Abed K. F., Jasim H. A.


Department of Radiology, College of Medicine, University of Babylon. Babylon, Iraq.


he ovarian masses represent a special challenge in the diagnosis if radiological imaging findings cannot be differentiated into benign or malignant. Ultrasonography (US) is useful as preoperative imaging while magnetic resonance imaging (MRI) is helpful in identifying the complex masses.

Purpose. The study aimed to determine specific criteria in the radiological differential diagnosis of ovarian masses in MRI and US.

Materials and methods. A prospective study of total of 62 women were enrolled in the research at a period from 22th October 2022 to 26th May 2023 at Department of Radiology. All the studied cases underwent trans abdominal US (Samsung HS50-abdominal and endo-vaginal US) and MRI (Philips N.V.2021 MRI unit 1.5 Tesla, SRN: 32534) examination.

Results. The mean age was 46.39±10.59 years. Most of ovarian masses sized more than 4 cm (71.0%). Solid component found in 32.3% of pelvic MRI. Out of 62 MRI, 43 (69.4%) showed enhancement by mass. Homogeneous masses accounted 31 (50.0%) whereas heterogeneous masses were (12, 19.4%). The ill-defined cystic masses found in 32.3% of MRI. Simple cyst was seen in 14.5% of cases. Internal cystic mass was scanned in 53.2%. Septal (wall) thickness was <3 mm in 83.9% and >3 mm in 16.1%. T1 was mostly hypointense in 77.4% of masses. T2 was mostly hyperintense in 88.7% of masses. Although, fat saturation observed as hyperintense in 35 (56.5%), single drop in 17 (27.4%), hypointense in 5 (8.1%) and isointense in 4 (6.5%). The fat saturation is considered as better indicator in distinguishing ovarian masses with high AUC=0.828, followed by T2 images (AUC=0.493). Kappa statistic of MRI finding versus US images revealed that detection of ovarian cyst by MRI had perfect agreement (k=0.968) than US (k=0.581) with significant difference (p=0.049).

Conclusions. Radiologists must make a judgment by using multiple MRI sequences. Most of ovarian masses observed by MRI are sized more than 4 cm, no solid component, homogeneous enhancement, ill-defined cystic, septal thickness <3 mm, without calcification, necrosis, LVI or peritoneal implantation. The characteristic features of MRI sequences are T1 hypointense, T2 hyperintense, fat saturation hyperintense and FLAIR hypointense. Fat saturation consider as better indicator in the distinguish of ovarian masses with high AUC=0.828. Statistically, the detection of ovarian masses by MRI had perfect agreement (k=0.968) than US (k=0.581).


Keywords: ovarian masses, fat saturation, MRI, ultrasonography.


Corresponding author: Abed K.F., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Abed K. F., Jasim H. A. Specific criteria in the radiological differential diagnosis of ovarian masses in MRI and ultrasound. REJR 2023; 13(3):110-130. DOI: 10.21569/2222-7415-2023-13-3-110-130.

Received:        12.07.23 Accepted:       02.08.23