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 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 Although considered a separate examination in the ACR documentation, color and power Doppler evaluation is considered an integral part of the complete transabdominal and transvaginal sonographic assessment of an adnexal lesion. Doppler can help identify internal soft tissue with vascular flow within a suspected adnexal lesion that can help differentiate a malignancy from a solid-appearing component such as a clot or debris [20-22]. Optimal sonographic evaluation is achieved by using a combination of grayscale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas. Color Doppler characteristics, namely a color score of 1 to US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated. A full bladder provides a better acoustic window for the evaluation of pelvis/adnexa. US Pelvis Transabdominal and US Pelvis Transvaginal Transvaginal US is the most useful initial imaging modality in the assessment of adnexal pathology with a sensitivity >90%, and diagnostic performance is likely improved when undertaken by experienced operators [27,28]. It is widely accepted clinically as the initial imaging modality of choice [29-31].
Clinically Suspected Adnexal Mass No Acute Symptoms. 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 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 Although considered a separate examination in the ACR documentation, color and power Doppler evaluation is considered an integral part of the complete transabdominal and transvaginal sonographic assessment of an adnexal lesion. Doppler can help identify internal soft tissue with vascular flow within a suspected adnexal lesion that can help differentiate a malignancy from a solid-appearing component such as a clot or debris [20-22]. Optimal sonographic evaluation is achieved by using a combination of grayscale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas. Color Doppler characteristics, namely a color score of 1 to US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated. A full bladder provides a better acoustic window for the evaluation of pelvis/adnexa. US Pelvis Transabdominal and US Pelvis Transvaginal Transvaginal US is the most useful initial imaging modality in the assessment of adnexal pathology with a sensitivity >90%, and diagnostic performance is likely improved when undertaken by experienced operators [27,28]. It is widely accepted clinically as the initial imaging modality of choice [29-31].