妇科附件肿块影像诊断要点及MRI应用价值.pdfVIP

AdnexalMasses:FiveImagingPearls

Highlights:

•Adnexalmassesareamajorindicationforgynecologicsurgery.

•20%ofadnexalmassesareindeterminateontransvaginalultrasound.

•MRIisthemostaccurateimagingmodalitytocharacterizeadnexalmassesandisoftenableto

makeaspecificdiagnosisiftheionscontain:fat,blood,fibroustissue,papillaryprojectionsor

multi-locularvariableT2-Wsignalintensitycysts.

OneoftheleadingindicationsforgynecologicsurgeryintheUSisthepresenceofanadnexalmass.In

fact,itisestimatedthatupto10%ofwomenwillundergosurgeryforasuspectedadnexalmassduring

theirlifetime1.Imagingisperformedtocharacterizeadnexalionsandtriagepatientstoappropriate

therapy.Specifically,ifmalignancyissuspected,thepatientwillbereferredtoagynecologiconcologist

forstagingsurgery;whereasifabenignentityissuspected,thepatientcanbemanagedmore

conservativelybyageneralgynecologist.Whileultrasoundremainstheinitialimagingmodalityfor

womenwithaknownorsuspectedadnexalmass,upto20%ofpremenopausalpatientswillhavean

indeterminateUSinterpretationandrequirefurtherimaging2.MRI,andespeciallygadolinium-

enhancedMRIishighlyaccurateincharacterizingadnexalmasses,somuchso,thatarecentACRWhite

PaperonmanagingaladnexalmassesincludedatableofMRIfeaturesthatallowspecific

diagnosestobemade3.

ArrivingatspecificMRdiagnosisreliesonexploitingthetissuecharacterizationabilitiesofMRI.Inthe

ovary,ormorebroadlyintheadnexa,thiscanoftenbeaccomplishedbyaskingthefollowing5

questions:

1.Doesthemasscontainfat?

2.Doesthemasscontainblood?

3.Doesthemasscontainfibroustissue?

4.Doesthemasshavepapillaryprojections?

5.Doesthemasshavelocuofvaryingsignalintensity