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. 2020 Feb;30(2):1166-1181.
doi: 10.1007/s00330-019-06420-4. Epub 2019 Sep 16.

MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

Lotte W E van Nimwegen  1 , Annelies M C Mavinkurve-Groothuis  2 , Ronald R de Krijger  1   3 , Caroline C C Hulsker  1 , Angelique J Goverde  4 , József Zsiros  1 , Annemieke S Littooij  1   5
Affiliations

MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

Lotte W E van Nimwegen et al. Eur Radiol. 2020 Feb.

Abstract

Objectives: The use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass.

Methods: The review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018.

Results: Sixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance.

Conclusion: The addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass.

Key points: • MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively. • MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance. • Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.

Keywords: Magnetic resonance imaging; Ovarian neoplasms; Systematic review.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
An example of immature teratoma grade 1 of the right ovary in a 15-year-old girl, treated as a benign tumour with local resection and follow-up. Axial T1-weighted before and after administration of gadolinium contrast (a, c), axial T1-weighted with fat-suppression (b) and sagittal T2-weighted turbo spin echo (d) show a cystic-solid mass with fatty components (arrows). Intralesional fat is diagnostic for a teratoma. The relative large amount of enhancing parts increases the risk of immature components
Fig. 2
Fig. 2
An example of yolk sac tumour of the right ovary in a 16-year-old girl. Sagittal T2-weighted turbo spin echo TSE (a) and T1-weighted gradient echo with fat suppression before and after administration of gadolinium contrast (b, c) show a large cystic solid mass in the lower abdomen. The enhancing parts of the lesion show relative impeded diffusion (arrow) at axial DWI (b1000 and ADC map; d,e)
Fig. 3
Fig. 3
The flowchart summarises the search process with the number of studies included and excluded
See this image and copyright information in PMC

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