MR imaging of hemorrhagic adnexal masses

Magnetic resonance (MR) imaging, performed on 31 women with 40 surgically proven adnexal masses, was reviewed to determine whether MR can distinguish hemorrhagic from nonhemorrhagic masses. Fourteen masses proved to be hemorrhagic at surgery including functional ovarian cysts (seven cases), cystadenoma (one case), endometriomas (three cases), hematosalpinx (one case), ectopic pregnancy (one case), and parametrial extension from cervical carcinoma (one case). A high signal intensity (compared with adjacent pelvic fat) on a T1-weighted spin echo sequence was found to be a reliable indicator of hemorrhage and was demonstrated in all 14 hemorrhagic masses. The "hematocrit" effect was seen as an area of high signal intensity layering in the dependent portion of six hemorrhagic cysts. Only four of 26 nonhemorrhagic masses demonstrated high signal intensity on T1-weighted sequences and, of these, three proved to be fat-containing dermoid cysts and one was a simple cyst with adherent mesenteric fat. We conclude that high signal intensity on a T1-weighted spin echo pulse sequence is evidence for a hemorrhagic mass and that a hematocrit effect appears to be a specific sign for a hemorrhagic cyst. The clinical significance of hemorrhagic adnexal masses is discussed.