Magnetic resonance imaging findings in patients with benign and malignant ovarian masses versus pathologic outcomes


1 Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: The results of the former study confirmed the accuracy of magnetic resonance imaging (MRI) in determining the origin and content of ovarian masses. The present study aimed to evaluate the diagnostic value of MRI in differentiating benign and malignant ovarian masses in women. Materials and Methods: This was a cross-sectional study. All candidates for surgery to remove ovarian masses were selected to participate in this study. They underwent MRI with gadolinium before the surgery. MRI images were reviewed by an experienced radiologist who was aware of the ovarian mass found in pelvic ultrasonography (US). A thick-enhancing wall, mural nodules, septations, and internal enhancement within the mass were reviewed by the radiologist. Mass specimens were examined in the laboratory by an experienced pathologist to determine malignancy or benignancy of the masses. Pathological findings were compared with MRI results. Results: there was no significant difference between MRI findings and pathology denoted by benign and malignant (P = 0.06), but results showed a significant difference between US and pathology (P = 0.002). In MRI findings related to a thick-enhancing wall (P = 0.18), internal enhancement (P = 0.18), and pelvic fluid (P = 1.00), no significant difference was seen in benign or malignant masses. However, in findings related to septation, all cases had malignant reports (P = 0.006), and in mural nodule, 80% had malignant reports (P = 0.006). CA-125 blood level in patients with benign masses (1.72 ± 0.97) was significantly less than patients with malignant masses (3.20 ± 0.83) (P < 0.001). Conclusion: We showed that MRI has better results in diagnosing adnexal masses and their characteristics compared to simple ultrasound imaging based on pathological studies.


Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin 2018;68:284-96.  Back to cited text no. 1
Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: A review. Cancer Biol Med 2017;14:9-32.  Back to cited text no. 2
Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Primers 2016;2:16061.  Back to cited text no. 3
Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 2017;317:2402-16.  Back to cited text no. 4
Cordeiro Vidal G, Babin G, Querleu D, Guyon F. Primary debulking surgery of the upper abdomen and the diaphragm, with a plasma device surgery system, for advanced ovarian cancer. Gynecol Oncol 2017;144:223-4.  Back to cited text no. 5
Leibman AJ, Kruse B, McSweeney MB. Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses. AJR Am J Roentgenol 1988;151:89-92.  Back to cited text no. 6
Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990;97:922-9.  Back to cited text no. 7
Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. BJOG 1996;103:826-31.  Back to cited text no. 8
Tingulstad S, Hagen B, Skjeldestad FE, Halvorsen T, Nustad K, Onsrud M. The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol 1999;93:448-52.  Back to cited text no. 9
Bäumler M, Gallant D, Druckmann R, Kuhn W. Ultrasound screening of ovarian cancer. Hormone Molecular Biology and Clinical Investigation. 2019 Sep 17;1.  Back to cited text no. 10
Tailor A, Jurkovic D, Bourne TH, Collins WP, Campbell S. Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis. Ultrasound Obstet Gynecol 1997;10:41-7.  Back to cited text no. 11
Alcázar JL, Jurado M. Using a logistic model to predict malignancy of adnexal masses based on menopausal status, ultrasound morphology, and color Doppler findings. Gynecol Oncol 1998;69:146-50.  Back to cited text no. 12
Timmerman D, Bourne TH, Tailor A, Collins WP, Verrelst H, Vandenberghe K, et al. A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: The development of a new logistic regression model. Am J Obstet Gynecol 1999;181:57-65.  Back to cited text no. 13
DePriest PD, Varner E, Powell J, Fried A, Puls L, Higgins R, et al. The efficacy of a sonographic morphology index in identifying ovarian cancer: A multi-institutional investigation. Gynecol Oncol 1994;55:174-8.  Back to cited text no. 14
Tailor A, Jurkovic D, Bourne TH, Collins WP, Campbell S. Sonographic prediction of malignancy in adnexal masses using an artificial neural network. Br J Obstet Gynaecol 1999;106:21-30.  Back to cited text no. 15
Adusumilli S, Hussain HK, Caoili EM, Weadock WJ, Murray JP, Johnson TD, et al. MRI of sonographically indeterminate adnexal masses. AJR Am J Roentgenol 2006;187:732-40.  Back to cited text no. 16
Sohaib SA, Mills TD, Sahdev A, Webb JA, Vantrappen PO, Jacobs IJ, et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005;60:340-8.  Back to cited text no. 17
Grab D, Flock F, Stöhr I, Nüssle K, Rieber A, Fenchel S, et al. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 2000;77:454-9.  Back to cited text no. 18
Emil S, Youssef F, Arbash G, Baird R, Laberge JM, Puligandla P, et al. The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions. J Pediatr Surg 2018;53:2013-8.  Back to cited text no. 19
Sofic A, Husic-Selimovic A, Katica V, Jahic E, Delic U, Sehic A, et al. Magnetic resonance imaging (MRI) and transvaginal ultrasonography (TVU) at ovarian pain caused by Benign Ovarian Lesions. Acta Inform Med 2018;26:15-8.  Back to cited text no. 20
Shimada K, Matsumoto K, Mimura T, Ishikawa T, Munechika J, Ohgiya Y, et al. Ultrasound-based logistic regression model LR2 versus magnetic resonance imaging for discriminating between benign and malignant adnexal masses: A prospective study. Int J Clin Oncol 2018;23:514-21.  Back to cited text no. 21