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PubMedDate not supplied

MR imaging of hemorrhagic adnexal masses.

Magnetic resonance (MR) imaging, performed on 31 women with 40 surgically proven adnexal masses, was reviewed to determine whether MR can distinguish hemorrhagic from nonhemorrhagic masses. Fourteen masses proved to be hemorrhagic at surgery including functional ovarian cysts (seven cases), cystadenoma (one case), endometriomas (three cases), hematosalpinx (one case), ectopic pregnancy (one case), and parametrial extension from cervical carcinoma (one case). A high signal intensity (compared with adjacent pelvic fat) on a T1-weighted spin echo sequence was found to be a reliable indicator of hemorrhage and was demonstrated in all 14 hemorrhagic masses. The "hematocrit" effect was seen as an area of high signal intensity layering in the dependent portion of six hemorrhagic cysts. Only four of 26 nonhemorrhagic masses demonstrated high signal intensity on T1-weighted sequences and, of these, three proved to be fat-containing dermoid cysts and one was a simple cyst with adherent mesenteric fat. We conclude that high signal intensity on a T1-weighted spin echo pulse sequence is evidence for a hemorrhagic mass and that a hematocrit effect appears to be a specific sign for a hemorrhagic cyst. The clinical significance of hemorrhagic adnexal masses is discussed.

Adnexal Diseases↗
PubMedDate not supplied

Gadolinium-DOTA enhanced MR imaging of adnexal tumors.

We conducted a retrospective study to assess the potential of contrast enhanced magnetic resonance (MR) imaging in evaluating adnexal tumors. Sixty patients with a total of 77 pelvic lesions underwent MR imaging at 1.5 T and transabdominal ultrasound (US). Precontrast T1- and T2-weighted and Gd-DOTA enhanced T1-weighted MR images were obtained. Diagnoses were proved by surgery in 57 patients. Of the 77 lesions, 54 masses were of ovarian origin, including 12 malignant disorders. Ultrasound demonstrated the lesions in 92%, whereas the sensitivity of unenhanced T2-weighted and postcontrast MR images was 98 and 96%, respectively. Compared to the T2-weighted images, postcontrast MR imaging showed superior overall tumor delineation, assessment of intratumoral architecture, and definition of tumor origin. Contrast enhancement of tumors did not differ significantly between normal ovary and benign and malignant lesions. All modalities were unable to predict malignancy of complex lesions. Based on our study, US remains the screening modality of choice in the evaluation of adnexal tumors. Contrast enhanced MR imaging may be valuable for assessing complex lesions or when the origin of the mass cannot be determined by US. Using contrast enhanced T1-weighted images instead of T2-weighted images may lead to a significant reduction in acquisition time.

Adnexal Diseases↗
PubMedDate not supplied

PC-based multiparameter full-color display for tissue segmentation in MRI of adnexal masses.

OBJECTIVE: Our purpose was to apply full-color composite generation methods to multiparameter MRI to assess the ability of the technique to quantitatively segment clinically important anatomic and pathologic tissues. MATERIALS AND METHODS: With use of a personal computer with a 386 microprocessor and full-color (24 bit) graphics display capabilities, custom and commercially available image-processing softwares were applied to spatially aligned multiparameter SE MR image sets obtained from six patients undergoing diagnostic work-up for suspected adnexal or pelvic masses to generate intensity-based color composites. To quantitatively assess the ability of this technique to differentially segment anatomically and pathologically confirmed tissue types into unique color regions within the full-color spectrum, color image analysis was performed on the multiparameter color composites within each patient case, and the results were compared using 95% confidence intervals. RESULTS: Based on the results of pathologic correlation and color image analysis, the generation of full-color composites represents a feasible technique for compressing the diverse tissue contrast data present in multiparameter MR images of adnexal masses. CONCLUSION: With this technique, it is possible to generate composites that simultaneously display uniquely color-coded anatomic and pathologic tissue information within the context of partially natural-appearing images.

Adnexal Diseases↗
PubMed1986

Adnexal torsion: a mind-twisting diagnosis.

We have reviewed cases of adnexal torsion surgically managed at Scott and White Clinic during the past seven years, and have found that a high index of suspicion is the clinician's best tool in diagnosing adnexal torsion.

Adnexal Diseases↗
PubMed2005

Adnexal torsion in pediatric and adolescent girls.

