title: ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update.
abstract: An update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm2) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W-preferably DCE MRI-is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign.
  
  
  CONCLUSIONS
  • MRI is a useful complementary imaging technique for assessing sonographically indeterminate masses. • Categorization allows confident diagnosis in the majority of adnexal masses. • Type 3 contrast enhancement curve is a strong indicator of malignancy. • In sonographically indeterminate masses, complementary MRI assists in triaging patient management.
authors: Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, A-5020, Salzburg, Austria. R.Forstner@salk.at.
authors: Rosemarie
authors: R
authors: Forstner
authors: Sorbonne Universités, UPMC Univ. Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Radiologie, 54 avenue Gambetta, 75020, Paris, France.
authors: Isabelle
authors: I
authors: Thomassin-Naggara
authors: Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisboa, Portugal.
authors: Teresa Margarida
authors: TM
authors: Cunha
authors: Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, CH 1224, Chêne-Bougeries, Switzerland.
authors: Karen
authors: K
authors: Kinkel
authors: Radiology Department, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy.
authors: Gabriele
authors: G
authors: Masselli
authors: Institut of Radiology, Departement of Medical Services, Kantonsspital Baden, Im Ergel, CH-5404, Baden, Switzerland.
authors: Rahel
authors: R
authors: Kubik-Huch
authors: Department of Radiology, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
authors: John A
authors: JA
authors: Spencer
authors: Consultant Radiologist, The Royal Marsden Hospital NHS Foundation Trust, London, UK.|Visiting Professor, Imperial College, London, UK.
authors: Andrea
authors: A
authors: Rockall
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D017410:Practice Guidelines as Topic; D014463:Ultrasonography
keywords: Diagnostic imaging; Magnetic resonance imaging; Ovarian cancer; Ovarian neoplasm; Recommendations