Sahin et al [19] proposed a noncontrast MRI score based on ADNEX and O-RADS models using morphologic assessment and DWI with an 84.9% sensitivity, 95.9% specificity, and 94% accuracy with the caveat of a population with a lower malignancy rate (15.1%) than the original ADNEX and O- RADS models population (18.8% and 18.4%). Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. Variant 8: Clinically suspected adnexal mass, no acute symptoms. Pregnant. Initial imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. CT Pelvis Without IV Contrast CT pelvis without IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. MRI Pelvis Without and With IV Contrast Gadolinium-based contrast agents should not be routinely administered to pregnant patients [95]. Free gadolinium is toxic and thus administered in its chelated form. Gadolinium has been shown to cross the placenta and enter fetal circulation in nonhuman primate models. It has potential but is unclear or has unknown risks of exposure to the developing fetus [95,96]. A study by Ray et al [97] in 2016 showed a slightly increased risk of stillbirth or neonatal death (17.6/1,000 in exposed fetuses versus 6.9/1,000 in fetuses not undergoing MRI) and a slightly increased risk of childhood rheumatological, inflammatory, or infiltrative skin conditions.
Clinically Suspected Adnexal Mass No Acute Symptoms. Sahin et al [19] proposed a noncontrast MRI score based on ADNEX and O-RADS models using morphologic assessment and DWI with an 84.9% sensitivity, 95.9% specificity, and 94% accuracy with the caveat of a population with a lower malignancy rate (15.1%) than the original ADNEX and O- RADS models population (18.8% and 18.4%). Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. Variant 8: Clinically suspected adnexal mass, no acute symptoms. Pregnant. Initial imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. CT Pelvis Without IV Contrast CT pelvis without IV contrast has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has no role in the initial evaluation for an adnexal lesion and should be avoided in pregnant patients due to radiation dose. MRI Pelvis Without and With IV Contrast Gadolinium-based contrast agents should not be routinely administered to pregnant patients [95]. Free gadolinium is toxic and thus administered in its chelated form. Gadolinium has been shown to cross the placenta and enter fetal circulation in nonhuman primate models. It has potential but is unclear or has unknown risks of exposure to the developing fetus [95,96]. A study by Ray et al [97] in 2016 showed a slightly increased risk of stillbirth or neonatal death (17.6/1,000 in exposed fetuses versus 6.9/1,000 in fetuses not undergoing MRI) and a slightly increased risk of childhood rheumatological, inflammatory, or infiltrative skin conditions.