MR imaging in ovarian cancer

Abstract

Magnetic resonance (MR) imaging is increasingly being used in patients with gynaecological disorders due to its high contrast resolution compared to computed tomography (CT) and ultrasound. In women presenting with an adnexal mass, ultrasound remains the primary imaging modality in the detection and characterisation of such lesions. However, in recent years overwhelming evidence has accumulated for the use of MR imaging in patients with indeterminate adnexal masses particularly in younger women and where disease markers are unhelpful. In staging ovarian cancer and for evaluating therapeutic response MR imaging is as accurate as CT but CT remains the imaging modality of choice because it is more widely available and quicker. This article reviews that evidence and outlines a place for the use of MR imaging in ovarian cancer.

Figure 1

Bilateral dermoids. Axial (a) T1-weighted, (b) T2-weighted, and (c) post-intravenous gadolinium enhanced fat suppressed T1-weighted images show bilateral pelvic mass (arrows) containing fat in keeping with dermoids. The fat can be seen as high signal intensity on both the T1- and T2-weighted scans and shows loss of signal on the fat suppressed image, i.e. similar signal intensity to intra-pelvic and subcutaneous fat.

Figure 2

Ovarian adenocarcinoma. Axial (a) T2-weighted and fat suppressed T1-weighted images (b) before and (c) after intravenous gadolinium enhancement shows a large predominantly cystic ovarian mass with nodular vegetation seen on its internal surface (arrows).

Figure 3

Ovarian cystadenoma. (a) Sagittal T2-weighted images shows complex ovarian tumour with a low signal intensity nodule (arrows). Fat suppressed T1-weighted images (b) before and (c) after intravenous gadolinium enhancement shows that this nodule does not show any enhancement and therefore does not contain any vegetation. This case illustrates the importance of contrast medium enhancement in the evaluation of adnexal masses.

Figure 4

Bilateral borderline ovarian tumours. (a) Axial and (b) coronal T2-weighted images show bilateral complex ovarian tumour with a low signal intensity nodule (arrows). This shows enhancement on the (c) axial fat suppressed T1-weighted images after intravenous gadolinium.

Figure 5

Serous borderline ovarian tumours with papillary architecture. Sagittal (a) T2-weighted and (b) fat suppressed T1-weighted images after intravenous gadolinium shows a cystic mass with fronds of tissues. (c) Histopathology of the specimen showed that that this was a serous borderline ovarian tumour with papillary architecture.

Figure 6

Malignant change in an endometriotic cyst. (a) Ultrasound images from 8 years ago showed an endometriotic cyst which on serial follow up showed no change until the most recent ultrasound (b) which showed the development of the nodule in the wall of the cyst. MR imaging was performed; (c) sagittal T2-weighted image shows a cystic mass and axial fat suppressed T1-weighted images (d) before and (e) after intravenous gadolinium showing enhancing nodules from the malignant change within the endometriotic cyst.

Figure 7

Epithelial ovarian cancer with a co-existing dermoid. (a) Sagittal T2-weighted, (b) axial T1-weighted and (c) axial fat suppressed T1-weighted images after intravenous gadolinium enhancement showing the enhancing soft tissue component (arrow) of the ovarian cancer and with fat (arrowhead) from the dermoid seen centrally.