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Fat-containing pelvic lesions in females

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Abstract

Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely—from observation to surgical resection—and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.

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The author(s) declare(s) that they had full access to all of the data in this study and the author(s) take(s) complete responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Imaging, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, TX, USA

    Nikoo Fattahi

  2. Department of Diagnostic Imaging, The University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Aida Moeini

  3. Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Ajaykumar C. Morani, Khaled M. Elsayes & Mohamed Badawy

  4. University of Texas, Austin, TX, USA

    Hrishabh R. Bhosale

  5. Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA

    Christine O. Menias

  6. Department of Diagnositc Imaging, The University of Utah School of Medicine, Salt Lake City, UT, USA

    Maryam Rezvani & Akram M. Shaaban

  7. Department of Radiology, The University of Missouri Health Care, Columbia, MO, USA

    Ayman H. Gaballah

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  1. Nikoo Fattahi
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  2. Aida Moeini
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All authors contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

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Correspondence to Khaled M. Elsayes.

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Fattahi, N., Moeini, A., Morani, A.C. et al. Fat-containing pelvic lesions in females. Abdom Radiol 47, 362–377 (2022). https://doi.org/10.1007/s00261-021-03299-y

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