Cross-sectional imaging of the pelvic tumors and tumor-like lesions in gynecologic patients—misinterpretation points and differential diagnosis

Magnetic resonance imaging evaluation of non ovarian adnexal lesions

Differentiation of nonovarian from ovarian lesions is a diagnostic challenge. MRI (Magnetic Resonance Imaging) of the pelvis provides excellent tissue characterization and high contrast resolution, allowing for detailed evaluation of adnexal lesions. Salient MRI characteristics of predominantly cystic lesions and predominantly solid adnexal lesions are presented along with epidemiology and clinical presentation. Due to its excellent soft tissue resolution, MRI may be able to characterize indeterminate adnexal masses and aid the radiologist to arrive at the correct diagnosis, thus positively affect patient management.

Tumor feeding artery reconstruction with multislice spiral CT in the diagnosis of pelvic tumors of unknown origin

PURPOSE

We aimed to compare multislice spiral computed tomography (MSCT) angiography diagnosis with both surgical findings and postoperative pathological results in patients with pelvic tumors of unknown origin. In addition, the diagnostic accuracy of MSCT angiography was compared with that of routine computed tomography for tumor feeding artery volume reconstruction to determine the origin and nature of pelvic tumors.

MATERIALS AND METHODS

The records of 43 patients with pelvic tumors of unknown origin who underwent MSCT angiography were retrospectively reviewed. Volume reconstructions using add vessel and merge views methods were performed for abdominal and pelvic blood vessels. The tumor origin was identified based on observations of the origin, number, morphology, starting/ending locations, route, and distribution of the tumor feeding arteries.

RESULTS

Overall, the mean tumor diameter was 9.8±3.5 cm (range, 4.2-23.5 cm); 11 tumors (25.6%) were cystic in nature; and 32 tumors (74.4%) were either solid/cystic or solid in nature. When considering all MSCT angiography examinations used to predict the nature of the tumor (e.g., malignant or benign), the sensitivity and specificity were 77.3% and 95.2%, respectively. The positive and negative predictive values were 94.4% and 80%, respectively. The overall diagnostic accuracy was 86.05% with an area under the curve of 0.961 (95% confidence interval, 0.913-1.000).

CONCLUSIONS

MSCT angiography volume reconstruction for pelvic tumor feeding arteries of unknown origin is highly valuable for localization, qualitative diagnosis, and quantitative diagnosis of pelvic tumors.

MR imaging for acute lower abdominal and pelvic pain

Acute lower abdominal and pelvic pain is a frequent complaint of patients in the emergency room. Usually, the condition of these patients is assessed with computed tomography (CT) and ultrasonography (US). However, the need to reduce radiation doses of as much as 20 mSv at CT, especially in younger patients and possibly pregnant patients, and the operator dependence of US have led to an increased use of magnetic resonance (MR) imaging to assess those patients. MR imaging shows high accuracy in these patients and can be used to establish an accurate diagnosis quickly and reliably. A short imaging protocol of about 10 minutes, without the use of an intravenous contrast agent in most cases, allows investigation of these patients. The basic imaging protocol that localizes the diseased anatomic region needs to be complemented by focused anatomic imaging of the diseased area. Although MR imaging might not be the modality of choice for all patients, it may be beneficial for a subset of patients for whom CT is not warranted (pregnant patients or young patients) and US findings are inconclusive. In patients with acute abdominal and pelvic pain, the range of diseases and disorders that can be diagnosed with MR imaging is extremely broad. Therefore, MR imaging should be considered as an excellent imaging modality for the evaluation of these patients.