Table 1 Summary, pearls and pitfalls of imaging protocol

Sagittal T2-weighted without fat saturation

Tissue characterization

Multiplanar analysis

Pelvic anatomy analysis

Location of the mass analysis

Shape, size and component of the mass analysis

1. Intravenous contrast injection (if very-dark signal on T2-W imaging, perform DWI scan, to search for both low T2, DWI scan signal to avoid gadolinium injection)

2. Failure to recognize intermediate T2W signal (combine with DWI to evaluate the need for contrast injection analysis)

3. Failure to identify the anatomical origin of the pelvic mass (look for “specific” anatomic sign, landmarks displacement and ipsilateral ovary visualization)

4. Failure to identify small tissular component as papillary projections (use thin slices < 4 mm)

Axial T2-weighted lombo-pelvic sequence

Same as above

Extra-pelvic organ analysis (kidney, liver, vascular structure, lymph node)

1. Failure to identify extra-pelvic disease (analyze all the slices of the sequence)

Axial unenhanced T1-weighted in-phase sequence

Tissue characterization

1. Wrong analysis of the component if hypersignal T1-W (analyze complementary T1W sequence to determine blood, high-protein or fat content)

Axial unenhanced T1-weighted water sequence

Tissue characterization

1. Wrong analysis of the fat component (analyze the loss of signal and correlate with T1-weighted fat sequence if doubt)

2. Wrong identification of mucinous component (correlate with morphological sequence to look for loci and high-signal T2W)

3. Wrong identification of pus component (correlate with inflammatory clinical findings, perform gadolinium sequence and DWI scan)

4. Wrong identification of colloid component (correlate with morphological sequence to look for loci and low-signal T2W)

5. Wrong analysis between endometriotic and other hemorrhagic content (correlate with clinical findings, T2W sequence “shading” and T1W “rim”)

Axial abdominal and -pelvic DWI scan

Tissue characterization

Identification of pathological lymph node

1. Technical issue with the acquisition (perform the sequence with a minimum upper b-value of 1000 s/mm² , section thickness < 4 mm and check the dark DWI signal of the bladder with high-b-value before interpretation)

2. Analyze the apparent diffusion coefficient to conclude (do not use ADC value to interpret adnexal masses)

3. Analyze the dark T2/DWI partially (analyze the whole tumor to avoid missing high-signal component)

4. Misclassifying the normal ovary with ovarian tumor (correlate to morphological T2W sequence)

Three-dimensional non-dynamic T1-weighted gadolinium sequence

Tissue characterization (identify tissular component)

1. Technical issue with the acquisition (ensure perform pre-contrast acquisition to enable subtraction sequences and use section thickness < 3 mm)

2. Failure to identify Rokitansky nodule or thin and regular septations (correlate with morphological T2W and T1W sequence)

3. Failure to identify endosalpingial folds and papillary projections in the context of inflammatory pelvic disease (correlate with clinical findings, morphological T2W sequence and DWI scan)

4. Failure to identify a physiological fimbria end of the tube (correlate with multiplanar T2W and search for stellar morphology)

5. Failure to identify hair, calcifications, debris (use T1W in-, opposed-, fat, and water sequence)

6. Failure to identify normal ovarian parenchyma (use T2W and DWI scan)

Three-dimensional DCE T1-weighted sequence

Tissue characterization using tissular component and enhancement analysis

1. Technical issue with the acquisition (perform the sequence with a spatial resolution of 3 mm and temporal resolution of 15 s, place the reference ROI on the outer myometrium avoiding arcuate vessels. Start contrast injection 10 s prior and last for at least 3 min)

2. Technical issue with the curve drawing (analysis must be performed using percentage of enhancement of relative enhancement not absolute)

3. Technical issue with the curve drawing in mixt tumor (perform subtraction sequence to put the ROI)

4. Failure to identify a shoulder and a plateau to differentiate low and intermediate-risk TIC (do not consider the slope of the curve but search for a shoulder and a plateau)

5. Being inconclusive in the context of hysterectomy (analyze the 30–40 s post-contrast sequence to search for an early enhancement of the mass)

6. Drawing enhancement curve in the context of adnexal torsion (correlate with clinical findings and T2W morphological sequences and DWI scan)

7. Systematically drawing enhancement curve in the context of dermoid cyst and struma ovarii (intrinsic component of the tumor can lead to misdiagnosis of a malignant tumor)