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Hello and welcome to Noon Conference hosted by MRI Online. Noon Conference

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was created when the pandemic hit as a way to connect the global

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MRI Online premium membership to get access to hundreds of case based micro

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learning courses across all key radiology subspecialties. Learn more at

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mrionline.com. Today we're honored to welcome Dr Satomi Kawamoto for a lecture

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on imaging of ovarian tumors with emphasis on differential diagnosis.

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Dr. Kawamoto is a professor of radiology, and radiological science at Johns

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Hopkins University School of Medicine. Her areas of expertise are computed

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tomography, ultrasound, and image guided interventional procedures. At the

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end of this lecture, join Dr. Kawamoto in a Q&A session where she

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will address questions you may have on today's topic.

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to as many as we can before our time is up.

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accurate. But that being said, we are ready to begin today's lecture.

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Dr. Kawamoto, please take it from here. Okay, so good afternoon everybody.

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I'm going to talk about imaging of ovarian tumors with emphasis on differential

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diagnosis. So, the ovarian tumors accounting for about 6% of female malignancies,

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and eighth most common malignancy in the world wide, most lethal gynecological

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malignancy. In the United States, approximately 20,000 new cases of ovarian

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cancer expected to be diagnosed in 2022, and about 12,000 estimated deaths

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in the United States in this year. And early diagnosis is very important

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because survival is much better in localized disease

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compared to the later disease with distant metastasis. So, ovarian masses

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are relatively common, and many of those are actually benign. So, I'm going

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to just go through some benign disease such as hemorrhagic cysts, endometrioma,

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and also talk about borderline neoplasms and some malignant neoplasms. So,

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imaging modalities for evaluation of ovarian lesions, ultrasound especially

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transvaginal ultrasound is primary modality for detection and characterization

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of ovarian lesions. And MRI is very good for characterization of indeterminate

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masses by ultrasound. And it has a higher accuracy, and specificity compared

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to the ultrasound. And CT is not the primary modality for evaluation of

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ovarian lesions but occasionally ovarian masses are incidentally discovered

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by CT scan, and we need to analyze those findings. And also CT is good for

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preoperative staging and surgical planning for malignant ovarian neoplasms.

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And PET CT is also good for evaluation of treatment response,

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predicting outcome and detection of recurrence, but today I'm going to talk

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mostly about ultrasound CT and some MRIs. So, features to suggest malignancy

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in general for ovarian masses, and worst things are the first is metastasis

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in outside of the ovaries and peritoneal nodules and ascites, those are

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suggestive of malignancy with metastasis. And in terms of ovarian lesions,

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a solid lesion with irregular outer contour is suspicious features, and

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other things as cysts with solid component and papillary projections and

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larger solid component and larger number of papillary projections are more

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worrisome. And irregular thick septations or inner wall, inner surface of

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the cyst wall are also worrisome. And higher vascularity is also concerning

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findings. And there is an O RADS system, ultrasound risk certification and

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management system, they have evaluated the scales from O RADS 0 to O RADS

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5, and higher number is a higher risk for malignancy. O RADS 0 is incomplete

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evaluation, one is normal pre menopausal ovary finding. And O RAD 2 is almost

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always benign, less than 1% risk of malignancy. And 3 is low risk upto 10%

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of malignancy. Four is intermediate risk upto 50%.

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And five is high risk, greater than 50%. And that is very good

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to assess, and decide for work, so it's very useful tool. And benign ovarian

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masses, I start with benign lesions. So, first case, this is a young

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lady, came with irregular bleeding, and ultrasound shows cystic lesion in

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the right ovary. So, right side ovary mass which measures 6.6 cm, so

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very good size. And internally, there's a lot of reticular band like structures,

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and mostly cystic looking and some increased fluid transmission posteriorly.

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And in the vaginal scan, you can again see the reticular band like structures,

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lacy structures with some low level internal echoes. And flow is seen in

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the ovarian tissue but no flow inside. And there's enough flow within the

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peripheral ovarian tissue, this one in that areas. And CNET clip better

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shows the reticular internal structures, and some low level echoes. And

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low level echoes are moving slowly.