Clinical Study on Findings of Ultrasound and Computed Tomography Scan in the Diagnosis of Ovarian Mass Lesions

  • M Sunil Al Azhar Medical College and Super specialty Hospital, Thodapuzha, Kerala
  • M M Mishal Mohammed Karuna Medical College and Super Specialty Hospital, Palakkad, Kerala, India
Keywords: Computed tomography scan, Malignancy and metastases, Ovarian tumors, Ultrasonography


Background: Ultrasonography (USG) is a simple and noninvasive diagnostic tool that gives lots of data to accurately characterize most of the ovarian mass lesions with a sensitivity and specificity of 88–96% and 90–96%, respectively. However, the presence of significant variability in the terminology and definition of USG findings has led to the need for more standardization and uniformity in adnexal USG. Computed tomography (CT) scan is used primarily in patients with ovarian malignancies, either to assess disease extent before surgery or as a substitute for second-look laparotomy. Moreover, spiral CT has several advantages such as its rapidity and possibility of identifying all potential sites of peritoneal implants or lymphadenopathy as well as of the primary tumor site.
Aim of the Study: The study was to the clinical findings of both USG and CT scan of abdomen and pelvis in the accurate diagnosis of ovarian mass lesions.
Materials and Methods: A total of 104 patients with mass lesions of the ovary were included and subjected to USG and CT scan of abdomen and pelvis. Transabdominal and transvaginal USG studies were undertaken in all the patients. USG findings and CT scan findings were observed recorded and analyzed. Ovarian pathologies were categorized as benign, malignant, and metastasized and the results of CT and USG were compared.
Observations and Results: A total of 104 patients with ovarian mass lesions attending the Radiology Department of a Tertiary Teaching Hospital in Kerala were included in the study; patients were aged between 18 and 68 years with a mean age of 42.46 ± 5.70 years. Patients aged between 19 and 58 years accounted for more than 80% of the entire subjects. Hemorrhagic cyst was the most common mass lesion diagnosed in this study and accounted for 28 (26.92%) patients. Tubo-ovarian abscess accounted for 19/104 (18.26%) of the total cases. This was followed by mucinous cystadenoma 17/104 (16.34%), serous cystadenoma in 13/104 (12.50%) cases, polycystic ovarian disease in 11/104 (10.57%), mature cystic teratoma in 7/104 (6.73%), simple cyst in 6 (5.76%), Brenner tumor in 2/104 (1.92%), and endometrioma in 1/104 (0.96%) patients.
Conclusions: CT scan and USG are two excellent noninvasive methods to differentiate ovarian mass lesions from benign and malignant lesions and both imaging techniques seemed to be comparable in differentiating malignant from benign ovarian tumors. CT scan was more sensitive than USG, but sonography is more specific than CT scan in diagnosis of malignant lesions. USG has high positive predictive value as compared to CT scan to diagnose malignant lesions.

Author Biographies

M Sunil, Al Azhar Medical College and Super specialty Hospital, Thodapuzha, Kerala

Associate Professor, Department of Radiodiagnosis, 

M M Mishal Mohammed, Karuna Medical College and Super Specialty Hospital, Palakkad, Kerala, India

