Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging

Utility of the T2 dark spot sign

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36 Citations (Scopus)

Abstract

Purpose: To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. Materials and Methods: This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated. Results: Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively. Conclusion: The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas.

Original languageEnglish (US)
Pages (from-to)126-132
Number of pages7
JournalRadiology
Volume271
Issue number1
DOIs
StatePublished - 2014

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Endometriosis
Cysts
Confidence Intervals
Sensitivity and Specificity
Serous Cystadenoma
Health Insurance Portability and Accountability Act
Neoplasms
Research Ethics Committees
Informed Consent
Radiology
Ultrasonography
Magnetic Resonance Spectroscopy
Retrospective Studies
Databases
Hemorrhage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

@article{3e3a60211aa54ac0b24cfe030d0b37d6,
title = "Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: Utility of the T2 dark spot sign",
abstract = "Purpose: To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. Materials and Methods: This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated. Results: Sixteen of 45 endometriomas (36{\%}), zero of 25 hemorrhagic cysts, and two of four neoplasms (50{\%}) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93{\%}), 12 of 25 hemorrhagic cysts (48{\%}), and four of four neoplasms (100{\%}) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36{\%} (95{\%} confidence interval [CI]: 19.8, 51.3), 93{\%} (95{\%} CI: 83.9, 100), 89{\%} (95{\%} CI: 63.9, 98.1), and 48{\%} (95{\%} CI: 34.8, 61.8), respectively, and for T2 shading, they were 93{\%} (95{\%} CI: 84.0, 100), 45{\%} (95{\%} CI: 27.8, 61.9), 72{\%} (95{\%} CI: 58.9, 83.0), and 81{\%} (95{\%} CI: 53.7, 95.0), respectively. Conclusion: The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas.",
author = "Corwin, {Michael T} and Gerscovich, {Eugenio O} and Ramit Lamba and Machelle Wilson and McGahan, {John P}",
year = "2014",
doi = "10.1148/radiol.13131394",
language = "English (US)",
volume = "271",
pages = "126--132",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "1",

}

TY - JOUR

T1 - Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging

T2 - Utility of the T2 dark spot sign

AU - Corwin, Michael T

AU - Gerscovich, Eugenio O

AU - Lamba, Ramit

AU - Wilson, Machelle

AU - McGahan, John P

PY - 2014

Y1 - 2014

N2 - Purpose: To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. Materials and Methods: This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated. Results: Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively. Conclusion: The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas.

AB - Purpose: To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. Materials and Methods: This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated. Results: Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively. Conclusion: The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas.

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