title: Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review.
abstract: OBJECTIVE
  Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem because imaging features of benign and malignant overlap. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is accurate tissue characterization resulting in surgery only for lesions that are indeterminate or frankly malignant. This study aims to conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care.
  
  
  METHODS
  A comprehensive computerized systematic literature search of English language studies was performed (from 2002 to 2012) of PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were hand searched.
  
  
  RESULTS
  Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review.
  
  
  CONCLUSIONS
  MRI with intravenous (IV) contrast administration provides the highest post-test probability of ovarian cancer detection. However, the preponderant contribution of MRI in adnexal mass evaluation is its specificity because it provides confident diagnosis of many benign adnexal lesions.
authors.affiliation: 3(rd) Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, "Ippokrateio" General Hospital of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece. Electronic address: christos.anthoulakis@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Anthoulakis
authors.affiliation: 2(nd) Department of Surgery, General Hospital of Serres, 2(nd) Km Serres-Drama, 62100 Serres, Greece. Electronic address: niknikoloudis@yahoo.gr.
authors.forename: N
authors.initials: N
authors.lastname: Nikoloudis
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography
keywords: Adnexal lesions; Ovarian cancer; Pelvic MRI; Second test; Ultrasound-indeterminate