When a lesion has sonographic features worrisome for malignancy, the PPV of cancer ranges from 29% to 50% [23,45,55,61,62]. For example, in a prospective multicenter study of 970 lesions, solid component with blood flow had a 32% frequency of malignancy and up to 50% in women >60 years of age [55]. Contrast-enhanced MRI can be used to increase the specificity for malignancy, which may aid in surgical decision making and preoperative planning [17,71,73]. The presence or absence of enhancing solid tissue and enhancement Clinically Suspected Adnexal Mass curve characteristics as evaluated on perfusion dynamic contrast-enhanced imaging drives the risk of malignancy on MRI [17,69,71,74-80]. Solid components with TIC with rapid enhancement greater than the myometrium (type 3) are only found in invasive malignant tumors with a sensitivity of 67% versus slow low level enhancement (type 1) found in benign tumors with a sensitively of 70% and specificity of 89% [79]. Evaluation with TIC performs better than visual assessment with respective sensitivities of 96% and 76% in detection of borderline and invasive tumors in a set of 320 lesions [94]. 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. When a lesion has sonographic features worrisome for malignancy, the PPV of cancer ranges from 29% to 50% [23,45,55,61,62]. For example, in a prospective multicenter study of 970 lesions, solid component with blood flow had a 32% frequency of malignancy and up to 50% in women >60 years of age [55]. Contrast-enhanced MRI can be used to increase the specificity for malignancy, which may aid in surgical decision making and preoperative planning [17,71,73]. The presence or absence of enhancing solid tissue and enhancement Clinically Suspected Adnexal Mass curve characteristics as evaluated on perfusion dynamic contrast-enhanced imaging drives the risk of malignancy on MRI [17,69,71,74-80]. Solid components with TIC with rapid enhancement greater than the myometrium (type 3) are only found in invasive malignant tumors with a sensitivity of 67% versus slow low level enhancement (type 1) found in benign tumors with a sensitively of 70% and specificity of 89% [79]. Evaluation with TIC performs better than visual assessment with respective sensitivities of 96% and 76% in detection of borderline and invasive tumors in a set of 320 lesions [94]. 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].