PURPOSE OF REVIEW: This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function. RECENT FINDINGS: This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion. The role of oophoropexy in the pediatric and adolescent population is also reviewed. SUMMARY: The discussion reinforces the role of detorsion in lieu of oophorectomy or adnextomy in an effort to preserve reproductive capacity in a young population. Long-term follow-up, including reproductive outcomes, is needed to determine the role of oophoropexy.

Abdominal Pain↗
PubMed1975

Adnexal polyp of neonatal skin.

The adnexal polyp of neonatal skin is a small, usually solitary tumour of the skin occurring mostly on the areola of the nipple of the neonate. Our statistics reveal an incidence of 4-0% in 3,257 newborn infants. Histologically it always contains hair follicles, eccrine glands and vestigial sebaceous glands, hence the term 'adnexal polyp of neonatal skin' is proposed. No similar report has been hitherto recorded.

Adnexal Diseases↗
PubMed1999

Sonographic prediction of malignancy in adnexal masses using an artificial neural network.

OBJECTIVE: To generate a neural network algorithm which computes a probability of malignancy score for pre-operative discrimination between malignant and benign adnexal tumours. DESIGN: A retrospective analysis of previously collected data. Information from 75% of the study group was used to train an artificial neural network and the remainder was used for validation. SETTING: The Gynaecological Ultrasound Research Unit at King's College Hospital, London. POPULATION: Sixty-seven women with known adnexal mass who had been examined using transvaginal B-mode ultrasonography and colour Doppler imaging with pulse spectral analysis immediately before surgery. The excised masses were classified histologically as benign (n = 52) or malignant (n = 15), of which three were borderline. METHODS: The variables that were put into the artificial neural network were: age, menopausal status, maximum tumour diameter, tumour volume, locularity, the presence of papillary projections, the presence of random echogenicity, the presence of analysable blood flow velocity waveforms, the peak systolic velocity, time-averaged maximum velocity, the pulsatility index, and resistance index. Histological classification, categorised as benign or malignant, was the output result. RESULTS: A variant of the back propagation method was selected to train the network. The overall architecture of the network with the best performance contained an input layer with four variables (age, time-averaged maximum velocity, papillary projection score and maximum tumour diameter), a hidden layer with three units and an output layer with one. The sensitivity and specificity at the optimum diagnostic decision value for the artificial neural network output (0.45) were 100% (95% CI 78.2%-100%) and 98.1% (95% CI 89.5%-100%), respectively. These values were significantly better than those obtained from the independent use of the resistance index, pulsatility index, time-averaged maximum velocity or peak systolic velocity at their optimum decision values (P < 0.01). CONCLUSION: Artificial neural networks may be used on clinical and ultrasound derived end-points to accurately predict ovarian malignancy. There is a need for a prospective evaluation of this technique using a larger number of patients.

Adnexal Diseases↗
PubMedDate not supplied

Using logistic regression analysis in preliminary differential diagnosis of adnexal masses.

The aim of our study was to generate predictive model, which would allow to estimate the influence of analyzed parameters on predictive accuracy of differential diagnosis of adnexal masses and to evaluate prospectively diagnostic efficacy of the statistic model in the new set of patients. A total of 686 women diagnosed and surgically treated in the Gynecological and Obstetrical Teaching Hospital of University of Medical Sciences in Poznan, Poland, were recruited into the study. Preoperative diagnostics included gynecological examination, ultrasonographic evaluation, tumor Doppler blood flow analysis, and serum levels of CA125 and TPS. In order to find the best combination of features and to calculate the individual probability of the malignancy, stepwise logistic regression analysis with quasi-Newton estimation was applied. The essential part of the best prognostic model, described by foregoing variables, is as follows: [z = -6.005 + 0.058 x age + 1.174 x septa + 1.317 x tumor localization + 1.185 x ascites + 2.28 x solid element + 2.429 x vessels localization -2.386 x PI + 0.084 x MEDV]. The highest sensitivity and specificity for the obtained model were 87.84% and 93.74%, respectively. Prognostic model, constructed with the use of logistic regression analysis, is characterized by higher sensitivity and specificity than individually applied diagnostic tests. Prospective evaluation of this model application in a larger group of patients with adnexal masses will enable precise assessment of its objective clinical usefulness.

Adnexal Diseases↗
PubMed2001

Laparoscopic management of adnexal masses the opportunities and the risks.