Associate Professor, Department of Radiodiagnosis, 


1. American College of Radiology, ACR Appropriateness Criteria.
Clinically Suspected Adnexal Mass. American College of Radiology;
2008. Available from:
qual i tysafety/appcr i ter ia/pdf /exper tpanelonwomenimaging/
suspectedadenexalmassesdoc11.aspx. [Last accessed on 2009 Nov 09].
2. Liu J, Xu Y, Wang J. Ultrasonography, computed tomography and magnetic
resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol
3. Valentin L, Ameye L, Jurkovic D, Metzger U, Lécuru F, Van Huffel S,
et al. Which extrauterine pelvic masses are difficult to correctly classify as
benign or malignant on the basis of ultrasound findings and is there a way
of making a correct diagnosis? Ultrasound Obstet Gynecol 2006;27:438-44.
4. Patel MD. Practical approach to the adnexal mass. Radiol Clin North Am
5. Geomini P, Kruitwagen R, Bremer GL, Cnossen J, Mol BW. The accuracy of risk scores in predicting ovarian malignancy: A systematic review. Obstet
Gynecol 2009;113:384-94.
6. Timmerman D, Schwärzler P, Collins WP, Claerhout F, Coenen M,
Amant F, et al. Subjective assessment of adnexal masses with the use of
ultrasonography: An analysis of interobserver variability and experience.
Ultrasound Obstet Gynecol 1999;13:11-6.
7. Van Calster B, Timmerman D, Bourne T, Testa AC, Van Holsbeke C,
Domali E, et al. Discrimination between benign and malignant adnexal
masses by specialist ultrasound examination versus serum CA-125. J Natl
Cancer Inst 2007;99:1706-14.
8. Valentin L. Use of morphology to characterize and manage common
adnexal masses. Best Pract Res Clin Obstet Gynaecol 2004;18:71-89.
9. American College of Obstetricians and Gynecologists. ACOG practice
bulletin. Management of adnexal masses. Obstet Gynecol 2007;110:201-14.
10. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian
mass at US: Incremental value of second imaging test for characterizationmeta-
analysis and bayesian analysis. Radiology 2005;236:85-94.
11. Koonings PP, Campbell K, Mishell DR Jr., Grimes DA. Relative frequency
of primary ovarian neoplasms: A 10-year review. Obstet Gynecol
12. Moszynski R, Szpurek D, Smolen A, Sajdak S. Comparison of diagnostic
usefulness of predictive models in preliminary differentiation of adnexal
masses. Int J Gynecol Cancer 2006;16:45-51.
13. Pérez-López FR, Chedraui P, Troyano-Luque JM. Peri and post-menopausal
incidental adnexal masses and the risk of sporadic ovarian malignancy: New
insights and clinical management. Gynecol Endocrinol 2010;26:631-43.
14. Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD,
Stern JL. Ovarian cancer: Staging with CT and MR imaging. Radiology
15. Sarti DA. Transvaginal sonography: A call for tempered enthusiasm. AJR
Am J Roentgenol 1993;161:95-6.
16. Taylor KJ, Schwartz PE. Screening for early ovarian cancer. Radiology
17. Young RH, Scully RE. Differential diagnosis of ovarian tumors
based primarily on their patterns and cell types. Semin Diagn Pathol
18. Woodward PJ, Hosseinzadeh K, Saenger JS. From the archives of the
AFIP: Radiologic staging of ovarian carcinoma with pathologic correlation.
Radiographics 2004;24:225-46.
19. Iyer VR, Lee SI. MRI, CT, and PET/CT for ovarian cancer detection and
adnexal lesion characterization. AJR Am J Roentgenol 2010;194:311-21.
20. Lalwani N, Shanbhogue AK, Vikram R, Nagar A, Jagirdar J, Prasad SR.
Current update on borderline ovarian neoplasms. AJR Am J Roentgenol
21. Prakash P, Cronin CG, Blake MA. Role of PET/CT in ovarian cancer. AJR
Am J Roentgenol 2010;194:W464-70.
22. Baert AL, Forstner R. Encyclopedia of Diagnostic Imaging: Carcinoma
Ovarium. Vol. 1. New York: Springer; 2008. p. 259.
23. Nam E, Kim Y, Kim J, Kim S, Kim S, Jang S, et al. Diagnosis and staging of
ovarian cancer: Comparative values of PET/CT, Doppler US, CT, and MRI
correlated with histopathologic analysis. J Clin Oncol 2008;26:55-67.
24. Lin FY, Schulman-Marcus J, Gransar H, Berman D, Callister T, DeLago A,
Hadamitzky M, et al. Coronary revascularization vs. medical therapy
following coronary-computed tomographic angiography in patients
with low, intermediate and high-risk coronary artery disease: Results
from the CONFIRM long-term registry. Eur Heart J Cardiovasc Imaging
25. Tsili AC, Tsampoulas C, Charisiadi A, Kalef-Ezra J, Dousias V,
Paraskevaidis E, et al. Adnexal masses: Accuracy of detection and
differentiation with multidetector computed tomography. Gynecol Oncol
26. Cochrane WJ, Thomas MA. Ultrasound diagnosis of gynecologic pelvic
masses. Radiology 1974;110:649-54.
27. Levi S, Delval R. Value of ultrasonic diagnosis of gynecological tumors in
370 surgical cases. Acta Obstet Gynecol Scand 1976;55:261-6.
28. Morley P, Barnett E. The use of ultrasound in the diagnosis of pelvic
masses. Br J Radiol 1970;43:602-16.
29. Queenan JT, Kubarych SF, Douglas DL. Evaluation of diagnostic ultrasound
in gynecology. Am J Obstet Gynecol 1975;123:453-65.
30. Meire HB, Farrant P, Guha T. Distinction of benign from malignant ovarian
cysts by ultrasound. Br J Obstet Gynaecol 1978;85:893-9.
31. Walsh JW, Taylor KJ, Wasson JF, Schwartz PE, Rosenfield AT. Gray-scale
ultrasound in 204 proved gynecologic masses: Accuracy and specific
diagnostic criteria. Radiology 1979;130:391-7.