MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

Abstract

Objectives The use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass. Methods The review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018.Results Sixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusionweighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance. Conclusion The addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass. Key Points • MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively. • MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance. • Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.

The Usefulness of Diffusion Weighted and Contrast Enhanced Magnetic Resonance Imaging in Characterization of Inconclusive Ovarian Mass

“…They showed that most of the malignant ovarian masses and some of the dermoid cysts had high intensity on DWI. Most of the benign lesions had low signal intensity on DWI [6] [18] [19].…”

Role of MRI Modalities in Assessment of Cystic Lesions of the Female Pelvis

“…In this study, conventional MRI suggested malignant pathology in three masses; all proved to be malignant. An increased risk of malignancy was related to increased size of the lesion, increased wall thickness, presence and increased size of vegetation, mixed cystic and solid configuration, intermediate to high intensity on T2-weighted imaging, presence of contrast enhancement and of ascites or peritoneal implants [4,12]. MRI also suggested borderline pathology in four masses, two of them were truly borderline tumors, while one of them was proven to be benign and the last was histopathologically proven malignant.…”

“…The use of Magnetic Resonance (MR) imaging in differentiation between benign and malignant adnexal masses might be of great value in the diagnostic workup of sonographically indeterminate cystic lesions, since preserving fertility is of particular importance [4].…”

Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement

“…Preoperative investigations for a child referred with a suspected benign ovarian tumor : Any patient with a complex ovarian lesion or an ovarian cyst >5 cm should undergo an ultrasound (US) scan as the first‐line investigation 19,20 For further assessment of the mass, the patient should have an abdomino‐pelvic magnetic resonance imaging (MRI) scan 19,21,22 Any patient with a complex ovarian lesion or simple ovarian cyst > 5 cm should have the serum tumor markers alpha fetoprotein (AFP) and beta human chorionic gonadotropin (beta‐HCG) assayed.…”