Suspected ovarian neoplasm is a common clinical problem affecting women of all ages. Although the majority of adnexal masses are benign, the primary goal of diagnostic evaluation is the exclusion of malignancy. It has been estimated that approximately 5-10% of women in the United States will undergo a surgical procedure for a suspected ovarian neoplasm during their lifetime. Despite the magnitude of the problem, there is still considerable disagreement regarding the optimal surgical management of these lesions. Traditional management has relied on laparotomy to avoid undertreatment of a potentially malignant process. Advances in detection, diagnosis, and minimally invasive surgical techniques make it necessary now to review this practice in an effort to avoid unnecessary morbidity among patients. Here, we review the literature on the laparosopic approach to the treatment of the adnexal mass without sacrificing the principles of oncologic surgery. We highlight potentials of minimally invasive surgery and address the risks associated with the laparoscopic approach.

Biomarkers, Tumor↗
PubMed1992

Simple adnexal cysts: the natural history in postmenopausal women.

Transabdominal and transvaginal ultrasound (US) examinations were performed in 184 asymptomatic postmenopausal volunteers to determine prospectively (a) the frequency and natural history of simple adnexal cysts in healthy postmenopausal women and (b) the relationship between cyst activity and both hormone replacement and length of time since menopause. Eighty-three simple adnexal cysts were found in 52 women. Thirty-two of 184 women (17%) had 37 cysts identified at initial examination; 46 new cysts appeared in 31 women (11 of whom previously had cysts). Forty-nine women with 72 cysts were reevaluated with subsequent US scanning over a period of 3-23 months. Thirty-eight of the 72 cysts (53%) disappeared completely, 20 (28%) remained constant in size, eight (11%) enlarged by 3 mm or more, two (3%) decreased in size by 3 mm or more, and four (6%) both increased and decreased in size on repeated examinations. No statistical relationship was found between presence of cysts or cyst activity with respect to the type of hormone replacement or length of time since menopause.

Adnexal Diseases↗
PubMed1993

Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study.

To assess the performance of published criteria for differentiation of endometriomas from other hemorrhagic adnexal lesions with magnetic resonance (MR) imaging, 74 lesions with pathologic proof in 46 patients were evaluated by means of a 1.5-T system with use of conventional T1-weighted and either T2-weighted spin-echo (SE) or fast SE sequences. The MR images were independently presented to each of three blinded readers, and receiver operating characteristic (ROC) curve analysis was performed. The criterion of a cyst with high signal intensity on short repetition time (TR)/echo time (TE) images and shading on long TR/TE images had a mean sensitivity of 68%, mean specificity of 83%, and mean accuracy of 76% for diagnosis of endometrioma. Ancillary findings previously reported to be suggestive of endometrioma (eg, low-signal-intensity rims, adhesions, bowel tethering, and implants) were proved inaccurate and showed low interobserver agreement. ROC analysis showed similar area measurements among the three radiologists for diagnosis of endometrioma. MR imaging had only moderate accuracy in distinction of endometriomas from other hemorrhagic adnexal lesions.

Adnexal Diseases↗
PubMed1993

Adnexal masses: comparison of specificity of endovaginal US and pelvic MR imaging.

In a prospective study, 32 women with suspected pelvic masses at physical examination underwent both endovaginal ultrasound (US) and magnetic resonance (MR) imaging to compare their ability in diagnosis of adnexal masses. Criteria for the diagnosis of various types of adnexal masses with MR imaging and endovaginal US were prospectively defined, and the ability of either modality to allow a specific diagnosis was assessed. For each modality, measures of sensitivity, specificity, and accuracy were obtained. Results indicated higher diagnostic capability of endovaginal US for simple cysts (five of five), hemorrhagic cysts (eight of nine), endometriomas (nine of 14), and ovarian carcinomas (three of three). MR imaging demonstrated higher diagnostic capability for dermoids (three of three). MR imaging and endovaginal US showed equal diagnostic capability for pedunculated fibroids (two of two). For all masses, observers, and observations, the overall sensitivity of endovaginal US was 76% versus 49% for MR imaging, and the overall accuracy of endovaginal US was 83% versus 70% for MR imaging. The authors suggest that endovaginal US is a better modality than MR imaging for the assessment of suspected pelvic masses.

Adnexal Diseases↗
PubMed1994

Prospective evaluation of adnexal masses with endovaginal gray-scale and duplex and color Doppler US: correlation with pathologic findings.

