Fig. 1

Female patient, 60 years old, complaining of lower abdominal pain for 5 months. US showed right adnexal complex cystic mass with soft tissue component. a–d Conventional MRI images confirmed the presence of right adnexal complex cystic mass measuring 6 × 5 × 5 cm AP, C.C, and TS with central cystic component shows hypo-intense signal in T1WI and hyper intense signal in T2WI, and its solid component with intermediate signal in both T1WI and T2WI and faint contrast enhancement in post-contrast image. e, f Proton MRS (TE = 288 m sec) a multi-voxel into the solid component and into the cystic component of the mass respectively; a sharp lipid, lactate peak is observed around 1.3 ppm in both. Conventional MRI-based diagnosis: Malignant looking right adnexal complex cystic mass inseparable from adjacent bowel loops; MRS diagnosis: Confirm the malignant nature of the lesion with Cho/Cr ratio 2.27; Pathological diagnosis: Serous cyst adenocarcinoma