Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign.
OBJECTIVE
To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions.


METHODS
This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated.


RESULTS
Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively.


CONCLUSIONS
The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas. Online supplemental material is available for this article.
From the Department of Radiology, University of California, Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817 (M.T.C., E.O.G., R.L., J.P.M.); and Department of Public Health Sciences, University of California-Davis, Davis, Calif (M.W.).
Michael T
MT
Corwin
Eugenio O
EO
Gerscovich
Ramit
R
Lamba
Machelle
M
Wilson
John P
JP
McGahan
D000291:Adnexal Diseases / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010048:Ovarian Cysts / Q000175:diagnosis*; D012189:Retrospective Studies