MRI classification and characterization of complex ovarian m
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Adnexal masses often are indeterminate at ultrasound, the diagnostic imaging modality of choice in the workup of women with symptoms of such entities, and confirming ovarian etiology can be difficult. Additional diagnostic imaging is frequently indicated, as a common benign diagnosis may obviate the need for surgery, while prompt identification of malignant features requires intervention by subspecialist oncological surgeons.

Magnetic resonance imaging (MRI) is useful in the workup of complex adnexal masses. The modality has several problem-solving utilities that can be correlated with ultrasound findings, clinical history, physical examination and laboratory investigations when a diagnosis remains indeterminate. MR imaging also is more reproducible than sonography, and it can help determine additional diagnostic information, such as the presence of fat, blood products, fibrosis and enhancement pattern or diffusion restriction. DWI, for example, has been beneficial in differentiating benign from malignant tumors with high sensitivity.

Ovarian neoplasms range from benign to malignant and may be primary or secondary. Usually, they are classified by tissue of origin (surface epithelial, germ cell and sex-cord stromal) and metastatic (one secondary) (Table 1).
In this article, however, we classify ovarian masses into three main MR imaging categories: Cystic neoplasms (with septations), Complex neoplasms (solid-cystic) and Solid neoplasms (predominantly solid). These three categories are further subdivided according to specific MR imaging features, such as the presence of calcifications, fat, blood, proteinaceous content and signal intensities.

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