Imaging of the ovary and adnexa: clinical issues and applications of MR imaging

Many if not most adnexal masses that are resected for suspicion of malignancy are benign, and the ratio of benign to malignant masses removed increases dramatically if asymptomatic women are screened. More specific diagnostic tests may reduce the rate of unnecessary surgery in these patients. Magnetic resonance (MR) imaging may play a role in evaluating women with problematic ultrasound diagnoses. Conventional and chemical shift MR imaging can allow specific diagnosis of dermoid cysts, pedunculated leiomyomas, ovarian fibromas, most endometriomas, and hydrosalpinx. Gadolinium-enhanced MR imaging allows identification of papillary projections and septa in ovarian neoplasms and differentiation of clot and debris from vascularized tissue. Results of available studies suggest that MR imaging of the female pelvis is cost-effective in selected patients and can be used to obviate surgery in some patients. MR imaging with the use of these techniques may allow more appropriate clinical decisions to be made in selected patients with complex adnexal disease.