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Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions

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Abstract

Objective

To determine the impact of MRI including DWI on therapeutic decision-making and costs in the work-up of patients with a indeterminate adnexal mass on ultrasound.

Methods

Thirty-eight patients with indeterminate ovarian lesions scheduled for surgery were included in this prospective study. In a questionnaire, the surgeon characterised the lesions based on a morphological score and determined the surgical procedure. The assessment was re-evaluated knowing MR findings and correlated with the final diagnosis. A cost-benefit analysis of MRI was performed. The impact of including DWI in the MR protocol was assessed.

Results

MRI provided major diagnostic information in 11/38 cases (28.9%) resulting in abstention from surgery in 5 cases; moderate additional information was recorded in 10/38 (26.3%) patients. Overall a net cost saving (3’676 EUR) was achieved. DWI did not show a significant difference between benign and malignant lesions. Teratomas yielded significantly lower mean ADC values (0.597 × 10-3 mm2/s) compared with all other adnexal lesions (1.812 × 10-3 mm2/s); the mean ADC values in endometrioma (1.387 × 10-3 mm2/s) were significantly lower than in other cystic lesions (2.372 × 10-3 mm2/s).

Conclusion

Inclusion of MRI in the diagnostic algorithm of the indeterminate adnexal mass allows better differentiation of ovarian lesions resulting in a change of therapeutic decision-making with net cost savings.

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Acknowledgements

We would like to thank Alex Peters for his valuable technical assistance during the study. Moreover, the authors would like to thank Nicole Graf, MSc, for providing statistical support. We are grateful for the assistance from our colleagues of the Department of Gynecology in patient care.

This study was in part supported by a research grant from Guerbet Switzerland. Authors maintained full control of the data and there is no conflict of interest concerning the funding of this study and the addressed subject. Froehlich JM works as a consultant for Grebert. This had no implications for our research project.

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Authors and Affiliations

  1. Department of Radiology, Kantonsspital Baden, CH-5404, Baden, Switzerland

    Bianka Chilla, Johannes M. Froehlich & Rahel A. Kubik-Huch

  2. Department of Gynecology, Kantonsspital Baden, CH-5404, Baden, Switzerland

    Nik Hauser

  3. Department Pathology, Kantonsspital Baden, CH-5404, Baden, Switzerland

    Gad Singer & Mafalda Trippel

  4. Institute of Radiology, Kantonsspital Baden, CH 5404, Baden, Switzerland

    Bianka Chilla

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  1. Bianka Chilla
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Correspondence to Bianka Chilla.

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Chilla, B., Hauser, N., Singer, G. et al. Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions. Eur Radiol 21, 1301–1310 (2011). https://doi.org/10.1007/s00330-010-2018-x

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  • DOI: https://doi.org/10.1007/s00330-010-2018-x

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