Discriminating between ovarian cancer and mimickers at MRI: a case-based approach
Number:28ESURABS0064
Type:Educational Electronic Presentation
Authors: Marianna Konidari, Lia Angela Moulopoulos, Charis Bourgioti
Keywords:ovarian cancer, MRI, ovarian mass, mimickers
SECTIONS
Educational objective
  • Learn the typical appearances of epithelial ovarian cancer (EOC) at MRI
  • Learn how other ovarian tumors and pelvic diseases that mimic EOC appear on imaging using a case-based approach
  • Get helpful tips at MRI that may narrow the differential diagnosis of pelvic masses
  • Become familiar with ovarian tumors that commonly appear in certain subgroups, including adolescents and pregnant women
Topic Review

Imaging plays a significant role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses.

 

The majority of malignant ovarian neoplasms in the adult, non-pregnant population are of the epithelial subtype.  High-grade serous cystadenocarcinoma (HGSC) is the most common one, accounting for 70% of epithelial ovarian cancer cases. Typically, HGSC manifests as bilateral, predominantly cystic masses with a variable amount of solid tissue which often demonstrates intense enhancement (i.e. Time Intensity Curve, TIC III: initial slope greater than myometrium, marked increase in signal intensity with a plateau) and restricted diffusion. It most commonly presents with advanced disease at the time of diagnosis, including peritoneal dissemination,...

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Fig 1. Axial T2W image (a) shows a multiloculated right ovarian cystic mass (black arrows) with large solid component (white arrow). The solid portion (white arrow) demonstrates high signal on axial 1200 b value DWI (b) and low signal on ADC map (c). DCE image analysis (d) demonstrates an intermediate-risk time intensity curve of the solid tissue (orange line: myometrium, blue line: solid tissue). Axial T2W image of the upper abdomen of the same patient (e) shows right paraaortic lymphadenopathy (white arrow). Also shown is a large peritoneal implant in the pelvis (asterisk in a, b). Diagnostic laparoscopy was performed and histology showed a high grade serous cystadenocarcinoma with peritoneal implants and metastatic lymphadenopathy.
Fig 2. Axial T2W image (a) shows a multiloculated, predominantly cystic mass in the left ovary (white arrows) with solid tissue (asterisks) showing avid enhancement on the T1W fat-suppressed contrast enhanced image (b, arrows). Surgicopathological examination was consistent with a low grade serous cystadenocarcinoma.
Conclusions

Accurate differential diagnosis of suspicious pelvic masses based on MRI is crucial since it largely affects the clinical management.

Radiologists should be familiar with appearances of ovarian cancer as well as other pelvic diseases that can act as mimickers and be able to confidently establish the site of origin and provide the most likely diagnosis.

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