Adnexal masses in pregnancy: Added value of magnetic resonance imaging in guiding patient management—our initial experience

Abstract

Aim: To assess the role of magnetic resonance imaging in management of adnexal masses encountered during pregnancy. Materials and methods: A prospective study was conducted in 40 pregnant patients referred for magnetic resonance imaging (MRI) abdomen and pelvis after indeterminate findings on ultrasound examination. Total 13 of these 40 patients with adnexal lesions on both ultrasound and MRI were further studied in detail. The MRI images were acquired on 1.5 T machines. Only patients in whom follow up and final diagnosis were available were included in the study. Results: The 13 cases of adnexal lesions included 9 benign pathologies and 4 malignant adnexal lesions. MRI had accurately diagnosed malignancy in three of these patients with torsion additionally detected in the fourth patient. The 9 remaining cases were correctly interpreted as benign pathologies on MRI, which included cases of benign serous cystadenomas (n = 2), mature cystic teratomas (n = 2), endometriotic cyst (n = 1), hemorrhagic corpus luteal cyst (n = 1), torsed ovary (n = 1), hyperstimulated ovaries (n = 1) and subserosal fibroid with red degeneration (n = 1). MRI played a definitive role in deciding course of management in all cases of adnexal masses that required further characterization following initial ultrasound. ollowing MRI, nine patients underwent surgery during the ongoing pregnancy, one patient underwent ovarian cystectomy concurrently at the time of caesarean section, two patients were managed conservatively with imaging follow up and surgery was deferred until after delivery in one case. Conclusion: Although sonography is the primary imaging tool in evaluating obstetric patients, in selected cases where ultrasound is equivocal or indeterminate, MRI can serve as a problem solving tool to arrive at an accurate diagnosis and guide patient management. Clinical significance: Adnexal masses discovered in pregnancy present a clinical and imaging challenge. The MRI can decide the course of management by delineating benign and malignant entities and dictating the need for surgical intervention versus feasibility of conservative treatment.