Simulated impact of pelvic MRI in treatment planning for pediatric adnexal masses.
BACKGROUND
There are no studies on utility of MRI in management of pediatric adnexal masses.


OBJECTIVE
To determine the diagnostic and therapeutic impact of pelvic MRI in adnexal masses in children and adolescents.


METHODS
We included 32 females age 18 years and younger who had adnexal masses and who underwent both pelvic ultrasound (US) and MRI. A radiologist retrospectively reviewed US and MR images and created a standard radiologic report for each patient. In a prospective theoretical fashion, two pediatric gynecologists reviewed the clinical data and US report for each patient and indicated conservative versus surgical management; in surgical cases the options were laparoscopy versus laparotomy, midline versus Pfannenstiel incision, and oophorectomy versus cystectomy. Subsequently, the gynecologists were presented the MRI report and were asked to indicate their treatment options again. A binomial test was conducted to determine the effect of adding MRI findings to the management plan.


RESULTS
The addition of MRI significantly changed management in 10 of 32 patients (P=0.0322), with a change in surgical versus conservative treatment in 5, a change in laparotomy vs. laparoscopy in 2, and a change from oophorectomy to cystectomy along with change in incision in 3 cases. This was based on additional information provided by MRI regarding the nature of the mass in 8 cases and origin of the mass in 2 cases.


CONCLUSIONS
Preoperative pelvic MRI findings might change the surgical management of pediatric patients with adnexal masses, so it is a valuable addition to the conventional workup in the clinical management.
Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
Alessandro
A
Marro
Department of Pediatric Gynecology, The Hospital for Sick Children, University Of Toronto, Toronto, ON, Canada.
Lisa M
LM
Allen
Department of Pediatric Gynecology, The Hospital for Sick Children, University Of Toronto, Toronto, ON, Canada.
Sari L
SL
Kives
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Rahim
R
Moineddin
Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada. drgovindchavhan@yahoo.com.
Govind B
GB
Chavhan
D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010347:Patient Care Planning; D011446:Prospective Studies; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods
D003287:Contrast Media
Adnexal mass; Children; Magnetic resonance imaging; Ovarian mass; Ultrasound