Magnetic resonance evaluation of adnexal masses.

Guerra A, Teresa Margarida Cunha, Ana Félix
Acta radiologica (Stockholm, Sweden : 1987) · 2008 · doi:10.1080/02841850802064995 · PMID:18568564
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Retrospective analysis of 199 surgically confirmed adnexal masses demonstrates that magnetic resonance imaging accurately diagnoses malignancy with 98% sensitivity and 93% specificity, facilitating appropriate surgical management.

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This retrospective study evaluated the diagnostic accuracy of magnetic resonance imaging for determining malignancy in surgically confirmed adnexal masses. Researchers analyzed pelvic MRI scans from 161 patients, comparing radiological findings against histopathologic results to establish sensitivity and specificity metrics. The analysis demonstrated that MRI achieved a high overall accuracy of 95%, with a sensitivity of 98% and specificity of 93% in distinguishing malignant lesions from benign ones. This paper is centrally about endometriosis — specifically, the differential diagnosis of adnexal masses where endometriomas are a common benign mimic of ovarian malignancy.

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Abstract

BackgroundAccurate evaluation of adnexal masses allows correct surgical procedure, avoiding unnecessary surgery.PurposeTo evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of malignancy of adnexal lesions.Material and methodsWe 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.ResultsOn 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.ConclusionMRI 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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