![]() ![]() CT may occasionally be helpful if a gastrointestinal origin of an adnexal mass is suspected or to search for a primary neoplasm when ovarian metastases are suspected. Although computed tomography (CT) is helpful in staging of patients with known or suspected ovarian malignancy, it does not usually have a significant role in the characterization of adnexal masses. In a small minority of patients, additional pelvic imaging with MRI may be helpful when ultrasound fails to clarify the origin of an adnexal mass, when the sonographic features are indeterminate, or when an adnexal mass is inadequately imaged with ultrasound (such as in an obese patient or in one who cannot undergo or declines transvaginal scanning). Standardized terminology and reporting have been suggested for ovarian masses neither has been widely adopted at this time, but both may be further developed in the future. For masses with indeterminate sonographic findings, management will vary depending upon the clinical circumstances, but options would typically include follow-up sonography, MRI, or surgical evaluation. If a mass has characteristic malignant findings, imaging for characterization or diagnosis is also typically complete, though further evaluation for staging may be needed. When an adnexal mass has one of the classic benign appearances (to be discussed in this chapter), characterization is complete, although some may warrant sonographic follow-up. Detailed sonographic evaluation can prompt referral to gynecologic oncologists for management of adnexal masses that are likely to be malignant. Appropriate sonographic characterization of adnexal masses may help prevent unnecessary follow-up imaging along with its attendant patient anxiety and unnecessary surgery as well as its attendant risks. Thus, it is essential to recognize these common benign ovarian masses as frequently as possible and not mistake them for ovarian malignancy. Although accurate and timely identification of ovarian malignancy is extremely important, most adnexal masses are benign and most have a typical sonographic appearance. However, subjective assessment has been shown to perform as well or better than mathematical scoring systems. Scoring systems have been used to characterize ovarian and other adnexal masses sonographically, and they perform reasonably well. In most patients, sonography is adequate to evaluate an ovarian mass. Its high sensitivity and specificity for ovarian malignancy, lack of ionizing radiation, relatively low cost, and wide availability make it an ideal method for evaluation of the ovary. Pelvic sonography, including transvaginal scanning, is the preferred initial imaging modality for evaluation of a suspected ovarian or other adnexal mass. The occasional indeterminate appearing ovarian mass can be managed variably by repeat sonography, magnetic resonance imaging (MRI), or surgical evaluation. ![]() Many simple and hemorrhagic cysts do not need sonographic follow-up in asymptomatic patients.īefore diagnosing a simple ovarian cyst, it is important to search carefully for small nodules along the wall.Ī solid area with flow on Doppler imaging is the most important morphologic characteristic of an ovarian mass that raises concern for malignancy. Most ovarian masses are benign and have a typical sonographic appearance that allows accurate diagnosis. A simple cyst less than 3 cm in the ovary of a premenopausal patient is best termed a follicle and is a normal finding.Ī simple cyst less than 1 cm in the ovary of a postmenopausal patient is considered inconsequential.
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