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Multi-detector CT Features of Benign Adnexal Lesions

Posted Dec 31, 2009 Updated Apr 7, 2023
By Athina C. Tsili MD , Nikolaos Dalkalitsis MD , Evagellos Paraskevaidis MD , Konstantine Tsampoulas MD
7 min read

Rationale and Objectives

The purpose of our study was to evaluate the multidetector computed tomography (MDCT) features of benign adnexal lesions.

Methods and Materials

We report the MDCT features of 68 histologically proven benign adnexal lesions. Pathologic diagnoses were nonneoplastic adnexal cysts ( n = 16), endometriomas ( n = 12), serous or mucinous cystadenomas ( n = 15), fibromas or fibrothecomas ( n = 7), teratomas ( n = 6), and a variety of benign adnexal lesions ( n = 12). The CT protocol included scanning of the abdomen after the intravenous administration of iodinated contrast material (portal phase) using a detector collimation of 16 × 0.75 mm and a pitch of 1.2.

Results

Ovarian cysts had a characteristic CT appearance of a cystic lesion, with smooth, thin wall, and occasionally a few septa. Serous and mucinous cystadenomas were detected as multilocular cystic tumors containing serous fluid or liquids of higher than water CT density, respectively. Dilated fallopian tube was seen as an oblong, tubular, fluid-filled structure. MDCT was accurate to characterize mature cystic teratomas. Endometriomas had a variable CT appearance, including a unilocular or multilocular cystic mass, and a homogeneous hyperdense mass lesion. Fibrous tissue had a 50 HU CT density in patients with fibromas or fibrothecomas.

Conclusion

MDCT may provide accurate diagnostic information about the benign nature of adnexal lesions.

Ultrasonography remains the primary imaging modality in the workup of patients with suspected adnexal masses, with magnetic resonance imaging (MRI), although more specific in the characterization and differentiation of ovarian masses, reserved for problem-solving cases . The relatively uncommon use of computed tomography (CT) in the evaluation of benign adnexal mass lesions has resulted in a paucity of the English-language literature regarding their CT findings . Benign adnexal masses were evaluated by CT either during the investigation of an undiagnosed abdominal mass or as an incidental finding during CT examination performed for other reasons .

Multidetector CT (MDCT) greatly improved the accuracy of CT in detecting and characterizing adnexal mass lesions . Although MDCT is not considered the study of choice in the initial evaluation of adnexal masses, it proved accurate in the detection of ovarian masses, providing an accurate assessment of their internal architecture characteristics, a reliable differentiation of benign from malignant adnexal mass lesions, and an accurate preoperative staging of the disease in cases of ovarian malignancies .

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Materials and methods

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CT Protocol

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CT Data Interpretation

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Results

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Figure 1, Left serous ovarian cyst in a 77-year-old woman. Transverse multiplanar reformatted image depicts an ovoid, sharply-demarcated cystic left adnexal mass (asterisk) . The computed tomography attenuation measurement was within the water range (5 HU). The lesion had a thin wall and one small, thin calcified septum (arrow) .

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Figure 2, Left ovarian endometrioma in a 50-year-old woman. Transverse multiplanar reformatted images depict an ovoid, homogeneous, sharply demarcated left adnexal mass ( asterisk ). The computed tomography density was 60 HU, corresponding to the hemorrhagic content.

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Figure 3, Right serous ovarian cystadenoma in a 36-year-old woman. (a) Coronal and (b) sagittal reformatted images show a unilocular, cystic mass (asterisk) , with a thin, enhancing wall (arrow) . The computed tomography density (3 HU) of the lesion was compatible with watery content.

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Figure 4, Mucinous cystadenoma of the right ovary in a 40-year-old woman. (a) Coronal and (b) sagittal multiplanar reformatted images depict a huge, multicystic mass, occupying most of the abdomen. The tumor had a thin wall and innumerable, thin septa containing cystic parts (computed tomography [CT] density: 10 HU), but mainly hyperdense components (CT density: 47 HU, asterisk ). Sagittal reformation shows the presence of small papillary projections (arrows) within the lesion.

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Figure 5, Left ovarian fibrothecoma in a 72-year-old woman. (a) Coronal and (b) sagittal multiplanar reformatted images show a large, multilobular left adnexal tumor. The dimensions of the lesion were 12 × 8.7 cm. The mass had cystic parts (mean computed tomography density: 19 HU, arrow ) and solid, homogeneous components, of 45 HU computed tomography attenuation measurement (asterisk) , the latter corresponding to fibrous tissue on pathology.

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Figure 6, Right mature cystic teratoma in a 58-year-old woman. Sagittal multiplanar reformatted image shows a sharply delineated, unilocular adnexal mass (asterisk) , with fatty component (computed tomography attenuation measurement: -122 HU). A small calcification (arrow) is detected on the cystic wall.

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Figure 7, Bilateral pyosalpinx in a 55-year-old woman. Coronal reformation depicts multicystic lesions (asterisk) , involving both ovaries, with slightly thickened walls and small papillary projections (small arrow) . There is also a small amount of ascites, thickening, and enhancement of the peritoneum and small peritoneal lesions (arrows) , proved inflammatory pathologically.

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Figure 8, Left struma ovarii in a 67-year-old woman. (a) Transverse and (b) sagittal multiplanar reformatted images show a multilocular cystic left adnexal mass, consisting of hyperdense parts (of 40–50 HU density). The dimensions of the lesion were 4 × 4 × 4.5 cm. The tumor was sharply demarcated, with thick septations (septal thickness greater than 3 mm) and nodular components, of 80–90 HU computed tomography density (arrows) .

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Discussion

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Academic Radiology, Volume 17, Issue 1
Journals General Radiology
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