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Role of MRI in the Evaluation of Adnexal Masses - a Prospective Study

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Role of MRI in the Evaluation of Adnexal Masses - a Prospective Study Jebmh.com Original Research Article Role of MRI in the Evaluation of Adnexal Masses - A Prospective Study Aswini Jyothi Jayam Subramanyam1, Surya Prakash Cheedalla2, Vanaja Bulkapuram3, Veena Madireddy4, Vijaya Kumari5 1, 2, 3, 4, 5 Department of Radiology, Osmania Medical College, Hyderabad, Telangana, India. ABSTRACT BACKGROUND Among all the disorders of female reproductive system, adnexal masses are one Corresponding Author: of the most common disorders. The main purpose of the study was to evaluate an Dr. Aswini Jyothi Jayam Subramanyam, Flat: 204, Vasavi Bhuvana Apartments, adnexal mass and to differentiate the mass as benign or malignant and facilitate H: 8-3-981 / 1,3,4,6,8,10,11, selection of appropriate treatment algorithm. For few benign lesions, radiological Srinagar Colony, Hyderabad - 500037, follow-up is very suitable for further management and additional follow-up may Telangana, India. not be useful when an imaging abnormality is not found. E-mail: [email protected] METHODS DOI: 10.18410/jebmh/2021/185 Our study was conducted in Osmania General Hospital and its allied hospital named Government Maternity Hospital, Hyderabad, on about 150 patients. This is How to Cite This Article: Subramanyam AJJ, Cheedalla SP, an institution-based, multicentric, cross-sectional, prospective, analytical study. All Bulkapuram V, et al. Role of MRI in the clinically suspected female patients with adnexal masses referred to the evaluation of adnexal masses - a Department of Radiodiagnosis were evaluated. These patients were first subjected prospective study. J Evid Based Med to ultrasonography, followed by magnetic resonance imaging (MRI) (plain and Healthc 2021;8(15):956-962. DOI: contrast wherever required). MRI findings were compared with ultrasonography. 10.18410/jebmh/2021/185 These findings were compared with operative findings and histopathological findings, wherever performed. Submission 11-07-2020, Peer Review 18-07-2020, Acceptance 23-02-2021, RESULTS Published 12-04-2021. In the present study, females in the age group of 21 – 40 years showed majority of pelvic lesions - 81 (54 %). Most of the pelvic masses were arising from the Copyright © 2021 Aswini Jyothi Jayam ovary - 102 (68 %). Majority of the adnexal lesions on MRI were benign in nature Subramanyam et al. This is an open - 132 (88 %). MRI showed a sensitivity of 100 %, specificity of 97.7 %, and a access article distributed under positive predictive value of 83 %, & a negative predictive value of 100 %. Creative Commons Attribution License [Attribution 4.0 International (CC BY CONCLUSIONS 4.0)] In practice, ultrasonography (USG) is the primary modality for diagnosing the pelvic mass. MRI is superior to ultrasound and can be used as problem solving technique in the assessment of pelvic mass. The multiplanar imaging capability allows accurate identification of origin of mass and characterisation of mass. This is helpful to the preoperative planning of sonographically detected mass and avoids surgery in possible cases. MRI is the technique of choice for staging, treatment planning and post treatment follow-up of pelvic malignancies. KEYWORDS MRI, USG, Adnexal Masses, Ovarian Masses, Board Ligament Lesions, Fallopian Tube Lesions, Cysts J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 15 / Apr. 12, 2021 Page 956 Jebmh.com Original Research Article BACKGROUND All clinically suspected female patients with adnexal masses referred to the Department of Radiology, OGH / Major components of adnexal region are ovary, fallopian MGMH were enrolled in the study. tube, broad ligament, and associated blood supply and nerve supply. About two thirds of adnexal lesions are ovarian These patients were first subjected to ultrasonography, tumours. Among these, ovarian cancer is the deadliest of all followed by MRI (plain and contrast wherever required). gynaecological cancers, because of its late presentation and MRI findings were compared with that of poor response to treatment.1 The main purpose of ultrasonography. radiological evaluation of an adnexal mass is to distinguish These findings were compared with that of operative between malignant and benign diseases, which help clinician findings and histopathological findings wherever to choose appropriate treatment algorithm for the patient. performed. Ultrasound of pelvis is used as first imaging study in USG studies were performed by using multi frequency, evaluating women with suspected adnexal masses, due to linear, curvilinear and transvaginal transducers on its easy availability, relatively cheap and high sensitivity in Esaote MY LAB CLASSIC the detection of lesions.2,3 But, USG