title: Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions.
abstract: OBJECTIVE
  To determine the impact of MRI including DWI on therapeutic decision-making and costs in the work-up of patients with a indeterminate adnexal mass on ultrasound.
  
  
  METHODS
  Thirty-eight patients with indeterminate ovarian lesions scheduled for surgery were included in this prospective study. In a questionnaire, the surgeon characterised the lesions based on a morphological score and determined the surgical procedure. The assessment was re-evaluated knowing MR findings and correlated with the final diagnosis. A cost-benefit analysis of MRI was performed. The impact of including DWI in the MR protocol was assessed.
  
  
  RESULTS
  MRI provided major diagnostic information in 11/38 cases (28.9%) resulting in abstention from surgery in 5 cases; moderate additional information was recorded in 10/38 (26.3%) patients. Overall a net cost saving (3'676 EUR) was achieved. DWI did not show a significant difference between benign and malignant lesions. Teratomas yielded significantly lower mean ADC values (0.597 × 10(-3) mm(2)/s) compared with all other adnexal lesions (1.812 × 10(-3) mm(2)/s); the mean ADC values in endometrioma (1.387 × 10(-3) mm(2)/s) were significantly lower than in other cystic lesions (2.372 × 10(-3) mm(2)/s).
  
  
  CONCLUSIONS
  Inclusion of MRI in the diagnostic algorithm of the indeterminate adnexal mass allows better differentiation of ovarian lesions resulting in a change of therapeutic decision-making with net cost savings.
authors.affiliation: Department of Radiology, Kantonsspital Baden, CH-5404, Baden, Switzerland. bianka.chilla@ksb.ch
authors.forename: Bianka
authors.initials: B
authors.lastname: Chilla
authors.forename: Nik
authors.initials: N
authors.lastname: Hauser
authors.forename: Gad
authors.initials: G
authors.lastname: Singer
authors.forename: Mafalda
authors.initials: M
authors.lastname: Trippel
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Froehlich
authors.forename: Rahel A
authors.initials: RA
authors.lastname: Kubik-Huch
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000191:economics*; D013557:Switzerland; D016896:Treatment Outcome; D014463:Ultrasonography / Q000191:economics*