title: Magnetic resonance imaging features of massive ovarian edema in pregnancy: utility for decisions in expectant management.
abstract: BACKGROUND
  Massive ovarian edema (MOE) is a rare disease and few reports have described the magnetic resonance (MR) imaging manifestations in pregnancy.
  
  
  METHODS
  We report here a case of MOE in a patient at 12 weeks' gestation. Abdominal T2-weighted MR images showed asymmetric ovarian enlargement in a teardrop configuration, hyperintense peripherally displaced follicles, and twisting of the vascular pedicle between the enlarged ovary and uterus. The diagnosis of MOE due to ovarian torsion was confirmed by exploratory laparotomy. Preoperative imaging, especially the MR imaging could distinguish MOE from other conditions and demonstrate the relations of adjunct organ, and allowed for untwisting during laparotomy with successful preservation of the ovary.
  
  
  RESULTS
  Ultrasonography is important in detecting, evaluating, and determining the malignant potential of adnexal masses in pregnancy, but its findings may be nonspecific and then MR may assist characterization. This case was tentatively diagnosed as typical MOE by preoperative imaging, but the shape and location of the hugely enlarged ovarian mass suggested torsion of the ovarian pedicle. In our case, the diagnosis was confirmed by exploratory laparotomy and the pedicle was successfully untwisted.
  
  
  CONCLUSIONS
  MR imaging proved useful for decisions on expectant management of MOE in pregnancy, and the patient's affected ovary could be preserved.
authors.affiliation: Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Gobara
authors.affiliation: Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshizako
authors.affiliation: Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Yoshida
authors.affiliation: Department of Radiology, Ohda Municipal Hospital, P.O. Box 00694-0063, 1428-3 Ohdacho, Ohda, Japan.
authors.forename: Naruhito
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Gynecology, Ohda Municipal Hospital, P.O. Box 00694-0063, 1428-3 Ohdacho, Ohda, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Makihara
authors.affiliation: Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kitagaki
keywords: Magnetic resonance imaging; Massive ovarian edema; Pregnancy