Ovarian cancer is the leading cause of death in women among gynecological cancers. For this reason adnexal masses diagnosis is important to make differentiation of malignant lesions from benign lesions. Ultrasound is generally used as a second step of evaluation of adnexal masses after pelvic examination. Unfortun ately ultrasound may not be enough to detect malignant lesions in adnexa. For this reason several diagnostic approaches are being used. Magnetic resonance imaging can be used in adnexal masses which have malignancy suspicion. This study aims to show the di agnostic value of MRI in diagnosis of adnexal masses. Files of 98 patients who underwent surgery for adnexal masses were retrospectively investigated. Patients under 18 years of age, patients whose adnexal mass were incidentally diagnosed during surgery and patients who don’t have preoperative imaging studies were excluded from the study. Postoperative pathology results and preoperative MRI findings were compared. For MRI evaluation of the patients; the contrast enhancement was found to be more positive in masses diagnosed as malignant (44%vs.6.4%). Also presence of both omental cake and free fluid was found to be related with diagnosis of malignancy in final result. Bilaterally located masses in MRI were found to be more malignant (57%vs.27 .14%). When MRI finding were evaluated as malignant or benign the consistency with the final pathology results were studied. A moderate correlation with the final results was found with the MRI results. MRI can be used in differentiation of malignant adnexal masses.
___
1. Liu JH, Zanotti KM. Management of the adnexal mass. Obstetrics & Gynecology 2011; 117: 1413-1428.
2. Horner ML, Ries M, Krapcho N, et al., SEER Cancer Statistics Review, 1975-2006, National Cancer Institute. Bethesda MD. 2009.
3. McDonald JM, Modesitt SC. The incidental postmenopausal adnexal mass. Clin Obstet Gynecol 2006; 49: 506-516.
4. Jeong YY, Outwater EK, Kang H.K. Imaging evaluation of ovarian masses. Radiographics 2000; 20: 1445-1470.
5. Adusumilli S, Hussain HK, Caoili EM, et al. MRI of sonographically indeterminate adnexal masses. American Journal of Roentgenology 2006; 187: 732-740.
6. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization-meta-analysis and Bayesian analysis. Radiology 2005; 236: 85-94.
7. Murta E, Da Silva C, R. Gomes B. TavaresMurta, Melo A. Ultrasonographic criteria and tumor marker assay are good procedures for the diagnosis of ovarian neoplasia in preselected outpatients. European journal of gynaecological oncology 2003; 25: 707-712.
8. Grab D, Flock F, Stöhr I, et al.. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecologic oncology 2000; 77: 454-459.
9. Meray O. Adneksiyal kitlelerin malign-benign ayrımında malignite risk indeksi (RMİ)’nin prediktif değeri, in Kadin Hastalıkları ve Doğum Anabilim Dalı. 2009, İnönü Üniversitesi: Malatya.
10. Haggerty AF, Hagemann AR, Chu C, Siegelman ES, Rubin SC. Correlation of pelvic magnetic resonance imaging diagnosis with pathology for indeterminate adnexal masses. International Journal of gynecological cancer 2014; 24: 1215-1221.
11. Yamashita Y, Torashima M, Hatanaka Y. et al. Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging. Radiology 1995; 194: 557-565.
12. Komatsu T, Konishi I, Mandai M, et al. Adnexal masses: transvaginal US and gadolinium-enhanced MR imaging assessment of intratumoral structure. Radiology 1996; 198: 109-115.
13. Hata K, Hata T, Manabe A, Sugimura K, Kitao M. A critical evaluation of transvaginal Doppler studies, transvaginal sonography, magnetic resonance imaging, and CA 125 in detecting ovarian cancer. Obstetrics & Gynecology 1992; 80: 922-926.
14. Low RN, Duggan B, Barone R.M, Saleh F, Song ST. Treated ovarian cancer: MR imaging, laparotomy reassessment, and serum CA-125 values compared with clinical outcome at 1 year. Radiology 2005; 235: 918-926.
15. Nam EJ, Yun MJ, Oh YT, et al. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecologic oncology 2010; 116: 389- 394.