Early View
MEDICAL IMAGING—PICTORIAL ESSAY

Imaging Clues to Differentiate Uterine From Adnexal Masses—Value of Vascular Anatomy and Enhancement Patterns—A Pictorial Essay

Chandrika Kandur

Chandrika Kandur

Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, India

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Amit Patle

Amit Patle

Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, India

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Abhishek Arora

Abhishek Arora

Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, India

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Annapurna Srirambhatla

Corresponding Author

Annapurna Srirambhatla

Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, India

Correspondence:

Annapurna Srirambhatla ([email protected])

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First published: 02 July 2025

Funding: The authors received no specific funding for this work.

ABSTRACT

In gynaecologic imaging, recognising the organ of origin of a pelvic mass, uterine versus adnexal, is crucial because it significantly impacts the surgical approach and treatment outcome. Ultrasound is the first line of imaging for female pelvic masses. However, due to its inherent drawbacks, ultrasonography cannot delineate the origin of large masses that distort the normal relations between the pelvic organs. Contrast-enhanced MR imaging (CE-MRI) is a problem-solving tool due to its multidimensional imaging capabilities and soft tissue contrast. Imaging features such as the anatomical location, signal intensity of mass on T2W images, displacement/mass effect on adjacent pelvic/vascular structures and enhancement patterns are studied for making this distinction. A key aspect of this differentiation is the analysis of vascular anatomy, displacement of vessels and the patterns of enhancement. This pictorial essay discusses how the vascular supply, displacement of vessels and enhancement pattern of masses on MRI provide imaging clues which help in distinguishing uterine from adnexal masses.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data are available with the corresponding author on reasonable request.

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