Skip to main content
SpringerLink
Log in

Simulated impact of pelvic MRI in treatment planning for pediatric adnexal masses

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

There are no studies on utility of MRI in management of pediatric adnexal masses.

Objective

To determine the diagnostic and therapeutic impact of pelvic MRI in adnexal masses in children and adolescents.

Materials and methods

We included 32 females age 18 years and younger who had adnexal masses and who underwent both pelvic ultrasound (US) and MRI. A radiologist retrospectively reviewed US and MR images and created a standard radiologic report for each patient. In a prospective theoretical fashion, two pediatric gynecologists reviewed the clinical data and US report for each patient and indicated conservative versus surgical management; in surgical cases the options were laparoscopy versus laparotomy, midline versus Pfannenstiel incision, and oophorectomy versus cystectomy. Subsequently, the gynecologists were presented the MRI report and were asked to indicate their treatment options again. A binomial test was conducted to determine the effect of adding MRI findings to the management plan.

Results

The addition of MRI significantly changed management in 10 of 32 patients (P=0.0322), with a change in surgical versus conservative treatment in 5, a change in laparotomy vs. laparoscopy in 2, and a change from oophorectomy to cystectomy along with change in incision in 3 cases. This was based on additional information provided by MRI regarding the nature of the mass in 8 cases and origin of the mass in 2 cases.

Conclusion

Preoperative pelvic MRI findings might change the surgical management of pediatric patients with adnexal masses, so it is a valuable addition to the conventional workup in the clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cartault A, Caula-Legriel S, Baunin C et al (2012) Ovarian masses in adolescent girls. Endocr Dev 22:194–207

    Article  CAS  PubMed  Google Scholar 

  2. Kirkham YA, Lacy JA, Kives S et al (2011) Characteristics and management of adnexal masses in a Canadian pediatric and adolescent populations. J Obstet Gynaecol Can 33:935–943

    Article  PubMed  Google Scholar 

  3. Skiadas VT, Koutoulidis V, Eleytheriades M et al (2004) Ovarian masses in young adolescents: imaging findings with surgical confirmation. Eur J Gynaecol Oncol 25:201–206

    CAS  PubMed  Google Scholar 

  4. Mitchell DG, Javitt MC, Glan P et al (2013) ACR appropriateness criteria and follow-up of ovarian cancer. J Am Coll Radiol 10:822–827

    Article  PubMed  Google Scholar 

  5. Sala E, Rockall AG, Freeman SJ et al (2013) The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 266:717–740

    Article  PubMed  Google Scholar 

  6. Ratner ES, Staib LH, Cross SN et al (2015) The clinical impact of gynecologic MRI. AJR Am J Roentgenol 204:674–680

    Article  PubMed  Google Scholar 

  7. Chilla B, Hauser N, Singer G et al (2011) Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions. Eur Radiol 21:1301–1310

    Article  PubMed  Google Scholar 

  8. Hricak H, Chen M, Coakley FV et al (2000) Complex adnexal masses: detection and characterization with MR imaging — multivariate analysis 1. Radiology 214:39–46

    Article  CAS  PubMed  Google Scholar 

  9. Ruwe PA, Wright J, Randall RL et al (1992) Can MR imaging effectively replace diagnostic arthroscopy? Radiology 183:335–339

    Article  CAS  PubMed  Google Scholar 

  10. Schwartz LB, Panageas E, Lange R et al (1994) Female pelvis: impact of MR imaging on treatment decisions and net cost analysis. Radiology 192:55–60

    Article  CAS  PubMed  Google Scholar 

  11. Hricak H, Powell CB, Yu KK et al (1996) Invasive cervical carcinoma: role of MR imaging in pretreatment work-up — cost minimization and diagnostic efficacy analysis. Radiology 198:403–409

    Article  CAS  PubMed  Google Scholar 

  12. Van Winter JT, Simmons PS, Podratz KC (1994) Surgically treated adnexal masses in infancy, childhood, and adolescence. Am J Obstet Gynecol 170:1780–1786

    Article  PubMed  Google Scholar 

  13. Oltmann SC, Garcia N, Barber R et al (2010) Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg 45:130–134

    Article  PubMed  Google Scholar 

  14. Adusumilli S, Hussain HK, Caolli EM et al (2006) MRI of sonographically indeterminate adnexal masses. AJR Am J Roentgenol 187:732–740

    Article  PubMed  Google Scholar 

  15. Sohaib SA, Mills TD, Sahdev A et al (2005) The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 60:340–348

    Article  CAS  PubMed  Google Scholar 

  16. Luijendijk RW, Jeekel J, Storm RK et al (1997) The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg 225:365–369

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Biswas KK (1973) Why not Pfannenstiel’s incision? Obstet Gynecol 41:303–307

    CAS  PubMed  Google Scholar 

  18. El-Boghdadly SA, Abel K (1984) Pfannenstiel incision for appendicectomy in females. Br J Clin Pract 38:17–19

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Alessandro Marro received equal funding from Comprehensive Research Experience for Medical Students (CREMS), Faculty of Medicine, University of Toronto and Department of Medical Imaging, University of Toronto as a medical student for this research.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Alessandro Marro & Govind B. Chavhan

  2. Department of Pediatric Gynecology, The Hospital for Sick Children, University Of Toronto, Toronto, ON, Canada

    Lisa M. Allen & Sari L. Kives

  3. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Rahim Moineddin

Authors
  1. Alessandro Marro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa M. Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sari L. Kives
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rahim Moineddin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Govind B. Chavhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Govind B. Chavhan.

Ethics declarations

Conflicts of interest

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marro, A., Allen, L.M., Kives, S.L. et al. Simulated impact of pelvic MRI in treatment planning for pediatric adnexal masses. Pediatr Radiol 46, 1249–1257 (2016). https://doi.org/10.1007/s00247-016-3606-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-016-3606-y

Keywords

Search

Navigation