Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful for follow-up of an indeterminate adnexal mass. Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. FDG-PET/CT Skull Base to Mid-Thigh There is no role for the use of FDG-PET/CT in the follow-up of indeterminate adnexal masses in postmenopausal patients. MRI Pelvis Without and With IV Contrast An indeterminate mass can be followed by contrast-enhanced MRI. This is helpful if the mass cannot be optimally visualized by US or if the mass shows suspicious change of appearance during US surveillance. Suspected ovarian thecoma-fibroma group tumors, typically classified as indeterminate based on US features can go on further imaging with MRI, with characteristics feature of T2 homogeneous hypointensity and low signal on DWI rendering the lesion almost certainly benign [17,88]. MRI Pelvis Without IV Contrast 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]. Both the ADNEX and O-RADS MRI risk stratification systems will have some decreased usefulness in the noncontrast setting given the limited ability to identify enhancing solid tissue and its enhancement pattern, both crucial for characterizing indeterminate lesions [17,71,73]. For example, the overall specificity for malignancy of the ADNEX MR system falls below 90% if used without dynamic contrast enhancement [71,87].
Clinically Suspected Adnexal Mass No Acute Symptoms. Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful for follow-up of an indeterminate adnexal mass. Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. FDG-PET/CT Skull Base to Mid-Thigh There is no role for the use of FDG-PET/CT in the follow-up of indeterminate adnexal masses in postmenopausal patients. MRI Pelvis Without and With IV Contrast An indeterminate mass can be followed by contrast-enhanced MRI. This is helpful if the mass cannot be optimally visualized by US or if the mass shows suspicious change of appearance during US surveillance. Suspected ovarian thecoma-fibroma group tumors, typically classified as indeterminate based on US features can go on further imaging with MRI, with characteristics feature of T2 homogeneous hypointensity and low signal on DWI rendering the lesion almost certainly benign [17,88]. MRI Pelvis Without IV Contrast 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]. Both the ADNEX and O-RADS MRI risk stratification systems will have some decreased usefulness in the noncontrast setting given the limited ability to identify enhancing solid tissue and its enhancement pattern, both crucial for characterizing indeterminate lesions [17,71,73]. For example, the overall specificity for malignancy of the ADNEX MR system falls below 90% if used without dynamic contrast enhancement [71,87].