Epithelial ovarian tumors MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Huda A. Karman, M.D.

Epithelial ovarian tumors Microchapters
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Overview

MRI of the pelvis, abdomen, and chest can be helpful as one of the evaluating tools of epithelial ovarian tumors.

MRI

Endometrioid Carcinoma of the Ovary

Pelvic MRI: Reported signal characteristics include:

• T2:
  • Relatively low signal intensity of the tumor wall
  • Shading sign may be seen
• T1C+(Gd):
  • Can show mild enhancement

Ovarian Serous Cystadenocarcinoma

• MRI is the modality of choice in the characterization of ovarian malignancy and in the detection of lymphatic, peritoneal, and distant metastases.
• Both for preoperative planning and post-treatment follow up.
• The cystic components
  • Are high T2, low T1 signal
  • If there has been intralesional hemorrhage (c.f. mucinous cystadenocarcinoma, there is typically slightly increased T1 signal of the cystic component)
• Solid malignant components
  • Demonstrate intermediate T1 and T2 signal, restricted diffusion, and gadolinium enhancement.
• DWI is useful for the detection of distant metastases.

Ovarian Mucinous Cystadenocarcinoma

• T1:
  • The signal intensity of mucin on T1-weighted images varies depending on the degree of mucin concentration
  • On T1-weighted images, loculi with watery mucin have a lower signal intensity than loculi with thicker mucin.
• T2
  • On T2-weighted images, the corresponding signal intensities are flipped, so that loculi with watery mucin have a high signal intensity and loculi with thicker mucin appear slightly hypointense.
• MRI
• Often seen as a cystic ovarian mass with the margin being generally smooth. Solid protrusions are often both round and few in number.
• Reported signal characteristics include:
• T1: can vary from low to very high (often dependent on the hemorrhagic component(s), not a specific feature)