US Pelvis Transabdominal Although the most useful modality for the evaluation of adnexal masses is combined transabdominal and transvaginal pelvis US, a sole transabdominal approach is reasonable and may be the best option for the assessment of adnexal lesions late in gestation when the ovaries are displaced higher in the pelvis. US-based ovarian scoring systems have been applied to adnexal lesions in pregnant patients in a limited fashion in a few small studies. Czekierdowski et al [112] compared subjective assessment, Simple Rules Risk, and ADNEX models and found that subjective assessment performed best in a small study of 36 patients. Another larger study by Lee et al [113] with 236 women compared IOTA ADNEX and Sassone and Lerner systems, with the Sassone system or a combined model using 6 features that were found to be significant in their study performing the best. Clinically Suspected Adnexal Mass US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 9: Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Pregnant. Next imaging study for characterization. CT Pelvis With IV Contrast CT pelvis with IV contrast has no role in the further characterization for an indeterminate 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 further characterization for an indeterminate 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 further characterization for an indeterminate adnexal lesion and should be avoided in pregnant patients due to radiation dose.
Clinically Suspected Adnexal Mass No Acute Symptoms. US Pelvis Transabdominal Although the most useful modality for the evaluation of adnexal masses is combined transabdominal and transvaginal pelvis US, a sole transabdominal approach is reasonable and may be the best option for the assessment of adnexal lesions late in gestation when the ovaries are displaced higher in the pelvis. US-based ovarian scoring systems have been applied to adnexal lesions in pregnant patients in a limited fashion in a few small studies. Czekierdowski et al [112] compared subjective assessment, Simple Rules Risk, and ADNEX models and found that subjective assessment performed best in a small study of 36 patients. Another larger study by Lee et al [113] with 236 women compared IOTA ADNEX and Sassone and Lerner systems, with the Sassone system or a combined model using 6 features that were found to be significant in their study performing the best. Clinically Suspected Adnexal Mass US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 9: Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Pregnant. Next imaging study for characterization. CT Pelvis With IV Contrast CT pelvis with IV contrast has no role in the further characterization for an indeterminate 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 further characterization for an indeterminate 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 further characterization for an indeterminate adnexal lesion and should be avoided in pregnant patients due to radiation dose.