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.