Magnetic resonance evaluation of adnexal masses

A Guerra, Guerra A, Teresa Margarida Cunha, T M Cunha, A Félix, Ana Félix
Acta radiologica (Stockholm, Sweden : 1987) · 2008 · doi:10.1080/02841850802064995 · PMID:18568564
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Magnetic resonance imaging demonstrated high accuracy, sensitivity, and specificity in diagnosing malignancy of surgically confirmed adnexal masses.

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This retrospective study evaluated how accurately pelvic MRI diagnoses malignancy in adnexal lesions using 161 patients with 199 surgically confirmed masses (1998–2005). Malignancy criteria included contrast-enhanced solid components (with exceptions based on low-signal intensity on T2WI), contrast-enhanced papillary projections in cystic lesions (with similar T2WI exceptions), septal thickness ≥3 mm, and associated findings such as ascites, peritoneal metastasis, and pelvic adenopathy. MRI performance showed 98% sensitivity and 93% specificity for malignancy, with 95% overall accuracy and near-perfect agreement with histopathology (kappa 0.906), though there were false positives/negatives and seven tumors categorized as uncertain malignant potential. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

BACKGROUND: Accurate evaluation of adnexal masses allows correct surgical procedure, avoiding unnecessary surgery. PURPOSE: To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of malignancy of adnexal lesions. MATERIAL AND METHODS: We retrospectively reviewed the pelvic MRI scans of 161 patients with 199 surgically confirmed adnexal masses, between November 1998 and June 2005. The criteria for adnexal malignancy were contrast-enhanced solid lesions, contrast-enhanced solid components in mixed lesions (except those with low-signal-intensity solid components on T2-weighted imaging [T2WI]), contrast-enhanced papillary projections in cystic lesions (except those with low-signal-intensity papillary projections on T2WI), or septal thickness >or=3 mm. Ascites, peritoneal metastasis, and pelvic adenopathy were also regarded as criteria for malignancy. RESULTS: On MRI evaluation, 97 adnexal lesions were malignant and 102 were non-malignant. Thirty-two percent of patients with ascites had benign lesions. Histopathologic evaluation of the adnexal lesions showed that 83 were malignant (true positives), 100 were non-malignant (true negatives), and seven were uncertain malignant potential tumors; two were false negative and seven were false positive. The MRI sensitivity and specificity for malignancy were 98% and 93%, respectively. MRI reached an accuracy of 95%, with a positive predictive value of 0.92 and a negative predictive value of 0.98 for malignant adnexal lesions. The kappa coefficient was 0.906, indicating almost perfect agreement between MRI and histological results. CONCLUSION: MRI is an accurate method for evaluating the malignancy of adnexal lesions.
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Background

Accurate evaluation of adnexal masses allows correct surgical procedure, avoiding unnecessary surgery. Purpose: To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of malignancy of adnexal lesions.

Material and methods

We retrospectively reviewed the pelvic MRI scans of 161 patients with 199 surgically confirmed adnexal masses, between November 1998 and June 2005. The criteria for adnexal malignancy were contrast-enhanced solid lesions, contrastenhanced solid components in mixed lesions (except those with low-signal-intensity solid components on T2-weighted imaging [T2WI]), contrast-enhanced papillary projections in cystic lesions (except those with low-signal-intensity papillary projections on T2WI), or septal thickness ]3 mm. Ascites, peritoneal metastasis, and pelvic adenopathy were also regarded as criteria for malignancy.

Results

On MRI evaluation, 97 adnexal lesions were malignant and 102 were nonmalignant. Thirty-two percent of patients with ascites had benign lesions. Histopathologic evaluation of the adnexal lesions showed that 83 were malignant (true positives), 100 were non-malignant (true negatives), and seven were uncertain malignant potential tumors; two were false negative and seven were false positive. The MRI sensitivity and specificity for malignancy were 98% and 93%, respectively. MRI reached an accuracy of 95%, with a positive predictive value of 0.92 and a negative predictive value of 0.98 for malignant adnexal lesions. The kappa coefficient was 0.906, indicating almost perfect agreement between MRI and histological results.

Conclusion

MRI is an accurate method for evaluating the malignancy of adnexal lesions. Descrição Palavras-chave Adnexal masses Genital Magnetic resonance imaging Ovarian tumor Pelvis Contexto Educativo Citação Guerra, A.; Cunha, T.M.; Félix, A.Magnetic Resonance Evaluation of Adnexal Masses, Acta Radiologica, 49, 6, 700-709, 2008.

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Condition tags

endometriosis

MeSH descriptors

Adnexal Diseases Cystadenoma Leiomyoma Magnetic Resonance Imaging Neoplasms, Germ Cell and Embryonal Ovarian Neoplasms Adnexal Diseases Adolescent Adult Aged Aged, 80 and over Contrast Media Contrast Media Cystadenoma Endometriosis Endometriosis Female Humans Image Enhancement Image Enhancement

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