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, 61 (2), 110-116
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Bilateral Ovarian Tumors on MRI: How Should We Differentiate the Lesions?

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Bilateral Ovarian Tumors on MRI: How Should We Differentiate the Lesions?

Naoko Mukuda et al. Yonago Acta Med.

Abstract

Background: We investigated the distinguishing pathological features of bilateral ovarian tumors using magnetic resonance (MR) imaging.

Methods: Eighty-six patients with bilateral ovarian tumors on MR imaging were evaluated. The pathological diagnosis was investigated, and the results were subjected to statistical analysis using Mann-Whitney U test, Fisher's exact test, Chi-squared test and receiver operating characteristic (ROC) curve to determine the features useful for the differentiation of distinct types of lesions.

Results: The diagnosis of bilateral ovarian tumors was confirmed in eighty-one patients and the majority of the lesions were further classified into serous carcinoma (n = 36), mature teratoma (n = 20) and metastasis (n = 12). We assessed the existence of factors useful for the MR imaging differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors. Cancer antigen (CA) 125 serum level and maximum tumor diameter were significantly different between metastasis and serous carcinoma and similarly, between metastasis and primary malignant ovarian tumors. MR imaging morphology, ascites and peritoneal implants did not show any significant difference between the different types of lesions.

Conclusion: Within our patient cohort, most bilateral ovarian tumor lesions were determined to be serous carcinoma, mature teratoma or metastasis. CA 125 serum level and maximum tumor diameter are useful markers for the differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors.

Keywords: bilateral; cancer antigen 125; magnetic resonance imaging; maximum tumor diameter; ovarian tumor.

Figures

Fig. 1.
Fig. 1.
Flow diagram of patients presenting bilateral ovarian tumors on MR imaging examination. MR, magnetic resonance.
Fig. 2.
Fig. 2.
Representative case of a 50-year-old female patient presenting serous carcinoma (CA 125 serum level: 5066 U/mL). Bilateral multilocular cystic ovarian tumors with solid components, massive ascites and peritoneal implants (arrows) in the cul-de-sac are demonstrated on T2 weighted image (a) and contrast-enhanced T1 weighted image with fat-suppression (b). Solid components of ovarian tumors and peritoneal implants (arrows) show high intensity on DW image (c). CA, cancer antigen; DW, diffusion weighted.
Fig. 3.
Fig. 3.
Representative case of a 73-year-old female presenting serous carcinoma (CA 125 serum level: 3532 U/mL). Bilateral solid ovarian tumors, massive ascites and peritoneal implants (arrows) in the cul-de-sac are shown on T2 weighted image (a) and contrast-enhanced T1 weighted image with fat-suppression (b). Ovarian tumors and peritoneal implants show high intensity on DW image (c). CA, cancer antigen; DW, diffusion weighted.
Fig. 4.
Fig. 4.
Representative case of a 57-year-old female presenting metastasis from sigmoid colon cancer (CA 125 serum level: 651 U/mL). Bilateral multilocular ovarian cystic tumors with thick internal septae (arrows) are shown on T2 weighted image (a) and contrast-enhanced T1 weighted image with fat-suppression (b). CA, cancer antigen.

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