Gynaecological Pelvic Masses: A Clinical Challenge – Radiological Evaluation using Ultrasound and CT with Pathological Correlation

Abstract

Introduction:The evaluation of the female pelvis is a radiological challenge due to the large consortium of differential diagnosis in terms of the origin of masses it houses. In the general population, the prevalence of adnexal lesions is 0.17%-5.9% in asymptomatic women and 7.1%-12% in symptomatic women. The radiological modalities used in evaluation are Ultrasonography,Computed Tomography and MRI. This study strives to demonstrate the role of USG and CT together in detecting the gynecological pelvic lesions,characterize them,evaluate the findings which can differentiate malignant and benign lesions and assess their diagnostic efficacy. Material and methods: This was a prospective study done in the Department of Radiology,RMCH,Bareilly, from November 2016-2018. All the patients of suspected pelvic mass in the age group 15-45 years in stipulated period fulfilling the inclusion criteria were enrolled for study. Results: Ovarian masses were most frequent (66%), followed by uterine (22%) and adnexal masses accounted for 12% of the cases. 38% of the ovarian masses were cystic, 36% were solid and rest 26% were mixed solid-cystic lesions. In uterine lesions, leiomyoma was found to be the commonest (45.5%). Conclusion: Of all pelvic gynecological masses,ovarian masses were the commonest.Transvaginal sonography and transabdominal sonography were very efficacious in diagnosis of gynecological masses and were diagnostic in 93.1% and 88% cases respectively. Computed tomography was diagnostic in 78% of cases.

Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Gynecological Masses

“…Majority of gynecological masses in the current study were ovarian (66.7%), while uterine masses were 33.3% of cases that is consistent with Sharma et al [19] who reported that ovarian masses represented 66% of the diagnosed gynecolical masses. Cass and Newton [22] also This is probable because the majority of uterine lumps are leiomyomas, which are asymptomatic and do not prompt patients to seek medical attention.…”

“…Other lesions were endometrial polyp (6.1%), endometrial hyperplasia (3%), and adenomyosis (3%). Similarly, Abd-Elmageed et al [20] and Sharma et al [19] found that the most prevalent benign tumors were leiomyomas. This is also consistent with the well documented data that uterine leiomyomas are the most prevalent benign pelvic tumor in women.…”

“…Both gradients should cancel each other, and the tissue with restricted diffusion will be fully rephrased, preserving its T2 signal intensity, whereas in the tissue with free diffusion, the water molecules would move significantly between the two gradients and not be fully rephrased, resulting in a decrease in T2 signal intensity [18]. DW-MRI can describe tissues in terms of cell organisation and density, microstructure, and microcirculation based on the water diffusion parameters associated with each of these characteristics [19]. [20].…”