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Pain Imaging pp 451-469 | Cite as

Imaging of Ovarian Disease-Related Pain

  • Kirsi HärmäEmail author
  • Philippe Vollmar
Chapter

Abstract

A number of different conditions in the ovaries, including the adnexa, can cause ovarian or pelvic pain. Sometimes the pain character, chronic or acute, or the time point of the appearance of the symptoms within menstrual cycle can give us diagnostic clues for the accurate imaging interpretation. Woman’s fertility and life-threatening conditions, such as rupture of ectopic pregnancy or tubo-ovarian torsion, should be rapidly diagnosed and treated. As ovarian cancer, even in advanced stage, rarely causes specific symptoms or pain, indications to imaging by unspecific pelvic or urinary symptoms of the women should be closely proved. Often the first-line imaging technique is gynecologic sonography with power Doppler examination. MRI possess a high spatial and temporal resolution, functional imaging sequences being easily incorporated and being a valuable and safe tool in the diagnostic of ovarian and adnexal masses of the female patients in any age. The choice of the imaging modality must be made individually, criterion such as age of the patient, experience of the sonologist, access to MRI, and indication to emergency CT contributing. In order to reach an accurate diagnosis, combining the radiological findings with clinical and laboratory findings is warmly recommended.

Keywords

Pelvic pain Adnexal torsion Pelvic inflammatory disease Ovarian neoplasms Ultrasonography Computed tomography Magnetic resonance 

Abbreviations

ADC

Apparent diffusion coefficient

CRP

C-reactive protein

CT

Computed tomography

DCE

Dynamic contrast enhanced

DMN

Default mode network

DWI

Diffusion-weighted imaging

DW-WB/MRI

Diffusion-weighted whole-body MRI

EP

Ectopic pregnancy

ESUR

European Society of Urogenital Radiology

EUG

Extrauterine gravidity

FHC

Fitz-Hugh-Curtis syndrome

FIGO

The International Federation of Gynecology and Obstetrics

FOV

Field of view

FSHR

Follicle Stimulating Hormone Receptor

hCG

Human chorionic gonadotropin

ITT

Isolated tubal torsion

IUD

Intrauterine device

Ki-67

Cell proliferation-associated Ki-67 antigen

MRI

Magnetic resonance imaging

NCS

Nutcracker syndrome

OC

Ovarian cancer

OHSS

Ovarian hyperstimulation syndrome

OP

Ovarian pregnancy

OT

Ovarian torsion

PD

Primary dysmenorrhea

PET/CT

Positron-emission tomography

PID

Pelvic inflammatory disease

SLE

Systemic lupus erythematosus

SRY Gene

Sex-determining region Y

T1W/T2W

T1 weighted, T2 weighted

TDF

Testis-determining-factor

TOA

Tubo-ovarian abscess

TV-US

Transvaginal ultrasonography

UO

Utero-ovarian

US

Ultrasonography

VEGF

Vascular endothelial growth factor

WHO

World Health Organization

Supplementary material

Video 22.1a

Normal ovaries on MRI (T2W). Normal anatomical location of the bilateral ovaries para uterine. Notice also endometrial hyperplasia. (AVI 33432 kb)

Video 22.1b

Ectopic ovary. “Ectopic ovary on the upper pelvic side wall left after ovariopexy proceeded before radiation in a patient with cervical cancer”. (AVI 39692 kb)

Video 22.2a

Axial T2-weighted series shows a central hyperintense cystic lesion with thickened wall of the right ovary. The imaging was proceeded because of uterine fibroids. (AVI 35120 kb)

Video 22.2b

DWI: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI. (AVI 113492 kb)

Video 22.2c

ADC map: corpus luteum cyst wall shows an Intermediate diffusion restriction in DWI and in ADC map. (AVI 41860 kb)

Video 22.3

Axial T1w fatsat post contrast series: left renal vein is compressed between the aorta and the superior mesenteric artery with a distension of the hilar part of the vein. Note the thickened left ovarian vein indicating nutcracker syndrome. (AVI 98608 kb)

Video 22.4a

Axial T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27976 kb)

Video 22.4b

Sagittal T2w series: twisted ovarian pedicle with enlarged, cystic left ovary. (AVI 27156 kb)

Video 22.5a

DWI: bilateral tubo-ovarian abscess, clearly diffusion restricted in DWI. (AVI 11864 kb)

Video 22.5b

ADC map: bilateral tubo-ovarian abscess, clearly diffusion restricted in ADC map. (AVI 14040 kb)

Video 22.5c

Axial T2w series: thickened fallopian tube on the right side. Free fluid in fossa Douglas. (AVI 15180 kb)

Video 22.5d

Correlating findings in PET/CT. (AVI 3711 kb)

Video 22.6

Axial T2w series: Hydrosalpinx. Notice the so called “waist sign”. (AVI 14112 kb)

Video 22.7

CECT series: massive haematoperitoneum an inhomogenous mass in fossa ovarica showed a contrast extravasation indicating an active bleeding component. (AVI 57231 kb)

Video 22.8a

Coronal T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 12671 kb)

Video 22.8b

Axial T2w series: large hyperintense cystic tumor with small amount of free fluid and a normal contralateral ovary. (AVI 35531 kb)

Video 22.8c

DWI: no diffusion restriction. (AVI 10936 kb)

Video 22.8d

ADC map: no diffusion restriction, ADC value 3.0 × 10−3 mm2/s. (AVI 5604 kb)

Video 22.9a

Coronal T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 12902 kb)

Video 22.9b

DWI: hyperintense restricted cystic wall. (AVI 17086 kb)

Video 22.9c

Axial T2w series: multilocular, cystic tumor in a pregnant woman. (AVI 19359 kb)

Video 22.10

Axial T2w series: ovarian dysgerminoma with “beak-sign”. (AVI 11249 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Diagnostic, Interventional and Pediatric RadiologyInselspital, Bern University Hospital, University of BernBernSwitzerland

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