Suspected classic lesions (cysts, endometriomas, dermoid) >10 cm, which are suboptimally seen on US due to size, can be confirmed as almost certainly benign, which may alter further imaging follow-up intervals [17]. 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]. 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. 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. US Pelvis Transabdominal and US Pelvis Transvaginal Indeterminate lesions are typically benign. In a multicenter prospective study of 303 indeterminate adnexal cysts, the incidence of malignancy was 3.6% [61].
Clinically Suspected Adnexal Mass No Acute Symptoms. Suspected classic lesions (cysts, endometriomas, dermoid) >10 cm, which are suboptimally seen on US due to size, can be confirmed as almost certainly benign, which may alter further imaging follow-up intervals [17]. 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]. 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. 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. US Pelvis Transabdominal and US Pelvis Transvaginal Indeterminate lesions are typically benign. In a multicenter prospective study of 303 indeterminate adnexal cysts, the incidence of malignancy was 3.6% [61].