MRI Pelvis Without IV Contrast If MRI is being used for follow-up of a benign lesion, IV contrast is recommended to evaluate for any developing enhancing component. 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]. A recent study evaluating the usefulness of noncontrast MRI in 350 lesions in a population with 15% malignancies and demonstrated a sensitivity of 85%, specificity of 96%, and accuracy of 94.2% to detect cancer [19]. 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 US can accurately diagnose benign adnexal lesions including simple cysts, hemorrhagic cysts, endometriomas, and dermoids as well as extraovarian cystic lesions such as parovarian cysts, hydrosalpinx, and peritoneal inclusion cysts. Adnexal lesions that can be adequately assessed and characterized on US may be followed-up with US. The vast majority of simple cysts in premenopausal patients are functional cysts, which will wax and wane over time or resolve, with a small portion reflecting benign neoplasms. A large body of evidence including several large recent studies has shown that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer [35,47-49].
Clinically Suspected Adnexal Mass No Acute Symptoms. MRI Pelvis Without IV Contrast If MRI is being used for follow-up of a benign lesion, IV contrast is recommended to evaluate for any developing enhancing component. 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]. A recent study evaluating the usefulness of noncontrast MRI in 350 lesions in a population with 15% malignancies and demonstrated a sensitivity of 85%, specificity of 96%, and accuracy of 94.2% to detect cancer [19]. 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 US can accurately diagnose benign adnexal lesions including simple cysts, hemorrhagic cysts, endometriomas, and dermoids as well as extraovarian cystic lesions such as parovarian cysts, hydrosalpinx, and peritoneal inclusion cysts. Adnexal lesions that can be adequately assessed and characterized on US may be followed-up with US. The vast majority of simple cysts in premenopausal patients are functional cysts, which will wax and wane over time or resolve, with a small portion reflecting benign neoplasms. A large body of evidence including several large recent studies has shown that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer [35,47-49].