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 (<3Â mm) no internal septations, papillary projections or solid components | high | low | no enhancement | Â | |
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 | Â | |
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 | Â | ||
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 | Â | |
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 | Â | |
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 | |