The differential diagnosis for adnexal masses is wide, encompassing a range of benign, borderline, and malignant entities. The majority of adnexal masses are benign, but identifying malignant lesions is of paramount importance. Risk stratification is based on age, menopausal status, imaging features, and tumor markers. Imaging evaluation should be used in combination with the patient’s age, menopausal status, history, clinical examination, and tumor markers [i.e., cancer antigen 125 (CA 125)] in order to derive an appropriate differential diagnosis. However, diagnosis may ultimately depend on histological confirmation. Magnetic resonance imaging (MRI) is an adjunct to ultrasound (US) in characterizing adnexal masses, with well-established imaging criteria for malignant ovarian tumors.


High Signal Intensity Dermoid Cyst Adnexal Mass Serous Cystadenoma Intermediate Signal Intensity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Levine D, Brown DL, Andreotti RF et al (2010) Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 256:943–954.PubMedCrossRefGoogle Scholar
  2. 2.
    Timmerman D, Ameye L, Fischerova D et al (2010) Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ 341:c6839.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Timmerman D, Valentin L, Bourne TH et al; International Ovarian Tumor Analysis (IOTA) Group (2000) Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 16:500–505. Review.Google Scholar
  4. 4.
    Buy JN, Ghossain MA, Hugol D et al (1996) Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone. AJR Am J Roentgenol 166:385–393.PubMedCrossRefGoogle Scholar
  5. 5.
    Caruso A, Caforio L, Testa AC et al (1996) Transvaginal color Doppler ultrasonography in the presurgical characterization of adnexal masses. Gynecol Oncol 63:184–191.PubMedCrossRefGoogle Scholar
  6. 6.
    Carter JR, Lau M, Fowler JM et al (1995) Blood flow characteristics of ovarian tumors: implications for ovarian cancer screening. Am J Obstet Gynecol 172:901–907.PubMedCrossRefGoogle Scholar
  7. 7.
    Guerriero S, Ajossa S, Risalvato A et al (1998) Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses. Ultrasound Obstet Gynecol 11:277–282.PubMedCrossRefGoogle Scholar
  8. 8.
    Yamashita Y, Torashima M, Hatanaka Y et al (1995) Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging. Radiology 194:557–565.PubMedCrossRefGoogle Scholar
  9. 9.
    Komatsu T, Konishi I, Mandai M et al (1996) Adnexal masses: transvaginal US and gadolinium-enhanced MR imaging assessment of intratumoral structure. Radiology 198:109–115.PubMedCrossRefGoogle Scholar
  10. 10.
    Hata K, Hata T, Manabe A et al (1992) A critical evaluation of transvaginal Doppler studies, transvaginal sonography, magnetic resonance imaging, and CA 125 in detecting ovarian cancer. Obstet Gynecol 80:922–926.PubMedGoogle Scholar
  11. 11.
    Yamashita Y, Hatanaka Y, Torashima M et al (1997) Characterization of sonographically indeterminate ovarian tumors with MR imaging: a logistic regression analysis. Acta Radiol 38:572–577.PubMedGoogle Scholar
  12. 12.
    Buist MR, Golding RP, Burger CW et al (1994) Comparative evaluation of diagnostic methods in ovarian carcinoma with emphasis on CT and MRI. Gynecol Oncol 52:191–198.PubMedCrossRefGoogle Scholar
  13. 13.
    Grab D, Flock F, Stohr I et al (2000) Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 77:454–459.PubMedCrossRefGoogle Scholar
  14. 14.
    Hricak H, Chen M, Coakley FV et al (2000) Complex adnexal masses: detection and characterization with MR imaging—multivariate analysis. Radiology 214:39–46.PubMedCrossRefGoogle Scholar
  15. 15.
    Huber S, Medl M, Baumann L et al (2002) Value of ultrasound and magnetic resonance imaging in the preoperative evaluation of suspected ovarian masses. Anticancer Res 22:2501–2507.PubMedGoogle Scholar
  16. 16.
    Jain KA, Friedman DL, Pettinger TW et al (1993) Adnexal masses: comparison of specificity of endovaginal US and pelvic MR imaging. Radiology 186:697–704.PubMedCrossRefGoogle Scholar
  17. 17.
    Sohaib SA, Mills TD, Sahdev A et al (2005) The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 60:340–348.PubMedCrossRefGoogle Scholar
  18. 18.
    Kurtz AB, Tsimikas JV, Tempany CM et al (1999) Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis—report of the Radiology Diagnostic Oncology Group. Radiology 212:19–27.PubMedCrossRefGoogle Scholar
  19. 19.
    Thomassin-Naggara I, Darai E, Cuenod CA et al (2008) Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors. J Magn Reson Imaging 28:111–120.PubMedCrossRefGoogle Scholar
  20. 20.
    Thomassin-Naggara I, Bazot M, Darai E (2008) Epithelial ovarian tumors: value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis. Radiology 248:148–159.PubMedCrossRefGoogle Scholar
  21. 21.
    Thomassin-Naggara I, Aubert E, Rockall A et al (2013) Adnexal masses: development and preliminary validation of an MR imaging scoring system. Radiology 267:432–443.PubMedCrossRefGoogle Scholar
  22. 22.
    Fujii S, Kakite S, Nishihara K (2008) Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging 28:1149–1156.PubMedCrossRefGoogle Scholar
  23. 23.
    Bernardin L, Dilks P, Liyanage S (2012) Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation. Eur Radiol 22:880–890.PubMedCrossRefGoogle Scholar
  24. 24.
    Thomassin-Naggara I, Aubert E, Rockall A et al (2013) Adnexal Masses: Development and Preliminary Validation of an MR Imaging Scoring System. Radiology 267:432–443.PubMedCrossRefGoogle Scholar
  25. 25.
    Spencer JA, Forstner R, Cunha TM, Kinkel K; ESUR Female Imaging Sub-Committee (2010) ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach. Eur Radiol 20:25–35.PubMedCrossRefGoogle Scholar
  26. 26.
    Forstner R, Sala E, Kinkel K, Spencer JA (2010) ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol 20:2773–2780.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Evis Sala
    • 1
  • Andrea Rockall
    • 2
  1. 1.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of RadiologyImperial College Healthcare NHS TrustLondonUK

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