CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion. Clinically Suspected Adnexal Mass CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion. FDG-PET/CT Skull Base to Mid-Thigh PET/CT cannot reliability differentiate between benign and malignant adnexal lesions [63]. In premenopausal women, normal ovaries with late follicular or early luteal cysts can have mildly increased uptake [64]. Although maximum standardized update value (SUVmax) are higher in malignant tumors and low in benign lesions, there is no clear SUVmax cutoff value to differentiate the two [65]. Additionally, PET/CT cannot reliably differentiate between borderline tumors and benign lesions and has low uptake on clear cell and mucinous invasive adenocarcinoma subtypes [66,67]. Although PET-avid lesions in postmenopausal women are concerning for malignancy, its use to detect primary cancer is not recommended [68]. MRI Pelvis Without and With IV Contrast MRI is the most useful modality for further evaluation of the subset of lesions that remain indeterminate after sonographic evaluation [69]. A recent study assessing the SRU guidelines ability to risk stratify lesions demonstrated potential of MRI to decrease surgical evaluation for benign cysts by 89% [44]. MRI has an excellent accuracy of >90% for the diagnosis of malignancy [69-71]. MRI can accurately identify solid tissue from nonsolid tissue such as fat, blood, or debris that may appear solid on initial US [72].
Clinically Suspected Adnexal Mass No Acute Symptoms. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion. Clinically Suspected Adnexal Mass CT Pelvis Without IV Contrast CT pelvis without IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion. FDG-PET/CT Skull Base to Mid-Thigh PET/CT cannot reliability differentiate between benign and malignant adnexal lesions [63]. In premenopausal women, normal ovaries with late follicular or early luteal cysts can have mildly increased uptake [64]. Although maximum standardized update value (SUVmax) are higher in malignant tumors and low in benign lesions, there is no clear SUVmax cutoff value to differentiate the two [65]. Additionally, PET/CT cannot reliably differentiate between borderline tumors and benign lesions and has low uptake on clear cell and mucinous invasive adenocarcinoma subtypes [66,67]. Although PET-avid lesions in postmenopausal women are concerning for malignancy, its use to detect primary cancer is not recommended [68]. MRI Pelvis Without and With IV Contrast MRI is the most useful modality for further evaluation of the subset of lesions that remain indeterminate after sonographic evaluation [69]. A recent study assessing the SRU guidelines ability to risk stratify lesions demonstrated potential of MRI to decrease surgical evaluation for benign cysts by 89% [44]. MRI has an excellent accuracy of >90% for the diagnosis of malignancy [69-71]. MRI can accurately identify solid tissue from nonsolid tissue such as fat, blood, or debris that may appear solid on initial US [72].