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Table 4 Chart summarizes the typical imaging features of the different ovarian lesions

From: MR imaging of ovarian masses: classification and differential diagnosis

Group Lesion Findings T2 T1 Gd-T1 Mean age
Cystic unilocular Functional cysts follicles (diameter <20 mm), dominant follicles (diameter 20–25 mm), follicular cysts, corpus luteum cysts. high low corpus luteum may show high signal no enhancement corpus luteum may enhance reproductive age
Serous cystadenoma often bilateral, thin regular wall (<3 mm) no internal septations, papillary projections or solid components high low no enhancement  
Cystadenofibroma sometimes: purely cystic lesion more often: complex cystic appearance with thick septa and solid components high fibrous stroma: low signal intensity low no enhancement  
Cystic multilocular Endometriosis haemorrhagic content intermediate to low shading sign high no enhancement reproductive age
Mucinous cystadenoma thin regular wall, several septations, no solid components monolateral variable signal intensity (stained glass appearance) no enhancement  
Borderline tumours septa, papillary projections intermediate intermediate enhancement of septa and papillary projections 45 younger patients than malignant ovarian cancer
Cystic and solid Mature cystic teratoma complex, heterogeneous appearance fat-tissue content fat-tissue: high fat-tissue: low on fat-saturated sequences teeth: low signal intensity variable 35
Struma ovarii (monodermal teratoma) complex mass with cystic spaces of variable signal intensity and solid areas thyroid tissue: thyrotoxicosis cystic spaces with both high and low signal intensity cystic spaces with low signal intensity because of the colloid of the struma enhancement of the cystic wall and solid components 50
Ovarian metastasis more often bilateral with a cystic and solid or a predominant solid morphological appearance from stomach, colon, breast, lung, contralateral ovary intermediate to high low to intermediate enhancement of the cystic wall and solid components  
Serous cystadenocarcinoma complex multilocular masses, thick and irregular walls, septations, solid components and papillary projections frequently bilateral cystic: high solid: low cystic: low to intermediate solid: intermediate enhancement of walls, septations, solid components and papillary projections 60
Mucinous cystadenocarcinoma complex multilocular masses, thick and irregular walls, septations, solid components and papillary projections cystic: high solid: low mucinous: variable cystic: low to intermediate solid: intermediate mucinous: variable enhancement of walls, septations, solid components and papillary projections  
Endometrioid adenocarcinoma complex masses with solid and cystic components associated with endometriosis haemorrhagic areas: intermediate haemorrhagic areas: high enhancement of walls and solid components 50–60
Yolk sac tumour mixed cystic and solid mass haemorrhagic areas: intermediate haemorrhagic areas: high bright dot sign: foci of enhancement, dilated vessels 15–25
Granulosa cell tumours mixed cystic and solid mass hyperestrogenism, endometrial hyperplasia cystic: high haemorrhagic: high solid: intermediate cystic: low haemorrhagic: high solid: intermediate enhancement of walls and solid components 60
Predominantly solid Brenner tumour fibrous content, calcifications low low to intermediate no enhancement 50–70
Dysgerminoma lobulated lesion with fibrovascular septa, surrounded by a fibrotic capsule solid component: intermediate to high septa: low low to intermediate enhancement of solid components and septa 25
Fibrothecomas fibrous tissue theca cells with lipidic content low to intermediate low to intermediate minimal enhancement 60
Fibromas prominent fibrosis with abundant collagen content low low moderate enhancement 60
Thecomas mainly lipidic content of theca cells intermediate intermediate lipidic content: low at chemical-shift (out of phase) minimal enhancement 60
Sertoli-Leydig cell tumours solid mass or mixed cystic and solid mass 1/3 patients: signs of androgen activity solid component: low scattered cystic areas: high solid component: intermediate enhancement of solid components 25–30