J Korean Soc Radiol.  2019 Nov;80(6):1060-1074. 10.3348/jksr.2019.80.6.1060.

Incidental Ovarian Lesions

• Kang S
• Park JJ
• Park SY

• KMID: 2464907
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1060

Abstract

Incidental ovarian lesions are diagnostic challenges owing to their wide disease spectrum, ranging from normal findings to malignant ovarian tumors. There are several physiologic ovarian lesions that may not require any follow-up or treatment. While some lesions demonstrate their benign nature on imaging, some significant radiologic features may suggest malignant potential. Therefore, precise interpretation of imaging findings and proper recommendations for clinicians by radiologists are essential for managing incidental ovarian lesions to avoid unnecessary examinations or invasive treatments. The aim of this review is to describe the radiologic findings of commonly encountered incidental ovarian lesions on ultrasonography or computed tomography and to explain the management plan according to the stratified risk for malignancy in each ovarian lesion.

MeSH Terms

Diagnosis, Differential
Follow-Up Studies
Ovarian Neoplasms
Tomography, X-Ray Computed
Ultrasonography

Figure

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  Fig. 1. Normal ovaries with follicles in a 25-year-old woman. A. Axial contrast-enhanced CT image shows bilateral ovaries (arrows). B, C. Right (B) and left (C) ovaries have multiple well-defined anechoic cysts suggesting the presence of follicles. A dominant follicle measuring 2 cm is located in the right ovary (asterisk).

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  Fig. 2. Normal atrophic ovaries in a 58-year-old postmenopausal woman. A, B. Axial (A) and coronal (B) contrast-enhanced CT images show atrophic band-like ovaries (arrows) without inner cystic structure.

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  Fig. 3. Ovarian simple cyst in a 63-year-old postmenopausal woman. A, B. Gray scale ultrasonography (A) and axial contrast-enhanced CT (B) images show a left ovarian simple cyst (arrows), measuring 4.5 cm, without inner septum or nodule.

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  Fig. 4. Corpus luteum cyst in a 47-year-old woman. A. Color Doppler ultrasonography image shows an irregularly thick-walled cyst with vascular flow indicating the “ring of fire” sign (arrow). B. Axial contrast-enhanced CT image shows a thick-walled cystic lesion with rim enhancement in the right ovary (arrow). C. Axial PET/CT image shows strong fluorodeoxyglucose uptake in the lesion (arrow).

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  Fig. 5. Hydrosalpinx in a 50-year-old woman. A, B. Gray scale ultrasonography (A) and axial contrast-enhanced CT image (B) show a tubular cystic structure (arrows) filled with serous fluid in the right adnexa. Each chamber of the cystic lesion is communicated, and the septum-like structures are tubal folds.

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  Fig. 6. Peritoneal inclusion cyst in a 43-year-old woman who underwent surgery for endometriosis previously. A, B. Gray scale ultrasonography (A) and coronal T2-weighted image (B) show a large thin-walled cystic lesion (arrows) in the left adnexa. A normal ovary (arrowheads) containing small follicles is visible inside the

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  Fig. 7. Adult granulosa cell tumor mimics hemorrhagic cyst in a 44-year-old woman. A. Initial gray scale ultrasonography shows a small lesion with interior echogenic strands (arrow) suggesting a hemorrhagic cyst inside the left ovary. B. Follow-up color Doppler ultrasonography after 6 months shows increased size and interior blood flow of the left ovarian lesion. C. Corresponding axial contrast-enhanced CT image shows an ill-defined low-density cystic mass (arrow) in the left ovary, which has faint hyper-dense area inside the lesion.

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  Fig. 8. Hemorrhagic cyst in a 33-year-old woman. A. Axial contrast-enhanced CT image shows a cystic lesion (arrow) in the left ovary. The lesion shows mild wall thickening, and the mean CT attenuation value was 20 HU. B. On color Doppler ultrasonography, fine reticular structures fill the cystic lesion (arrow), similar to cobwebs. However, the thin reticular structures do not show blood flow.

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  Fig. 9. Endometriosis in a 42-year-old woman. A. Axial contrast-enhanced CT image shows cystic lesion (arrow) in the left ovary. The lesion shows mild wall thickening, and the mean CT attenuation value is 26 HU. The imaging feature is similar to a hemorrhagic cyst. B. Unlike hemorrhagic cysts, the interior texture of the ovarian cyst (arrow) is predominantly homogeneous on color Doppler ultrasonography without blood flow.

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  Fig. 10. Clear cell carcinoma arising from endometriosis in a 39-year-old woman. A. Color Doppler ultrasonography image shows a large cystic ovarian mass, which is filled with homogeneous and diffuse hypoechoic material suggesting underlying endometriosis. Inner hyperechoic mass (asterisk) shows blood flow. B. Coronal contrast-enhanced CT image shows a large cystic mass (arrow) containing an inner solid component (asterisk) with enhancement.

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  Fig. 11. Mature teratoma in a 27-year-old woman. A well-defined cystic mass is visible in the right ovary (arrow). The lesion contains dense calcification (arrowhead) and fat (asterisk) on contrast-enhanced CT image.

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  Fig. 12. Fibroma in a 61-year-old woman. A. Axial contrast-enhanced CT image at the portal phase shows a well-defined homogeneous mass in the right ovary (arrow). The mean CT attenuation value is 40 HU, which is not significantly different from 32 HU on the pre-contrast image. B. On the axial T2-weighted image, the lesion (arrow) shows diffuse low signal intensity, suggesting a fibrotic component.

Reference

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