CT and MR imaging of ovarian tumors with emphasis on differential diagnosis

Ovarian tumors are classified on the basis of tumor origin as epithelial tumors (serous and mucinous tumors, endometrioid and clear cell carcinomas, Brenner tumor), germ cell tumors (mature and immature teratomas, dysgerminoma, endodermal sinus tumor, embryonal carcinoma), sex cord-stromal tumors (fibrothecoma; granulosa cell, sclerosing stromal, and Sertoli-Leydig cell tumors), and metastatic tumors. Epithelial tumors are primarily cystic and, when malignant, are associated with varying proportions of a solid component. Papillary projections are a distinctive feature of epithelial tumors. Profuse papillary projections are highly suggestive of borderline (low-malignant-potential) or malignant tumor. Ovarian teratomas demonstrate lipid material at computed tomography and magnetic resonance (MR) imaging. Malignant germ cell tumors manifest as a large, complex abdominal mass that contains both solid and cystic components. Tumor markers are helpful in diagnosis. The radiologic appearance of sex cord-stromal tumors varies from small solid masses to large multicystic masses. Granulosa cell tumors are usually large multicystic masses with solid components. Fibrothecoma, sclerosing stromal tumor, and Sertoli-Leydig cell tumors are usually solid masses. Fibromas have very low signal intensity on T2-weighted MR images. Certain radiologic findings predominate for each type of tumor. Knowledge of these key features of ovarian tumors provides the criteria for making a specific diagnosis or substantially narrowing the differential diagnosis.