الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diagnostic modalities that allow accurate characterization of indeterminate adnexal lesions reduce the unnecessary surgery in benign masses and help to determine surgical and chemotherapeutic planning in malignant lesions.
Although ultrasound is excellent at characterizing lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoids, and for identifying vascular solid tissue within malignant lesions however, approximately 20% of lesions are incompletely characterized after ultrasound evaluation.
An adnexal mass is defined as sonographically indeterminate: when it cannot be exactly placed into either the benign or malignant category even after Doppler assessment, or when the site of origin from the ovary, uterus or another pelvic structure, remains to be established theses Indeterminate adnexal lesions which cannot be classified as benign or malignant pose a dilemma for radiologists and clinicians.
Secondary assessment with MR imaging has demonstrated a highly accurate characterization of adnexal lesions and in excluding ovarian cancer.
The aim of our work was to assess the ability of MRI to characterize sonographically indeterminate adnexal masses.
Our study included twenty six patients with indeterminate adnexal lesions, nineteen patients had a final imaging diagnosis of ovarian lesions in (73.1 %) including: three patients had non neoplastic ovarian pathologies (11.5%), six patients had benign ovarian neoplasms (23%), four patients with borderline ovarian neoplasms (15.4%), and six patients with malignant ovarian neoplasms (19.2%).
Seven patients had extra ovarian pathologies (26.9%) including: two patients had fallopian tube pathologies (7.6%), one patient had broad ligament pathology (3.8%), one patient had uterine pathology (3.8%), and three patients had other extra-ovarian pathologies (11.5%) including paraovarian cyst and peritoneal inclusion cyst.
In our study the following algorithmic approach was done for characterization of indeterminate adnexal lesions and following sequences were applied:
For T1 hyper intense lesions :
T1 Fat sat sequence was done in all cases with T1 hyper intense lesions. It helped in diagnosis of cases of mature cystic teratoma effectively.
Susceptibility Weighted Imaging sequence (SWI) was done in all cases and helped in diagnosis of all cases of endometriomas .
For low / intermediate T2 solid lesions :
Diffusion weighted imaging sequence (DWI) was done in all patients with low/ intermediate T2 solid lesions. Benign ovarian neoplasms showed no restriction diffusion, while malignant ovarian neoplasms demonstrated restriction on DWI.
Contrast enhanced T1 weighted imaging sequence (CET1W imaging) was done in all cases. Benign ovarian neoplasms showed no appreciable enhancement. 2 cases of malignant ovarian neoplasms showed intense enhancement.
Dynamic contrast-enhanced magnetic resonance imaging sequence (DEC- MRI) was feasible in one case of solid malignant ovarian neoplasm and type 3 time intensity curve was demonstrated.