Imaging of Ovarian Disease-Related Pain

A 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. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Abbreviations - ADC: - Apparent diffusion coefficient - CRP: - C-reactive protein - CT: - Computed tomography - DCE: - Dynamic contrast enhanced - DMN: - Default mode network - DWI: - Diffusion-weighted imaging - DW-WB/MRI: - Diffusion-weighted whole-body MRI - EP: - Ectopic pregnancy - ESUR: - European Society of Urogenital Radiology - EUG: - Extrauterine gravidity - FHC: - Fitz-Hugh-Curtis syndrome - FIGO: - The International Federation of Gynecology and Obstetrics - FOV: - Field of view - FSHR: - Follicle Stimulating Hormone Receptor - hCG: - Human chorionic gonadotropin - ITT: - Isolated tubal torsion - IUD: - Intrauterine device - Ki-67: - Cell proliferation-associated Ki-67 antigen - MRI: - Magnetic resonance imaging - NCS: - Nutcracker syndrome - OC: - Ovarian cancer - OHSS: - Ovarian hyperstimulation syndrome - OP: - Ovarian pregnancy - OT: - Ovarian torsion - PD: - Primary dysmenorrhea - PET/CT: - Positron-emission tomography - PID: - Pelvic inflammatory disease - SLE: - Systemic lupus erythematosus - SRY Gene: - Sex-determining region Y - T1W/T2W: - T1 weighted, T2 weighted - TDF: - Testis-determining-factor - TOA: - Tubo-ovarian abscess - TV-US: - Transvaginal ultrasonography - UO: - Utero-ovarian - US: - Ultrasonography - VEGF: - Vascular endothelial growth factor - WHO: - World Health Organization

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(AVI 39692 kb) Axial 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) DWI: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI. (AVI 113492 kb) ADC map: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI and in ADC map. (AVI 41860 kb) Axial 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) Axial T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27976 kb) Sagittal T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27156 kb) DWI: bilateral tubo-ovarian abscess, clearly diffusion restricted in DWI. (AVI 11864 kb) ADC map: bilateral tubo-ovarian abscess, clearly diffusion restricted in ADC map. (AVI 14040 kb) Axial T2w series: thickened fallopian tube on the right side. Free fluid in fossa Douglas. (AVI 15180 kb) Correlating findings in PET/CT. (AVI 3711 kb) Axial T2w series: Hydrosalpinx. Notice the so called “waist sign”. (AVI 14112 kb) CECT series: massive haematoperitoneum an inhomogenous mass in fossa ovarica showed a contrast extravasation indicating an active bleeding component. (AVI 57231 kb) Coronal T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 12671 kb) Axial T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 35531 kb) DWI: no diffusion restriction. (AVI 10936 kb) ADC map: no diffusion restriction, ADC value 3.0 × 10−3 mm2/s. (AVI 5604 kb) Coronal T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 12902 kb) DWI: hyperintense restricted cystic wall. (AVI 17086 kb) Axial T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 19359 kb) Axial T2w series: ovarian dysgerminoma with “beak-sign”. (AVI 11249 kb) Rights and permissions Copyright information © 2019 Springer Nature Switzerland AG About this chapter Cite this chapter Härmä, 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 Download citation DOI: https://doi.org/10.1007/978-3-319-99822-0_22 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-99821-3 Online ISBN: 978-3-319-99822-0 eBook Packages: MedicineMedicine (R0)