In a systematic review of the literature on abdominal wall endometriosis, the authors concluded that the overall quality of evidence is poor with no prospective studies; however, US or MRI can assist with localization and aid in surgical planning [39]. US has several limitations. It can be less specific than other imaging modalities for characterizing masses [31]. US visibility of the abdominal wall is usually possible with few limitations. However, US may not provide details of deeper structures and relationship of masses to anatomic fascial planes. US also has advantages; it has the benefit of real-time imaging, such as assessing dynamic changes like Valsalva maneuvers, when evaluating for hernias. US is considered highly useful for real-time guidance for biopsy, but percutaneous biopsy should be considered carefully and in conjunction with oncologic specialist when a sarcoma is suspected [30]. MRI Abdomen There is little recent literature on the diagnostic accuracy of MRI for abdominal wall mass evaluation. MRI acquired without and with IV contrast is recognized as a useful modality to further narrow the differential diagnosis of detected masses, because of its high soft-tissue contrast resolution, ability to differentiate fat and enhancement within structures, and sequences that identify iron and blood products that may aid in differential considerations, such as endometriosis or extramedullary hematopoiesis [10,35]. MRI acquired without and with IV contrast can depict specific imaging features for many entities, including endometriosis, simple lipomas, epidermoid cysts, desmoid tumors, and hematomas [38]. MRI acquired without IV contrast may also still depict soft-tissue structures and define anatomy/pathology. MRI may be a useful second-line examination, often recommended if a malignant or indeterminate mass is detected on US [29,30]. In a series of 126 consecutive cases
Palpable Abdominal Mass Suspected Neoplasm. In a systematic review of the literature on abdominal wall endometriosis, the authors concluded that the overall quality of evidence is poor with no prospective studies; however, US or MRI can assist with localization and aid in surgical planning [39]. US has several limitations. It can be less specific than other imaging modalities for characterizing masses [31]. US visibility of the abdominal wall is usually possible with few limitations. However, US may not provide details of deeper structures and relationship of masses to anatomic fascial planes. US also has advantages; it has the benefit of real-time imaging, such as assessing dynamic changes like Valsalva maneuvers, when evaluating for hernias. US is considered highly useful for real-time guidance for biopsy, but percutaneous biopsy should be considered carefully and in conjunction with oncologic specialist when a sarcoma is suspected [30]. MRI Abdomen There is little recent literature on the diagnostic accuracy of MRI for abdominal wall mass evaluation. MRI acquired without and with IV contrast is recognized as a useful modality to further narrow the differential diagnosis of detected masses, because of its high soft-tissue contrast resolution, ability to differentiate fat and enhancement within structures, and sequences that identify iron and blood products that may aid in differential considerations, such as endometriosis or extramedullary hematopoiesis [10,35]. MRI acquired without and with IV contrast can depict specific imaging features for many entities, including endometriosis, simple lipomas, epidermoid cysts, desmoid tumors, and hematomas [38]. MRI acquired without IV contrast may also still depict soft-tissue structures and define anatomy/pathology. MRI may be a useful second-line examination, often recommended if a malignant or indeterminate mass is detected on US [29,30]. In a series of 126 consecutive cases