Struma ovarii MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

MRI may be helpful in the diagnosis of Struma ovarii. Findings on MRI suggestive of Struma ovarii include solid and cystic lesions.

MRI

• MRI may be helpful in the diagnosis of Struma ovarii. Findings on MRI suggestive of Struma ovarii include:
  • Solid and cystic lesions.
• Pre-operative radiological diagnosis is essential in order to avoid ovarian cancer type surgery (bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy).
• Advanced MRI may be helpful in identifying and to determine the unusual ovarian mass.
• Occasionally struma ovarii may present as a purely cystic lesion.

Three-tesla MR images of a mature teratoma or dermoid cyst arising from the left ovary in a 53-year-old patient. The fatty component in the lesion is hyperintense on the 3D-LAVA fat-only T1-weighted image (a) and hypointense on the water-only T1-weighted image (b) (arrows). c T2-weighted high-resolution image shows the fatty component within the lesion to be hyperintense (arrow). The nidus itself contains a fatty component that is also hyperintense on 3D-LAVA fat-only T1-weighted image (a) and hypointense on the water-only T1-weighted image (b) (arrowheads). d Diffusion-weighted image using a b value of 1,200 s/mm2 shows a high signal intensity rim representing restricted diffusion from sebaceous material surrounding the nidus and punctuate areas of restricted diffusion scattered throughout the nidus (arrowhead). The pedunculated uterine fibroid (T) at the level of the right lateral aspect of the uterus presents with typical hypointensity on T2 (c) without associated restricted diffusion (d)

(a), diffusion-weighted images with b = 1,200 mm/s2 (b) and T1 fat-saturated images (LAVA) pre-gadolinium (c) and post-gadolinium (d) within the left hemi-pelvis. The solid portion of the mixed solid and cystic lesion presents with the typical low signal intensity on the T2-weighted image (a) and intermediate signal intensity on the T1-weighted image (c) (arrows). d These solid components enhance markedly (arrow) which together with the multilobulate surface resemble a “lacy” pattern. b This lacy pattern in keeping with solid thyroid tissue is also obvious on the diffusion-weighted images (arrow)

Three-tesla T2 high-resolution images of a benign and malignant struma ovarii for comparison. a Sagittal image showing the large mixed solid and cystic malignant struma (arrow). b Axial plane image through a benign struma shows an equally complex large lesion (arrow). a, b Ascites is present in both the benign and the malignant case (A)