{"paper_id":"72b529ff-6686-4295-8181-f20ef5e9e316","body_text":"Abstract\nA number of different conditions in the ovaries, including the adnexa, can cause ovarian or pelvic pain. Sometimes the pain character, chronic or acute, or the time point of the appearance of the symptoms within menstrual cycle can give us diagnostic clues for the accurate imaging interpretation. Woman’s fertility and life-threatening conditions, such as rupture of ectopic pregnancy or tubo-ovarian torsion, should be rapidly diagnosed and treated. As ovarian cancer, even in advanced stage, rarely causes specific symptoms or pain, indications to imaging by unspecific pelvic or urinary symptoms of the women should be closely proved. Often the first-line imaging technique is gynecologic sonography with power Doppler examination. MRI possess a high spatial and temporal resolution, functional imaging sequences being easily incorporated and being a valuable and safe tool in the diagnostic of ovarian and adnexal masses of the female patients in any age. The choice of the imaging modality must be made individually, criterion such as age of the patient, experience of the sonologist, access to MRI, and indication to emergency CT contributing. In order to reach an accurate diagnosis, combining the radiological findings with clinical and laboratory findings is warmly recommended.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nAbbreviations\n- ADC:\n-\nApparent diffusion coefficient\n- CRP:\n-\nC-reactive protein\n- CT:\n-\nComputed tomography\n- DCE:\n-\nDynamic contrast enhanced\n- DMN:\n-\nDefault mode network\n- DWI:\n-\nDiffusion-weighted imaging\n- DW-WB/MRI:\n-\nDiffusion-weighted whole-body MRI\n- EP:\n-\nEctopic pregnancy\n- ESUR:\n-\nEuropean Society of Urogenital Radiology\n- EUG:\n-\nExtrauterine gravidity\n- FHC:\n-\nFitz-Hugh-Curtis syndrome\n- FIGO:\n-\nThe International Federation of Gynecology and Obstetrics\n- FOV:\n-\nField of view\n- FSHR:\n-\nFollicle Stimulating Hormone Receptor\n- hCG:\n-\nHuman chorionic gonadotropin\n- ITT:\n-\nIsolated tubal torsion\n- IUD:\n-\nIntrauterine device\n- Ki-67:\n-\nCell proliferation-associated Ki-67 antigen\n- MRI:\n-\nMagnetic resonance imaging\n- NCS:\n-\nNutcracker syndrome\n- OC:\n-\nOvarian cancer\n- OHSS:\n-\nOvarian hyperstimulation syndrome\n- OP:\n-\nOvarian pregnancy\n- OT:\n-\nOvarian torsion\n- PD:\n-\nPrimary dysmenorrhea\n- PET/CT:\n-\nPositron-emission tomography\n- PID:\n-\nPelvic inflammatory disease\n- SLE:\n-\nSystemic lupus erythematosus\n- SRY Gene:\n-\nSex-determining region Y\n- T1W/T2W:\n-\nT1 weighted, T2 weighted\n- TDF:\n-\nTestis-determining-factor\n- TOA:\n-\nTubo-ovarian abscess\n- TV-US:\n-\nTransvaginal ultrasonography\n- UO:\n-\nUtero-ovarian\n- US:\n-\nUltrasonography\n- VEGF:\n-\nVascular endothelial growth factor\n- WHO:\n-\nWorld Health Organization\nReferences\nWatkins BP, Kothari SN. 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Arch Gynecol Obstet. 2016;293(6):1367.\nMichielsen K, Dresen R, Vanslembrouck R, De Keyzer F, Amant F, Mussen E, et al. Diagnostic value of whole body diffusion-weighted MRI compared to computed tomography for pre-operative assessment of patients suspected for ovarian cancer. Eur J cancer. 2017;83:88–98.\nLindgren A, Anttila M, Rautiainen S, Arponen O, Kivela A, Makinen P, et al. Primary and metastatic ovarian cancer: characterization by 3.0T diffusion-weighted MRI. Eur Radiol. 2017;27(9):4002–12.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\n22.1 Electronic Supplementary Material\nNormal ovaries on MRI (T2W). Normal anatomical location of the bilateral ovaries para uterine. Notice also endometrial hyperplasia. (AVI 33432 kb)\nEctopic ovary. “Ectopic ovary on the upper pelvic side wall left after ovariopexy proceeded before radiation in a patient with cervical cancer”. (AVI 39692 kb)\nAxial T2-weighted series shows a central hyperintense cystic lesion with thickened wall of the right ovary. The imaging was proceeded because of uterine fibroids. (AVI 35120 kb)\nDWI: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI. (AVI 113492 kb)\nADC map: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI and in ADC map. (AVI 41860 kb)\nAxial T1w fatsat post contrast series: left renal vein is compressed between the aorta and the superior mesenteric artery with a distension of the hilar part of the vein. Note the thickened left ovarian vein indicating nutcracker syndrome. (AVI 98608 kb)\nAxial T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27976 kb)\nSagittal T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27156 kb)\nDWI: bilateral tubo-ovarian abscess, clearly diffusion restricted in DWI. (AVI 11864 kb)\nADC map: bilateral tubo-ovarian abscess, clearly diffusion restricted in ADC map. (AVI 14040 kb)\nAxial T2w series: thickened fallopian tube on the right side. Free fluid in fossa Douglas. (AVI 15180 kb)\nCorrelating findings in PET/CT. (AVI 3711 kb)\nAxial T2w series: Hydrosalpinx. Notice the so called “waist sign”. (AVI 14112 kb)\nCECT series: massive haematoperitoneum an inhomogenous mass in fossa ovarica showed a contrast extravasation indicating an active bleeding component. (AVI 57231 kb)\nCoronal T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 12671 kb)\nAxial T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 35531 kb)\nDWI: no diffusion restriction. (AVI 10936 kb)\nADC map: no diffusion restriction, ADC value 3.0 × 10−3 mm2/s. (AVI 5604 kb)\nCoronal T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 12902 kb)\nDWI: hyperintense restricted cystic wall. (AVI 17086 kb)\nAxial T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 19359 kb)\nAxial T2w series: ovarian dysgerminoma with “beak-sign”. (AVI 11249 kb)\nRights and permissions\nCopyright information\n© 2019 Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nHärmä, K., Vollmar, P. (2019). Imaging of Ovarian Disease-Related Pain. In: Cova, M., Stacul, F. (eds) Pain Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-99822-0_22\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-99822-0_22\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-99821-3\nOnline ISBN: 978-3-319-99822-0\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}