Fig. 2
From: Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses
A 37-year-old female presented with pelvic pain, urine incontinence, and menorrhagia. US revealed left complex (solid/cystic) adnexal lesion (GI-RADS 5). CA-125 was normal. a–d Conventional MRI: a–d axial T2, axial T1, and coronal T2-weighted images depict a large left adnexal predominantly solid lesion; it measures 17 cm with peripheral cystic area. It elicits low T1 and mixed T2 signals (intermediate/hyperintense). d Post-contrast fat suppression axial T1 WI shows intense heterogeneous enhancement of the solid component. e, f Diffusion WIs and ADC map demonstrate diffusion restriction of the solid component. ADC value measures 0.75 × 10−3 mm2/s. g DCE and color mapping: DCE shows type I curve, slowly raising curve. MRE%, 138.4%; Tmax, 197.7 s; WIR, 16.5. h Proton MRS at intermediate TE (144 ms): the spectrum shows sharp choline peak is observed around 3.2 ppm, small lactate peak is observed around 1.5 ppm, and absent NAA peaks, Cho/Cr ratio = 0.3. Conventional and multiparametric MRI diagnosis: Dynamic contrast MRI suggests benign nature of the lesion. Operative details: the patient was treated by myomectomy. i H&E stain with original magnification power 40 revealed a benign smooth muscle tumor formed of interlacing bundles of smooth muscles with fibro-vascular stroma. The muscle cells are spindle cells, with abundant eosinophilic cytoplasm and rod-shaped nuclei. Final pathological diagnosis: Left broad ligament fibroid