sex cord-stromal tumors including granulosa cell tumor, thecoma, Sertoli stromal cell tumor and steroid cell tumor are noted for their hormonal activity. However, there are many kinds of ovarian tumors other than sex cord-stromal tumors and tumor-like conditions with endocrine manifestations. Cross-sectional imaging, especially MR, can provide precise features of ovarian tumors and uterine morphological change even in a clinically latent excess of estrogen. In this article, we demonstrate typical imaging findings of ovarian tumors with hormonal activity. We also shortly explain the mechanism of the virilization and hyperestrogenism caused by ovarian tumors and tumor-like conditions.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
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