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