CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up. FDG-PET/CT Skull Base to Mid-Thigh There is no role for the use of FDG-PET/CT in the follow-up of benign adnexal masses in postmenopausal patients. MRI Pelvis Without and With IV Contrast Although MRI can accurately characterize these benign lesions, it is not the first-line imaging modality [16,17]. If a known lesion requiring surveillance is unable to be followed via US, MRI would be the alternative imaging modality of choice for follow-up. Classical benign lesions such as simple cysts, endometriomas and dermoid, and extraovarian benign lesions have characteristic appearances on MRI and can be confidently diagnosed as almost certainly benign [17]. MRI Pelvis Without IV Contrast If MRI is being used for follow-up of a benign lesion, IV contrast is recommended to evaluate for any developing enhancing component. Contrast-enhanced MRI performs superiorly to both US and noncontrast MRI due to its ability to confirm the presence of internal enhancing soft tissue components [18]. A recent study evaluating the usefulness of noncontrast MRI in 350 lesions in a population with 15% malignancies demonstrated a sensitivity of 85%, specificity of 96%, and accuracy of 94.2% to detect cancer [19]. Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. US Duplex Doppler Pelvis Color or power Doppler should be included in the US examination of the pelvis. Color Duplex is used to evaluate vascularity of any developing solid component. US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated. The bladder should be full to provide the best acoustic window for evaluation.
Clinically Suspected Adnexal Mass No Acute Symptoms. CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up. FDG-PET/CT Skull Base to Mid-Thigh There is no role for the use of FDG-PET/CT in the follow-up of benign adnexal masses in postmenopausal patients. MRI Pelvis Without and With IV Contrast Although MRI can accurately characterize these benign lesions, it is not the first-line imaging modality [16,17]. If a known lesion requiring surveillance is unable to be followed via US, MRI would be the alternative imaging modality of choice for follow-up. Classical benign lesions such as simple cysts, endometriomas and dermoid, and extraovarian benign lesions have characteristic appearances on MRI and can be confidently diagnosed as almost certainly benign [17]. MRI Pelvis Without IV Contrast If MRI is being used for follow-up of a benign lesion, IV contrast is recommended to evaluate for any developing enhancing component. Contrast-enhanced MRI performs superiorly to both US and noncontrast MRI due to its ability to confirm the presence of internal enhancing soft tissue components [18]. A recent study evaluating the usefulness of noncontrast MRI in 350 lesions in a population with 15% malignancies demonstrated a sensitivity of 85%, specificity of 96%, and accuracy of 94.2% to detect cancer [19]. Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. US Duplex Doppler Pelvis Color or power Doppler should be included in the US examination of the pelvis. Color Duplex is used to evaluate vascularity of any developing solid component. US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated. The bladder should be full to provide the best acoustic window for evaluation.