of pelvis has its MRI studies were performed on 1.5 Tesla electromagnet limitations like decreased specificity in diagnoses of benign (GE company). The primary pulse sequences included lesions4 which can vary from 60 % to 95 % and also has T1WI and T2WI. Images were obtained with a multislice limitation of classifying as many as 20 % of adnexal masses, technique using a slice thickness of 3 mm, interslice gap as indeterminate.5, 6 Main disadvantage of ultrasound is that of 6 mm, FOV of 220 – 240 mm and a matrix size of 512* the field of view is limited; sometimes bowel gas obscures 512. the pelvic organs. It is possible to suspect malignancy, but Contrast was given wherever necessary. The patient was definite diagnosis cannot always be made. To overcome followed up, to co-relate the findings with clinical these limitations of ultrasound, magnetic resonance imaging outcome or operative findings. is much better in delineating and diagnosing the pelvic Gadolinium-enhanced MR imaging using high resolution lesions. fat-suppressed axial, coronal, sagittal T1 FSE. Magnetic resonance imaging has shown promising Gadolinium contrast (Omniscan, GE health care, 0.1 results in pelvic imaging. MRI has advantage of better soft mmol / Kg body weight) was used. tissue contrast than in ultrasound. MRI T2 weighted images are much better for the soft tissue contrast and to characterise the abnormalities.7 The T1 weighted images Inclusion Criteria and fat saturated sequences are used to demonstrate the fat Clinically suspected cases of adnexal mass lesions were containing lesions like dermoid, which are difficult to included. diagnose on USG. The same images are also used to Adnexal mass lesions found on USG were included. differentiate between haemorrhagic and fat containing lesions. MRI helps to distinguish normal anatomical structures and the pathological lesions. MRI has high Exclusion Criteria sensitivity and specificity for differentiating benign pelvic All midline mass lesions were excluded. lesions from malignant lesions. Patients with cardiac pacemakers, prosthetic heart valves, cochlear implants or any metallic implants were excluded. Objectives Claustrophobic patients have been excluded. To assess the relative role of USG and MRI in diagnoses of adnexal mass lesions and compare them with clinical outcome or operative findings. Histopathology To study about the varied nature of adnexal mass All patients who underwent surgery; operative findings with lesions. their histopathology report were obtained. The MR To study the significance of MRI in diagnosing morphology was compared and correlated with sonographically detected indeterminate masses. histopathological features. Statistical Analysis METHODS Descriptive statistical analysis has been carried out in the present study. Diagnostic statistics such as sensitivity, This is an institution-based, multicentric, cross-sectional, specificity, positive predictive value (PPV), negative prospective, analytical study. 150 patients with clinically predictive value (NPV) and accuracy has been used to find suspected adnexal masses, who presented to Department of the correlation of USG scan and MRI scan with final Radiology, Osmania General Hospital and its allied hospital diagnosis. named, Modern Government Maternity Hospital, Hyderabad, from 2015 to 2018, were selected for this study. J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 15 / Apr. 12, 2021 Page 957 Jebmh.com Original Research Article Disease pregnancy 2 %, ovarian stromal oedema 2 %, broad Test Present a Absent a Total ligament haematoma 2 %, indeterminate 28 % and most Positive True positive a False positive c a + c Negative False negative b True negative d b + d common lesion type was indeterminate. Total a + b c + d In MRI analysis of various types of lesions the most Statistical Analysis common lesion was haemorrhagic cyst 14 %, other spectrum of lesions were haemorrhagic cyst 14 %, The following statistics can be defined subserosal fibroid 10 %, haematosalpinx 10 %, Sensitivity: is true positive rate, expressed as a endometriotic cyst 8 %, ovarian torsion 4 %, pyosalpinx 4 percentage = a / a + b %, ovarian dermoid cyst 6 %, hydrosalpinx 6 %, serous Specificity: is true negative rate, expressed as a cystadenocarcinoma 4 %, ectopic pelvic kidney 4 %, percentage = d / c + d paraovarian cyst 6 %, mucinous cystadenocarcinoma 2 %, Positive predictive value: = a / a + c congenital uterine anomalies 6 %, dysgerminoma 4 %, tubo- Negative predictive value: = d / b + d ovarian mass 2 %, thecal lutein cyst 4 %, mucinous Accuracy is = a + d / a + b + c + d cystadenoma 4 %, serous cystadenoma 4 %, ovarian stromal oedema 2 %, broad ligament haematoma 2 %, endodermal sinus tumour 2 %, and inconclusive 4 %. RESULTS In USG evaluation, out of 150 patients, majority were benign lesions. They
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