Original Research Article
Year: 2020 | Month: July-September | Volume: 5 | Issue: 3 | Pages: 560-564
Role of Magnetic Resonance Imaging in Characterization of Female Adnexal Pathology
H.P Parekh1, Priyanka Singhal2, Pranav Shah3
1Professor and Head, Department of Radio Diagnosis, Shri MP Shah Medical College, Jamnagar, Gujarat, India.
23rd Year Resident, Department of Radio Diagnosis, Shri MP Shah Medical College, Jamnagar, Gujarat, India.
3Senior Resident, Department of Radio Diagnosis, Shri MP Shah Medical College, Jamnagar, Gujarat, India.
Corresponding Author: Priyanka Singhal
ABSTRACT
Adnexal lesions are very common in both pre- and post-menopausal women. Most of these lesions are benign (80%) with cystic, solid and mixed characteristics and have favorable diagnosis. The rest of (20 %) masses are malignant, so we need diagnostic means which permits accurate classified adnexal lesions before surgery and other treatment.
USG is the primary imaging modality for both detection and characterization of adnexal lesions because it is widely available and relatively inexpensive. However, there are some shortcomings with this modality, such as the limited field of view, obscuration of pelvic organs by the presence of bowel gas, and it is operator dependent.
Magnetic resonance imaging (MRI) offers high contrast resolution, provides good tissue characterization, it is becoming a useful tool for the evaluation and characterization of female adnexal lesions.
MRI has been shown to have a 91–93% overall accuracy for differentiating benign from malignant adnexal tumors.
This study aims to review the key differentiating MRI features of adnexal masses by correlating the MR appearances with the findings at histopathology.
In this prospective study, a total of 100 patients who were referred to department of radio diagnosis from department of obstetrics and gynecology with clinically suspected adnexal pathology were included in the study. Lesions were characterized based on their location, size, margins and appearance on T1, T2, STIR, T1-fat suppressed, and diffusion weighted imaging and apparent diffusion coefficient. MRI diagnoses were further correlated with histopathological nature of the pathology.
Among benign ovarian lesions most cases were of functional cysts (simple +hemorrhagic) and 2nd most common is dermoid cyst-(10), one of surprising cases of ovarian torsion (6) which are more common in younger patients particularly less than 18. Among the 22 lesions identified as malignant on MRI, 16 were of epithelial origin, 10 being serous cystadenoma and 5 being mucinous cystadenoma.
Among the 22 lesions diagnosed as malignant on mri, 21 lesions were identified as malignant on histopathology and 1 was designated as benign and among the 78 lesions diagnosed as benign on MRI 77 were confirmed to benign on histopathology and 1 was identified as malignant. Sensitivity of MRI in identification of malignant adnexal lesions was 95.45% and the specificity was 98.7% and positive predictive value was 95.45% and negative predictive value 98.7%.
Keywords: Adnexal lesions, MRI, Obstetrics and gynecology, Women’s health.