Interactive Transcript
0:01
All right, so now we've talked
0:02
about some of the more common and
0:04
some non-neoplastic ovarian masses.
0:07
So now we'll start to move a little bit
0:08
more along the spectrum of ovarian tumors.
0:11
So I have posted here the WHO
0:14
classification of ovarian tumors.
0:17
So you can see that there's quite a detailed
0:20
breakdown of origin of these tumors.
0:23
So epithelial, mesenchymal, sex cord,
0:25
stromal, germ cell, mesothelial, soft tissue,
0:31
lymphoid, and then secondary tumors as well.
0:33
So we're not going to go through all of these
0:35
today, but I will give you a few tips on what
0:38
to look for on MRI and what the role of MRI
0:42
is in diagnosis and staging of these tumors.
0:46
So one of the areas where MRI really has
0:48
a significant role is in the differential
0:50
diagnosis of low T2 signal ovarian masses.
0:54
So as we know, low T2 signal signifies a
0:57
few things, including hemorrhage, fibrosis,
1:01
calcification, and then a few other rare
1:04
things that can cause low T2 signal.
1:06
But for the purposes of this discussion, we're
1:08
kind of looking at hemorrhage or fibrosis.
1:10
So these are the masses that
1:12
would fit in that category.
1:14
So endometrioma we know causes low T2 shading.
1:17
It's typically not to the level of fibrosis,
1:20
but it does have some low T2 signal.1 00:00:01,340 --> 00:00:02,690 All right, so now we've talked
0:02
about some of the more common and
0:04
some non-neoplastic ovarian masses.
0:07
So now we'll start to move a little bit
0:08
more along the spectrum of ovarian tumors.
0:11
So I have posted here the WHO
0:14
classification of ovarian tumors.
0:17
So you can see that there's quite a detailed
0:20
breakdown of origin of these tumors.
0:23
So epithelial, mesenchymal, sex cord,
0:25
stromal, germ cell, mesothelial, soft tissue,
0:31
lymphoid, and then secondary tumors as well.
0:33
So we're not going to go through all of these
0:35
today, but I will give you a few tips on what
0:38
to look for on MRI and what the role of MRI
0:42
is in diagnosis and staging of these tumors.
0:46
So one of the areas where MRI really has
0:48
a significant role is in the differential
0:50
diagnosis of low T2 signal ovarian masses.
0:54
So as we know, low T2 signal signifies a
0:57
few things, including hemorrhage, fibrosis,
1:01
calcification, and then a few other rare
1:04
things that can cause low T2 signal.
1:06
But for the purposes of this discussion, we're
1:08
kind of looking at hemorrhage or fibrosis.
1:10
So these are the masses that
1:12
would fit in that category.
1:14
So endometrioma we know causes low T2 shading.
1:17
It's typically not to the level of fibrosis,
1:20
but it does have some low T2 signal.
1:22
Fibromas, fibrothecomas, and Brenner
1:25
tumors are all along that fibrous tumor
1:28
spectrum because they contain fibrosis.
1:32
Granulosa cell tumors can also have areas
1:34
of low T2 signal, but they're typically
1:36
more complex and heterogeneous, and
1:39
they may cause endometrial thickening
1:42
because of their hormonal secretion.
1:44
So that's another clue.
1:47
This is probably the most common low T2 signal
1:51
ovarian mass, and it's just an exophytic fibroid
1:55
that's projected into the right adnexa.
1:57
So if I give you this single MRI image,
2:00
we're not sure if this low T2 signal
2:03
mass is actually attached to the uterus and
2:05
projecting into the right adnexa or whether
2:08
it's arising from the right ovary itself.
2:11
So don't forget that exophytic
2:13
fibroids can be pseudomasses and can
2:16
mimic low T2 signal ovarian masses.
2:20
And as we talked about earlier, rarely
2:22
ovarian torsion can cause hemorrhage,
2:24
which can manifest as low T2 signal.
2:28
All right, so this is a patient who was from
2:30
our practice, 54 years old, who came to us with
2:34
a low T2 signal mass in the right adnexa.
2:37
So we've got T1-weighted images that show
2:39
that it's isointense to skeletal muscle, T2-
2:42
weighted images which show fairly low uniform
2:45
T2 signal, and then we've got pre- and post-
2:47
gadolinium images with fat saturation showing
2:50
fairly uniform enhancement on post-gad images.
2:54
So in this case, we'd have that similar
2:57
differential diagnosis with exophytic ovarian
3:01
fibroid or a fibrous ovarian lesion, and
3:04
this one turned out to be an ovarian fibroma.
3:07
Here's another case of a patient who
3:09
presented with a left adnexal mass this
3:12
time, and you can see that it's primarily
3:14
cystic on T1 and T2 images, but it's got
3:18
this low signal component within the lesion.
3:23
And it doesn't really show much enhancement, but
3:25
that's a little bit unusual for a simple cyst.
3:28
And this was an older patient, postmenopausal.
3:32
And this lesion actually turned
3:33
out to be a cystadenofibroma.
3:35
So I wanted to talk a little bit about that.
3:37
So this is a benign tumor with
3:39
epithelial and stromal elements, and it
3:42
tends to contain large cystic spaces.
3:45
It's rarely malignant.
3:47
But because of the solid component, which can
3:49
sometimes enhance, it can mimic a malignancy.
3:52
And interestingly, the solid
3:54
component is usually low T2
3:56
signal, similar to skeletal muscle.
3:59
And it might have small cystic locules
4:02
within that solid part, and that's
4:05
characteristic for cystadenofibroma, and
4:08
we call that a black sponge appearance.
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