PURPOSE: To assess the reliability of gray-scale and color and duplex Doppler ultrasound (US) in making a specific diagnosis of malignant ovarian tumor. MATERIALS AND METHODS: Forty-two women with 50 adnexal masses underwent endovaginal and color and duplex Doppler US. Morphologic characteristics were evaluated with endovaginal US, and flow velocity patterns were evaluated with color and duplex Doppler US. The results were compared with pathologic findings. RESULTS: At pathologic examination, 40 masses (80%) were benign, one (2%) was borderline malignant, and nine (18%) were malignant. Endovaginal US enabled correct diagnosis of 38 of the 40 benign masses (95%) and all nine malignant masses (100%). Color and duplex Doppler US enabled correct diagnosis of 33 benign masses (82%) and seven malignant masses (78%). CONCLUSION: Because there is an overlap in the resistive index (RI) values of benign and malignant masses, RI values alone cannot be relied on. Combining the detailed analysis of internal architectural appearance with the flow velocity patterns obtained at pulsed Doppler US increases the specificity in the diagnosis of adnexal masses.

Adnexal Diseases↗
PubMed1995

Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging.

PURPOSE: To determine the accuracy of transvaginal ultrasound (TVUS) and of precontrast and contrast material-enhanced magnetic resonance (MR) imaging in the differentiation of adnexal masses. MATERIALS AND METHODS: Five blinded readers analyzed images of 80 masses in 72 patients. MR and TVUS images were interpreted in separate sessions. Findings were confirmed at surgery or laparoscopy. RESULTS: Higher diagnostic accuracy was attained with MR imaging in mature cystic teratomas and endometriomas. However, better accuracy was achieved with contrast-enhanced MR imaging and TVUS in simple cysts, cystadenomas, and malignant tumors because internal details could be visualized. Receiver operating characteristic study indicated that observer confidence was significantly higher with contrast-enhanced MR imaging than with precontrast MR imaging (P = .011) or TVUS (P = .002) in the differentiation of benign and malignant masses. CONCLUSION: Contrast-enhanced MR imaging is superior to precontrast MR and TVUS imaging in the characterization and differentiation of adnexal masses.

Adnexal Diseases↗
PubMed2003

Adnexal torsion during pregnancy -- management and literature overview.

We present a patient in the 30th week of gestation with adnexal torsion, which was treated by laparotomy with oophorectomy. After 2 days, we had to perform a cesarean section because of bowel obstruction. We discuss the diagnosis and treatment of adnexal torsion in pregnancy and compare laparoscopic management with laparotomy. By reviewing the literature, we evaluate the conservative therapy by detorsion employing Doppler sonography.

Adnexal Diseases↗
PubMed1999

Female adnexal tumour of probable Wolffian origin: MR findings.

Female adnexal tumour of probable Wolffian origin is a rare tumour that arises from remnants of the Wolffian duct. Clinical and pathological findings of this tumour have been documented, but the MR findings have not been previously reported. We report the MRI features of an adnexal tumour of probable Wolffian origin.

Adenoma↗
PubMed2004

Adnexal torsion following gonadotropin-releasing hormone analog therapy: a case report.

Adnexal torsion may occur in girls and adolescents. Often it is associated with ovarian diseases resulting in ovarian enlargement. Adnexal torsion may involve the ovary, fallopian tube or both, and the main symptom is acute pelvic pain. An 8-year-old girl complaining of acute pelvic and abdominal pain, who was previously diagnosed with precocious puberty and who received treatment with a GnRH analog, is reported. Ultrasound demonstrated a normal-sized uterus and bilaterally enlarged ovaries with multiple internal cysts. At laparotomy, we found a complete torsion in the right adnexa. The histological examination revealed massive edema associated with multiple antral follicles and reduction of the follicular reserve.

Adnexal Diseases↗
PubMed2006

CT and MRI of adnexal masses in patients with primary nonovarian malignancy.

OBJECTIVE: The purpose of this pictorial essay is to review the differential considerations when an adnexal mass is detected on CT or MRI in a patient with a primary nonovarian malignancy. CONCLUSION: Such adnexal masses may be metastases to the ovaries, primary ovarian malignancy, or incidental benign disorders. Solid masses are more likely metastases, but metastases can be predominantly cystic and primary ovarian cancers can be solid. MRI may help characterize incidental benign entities such as endometriosis, fibroma, and peritoneal inclusion cysts.

Adnexal Diseases↗