top of page

ADNEXAL FINDINGS (CT/MRI)

Last modified : September 23, 2025

Main reference: ACR 2020

Target population

  • Post menarcheal patients (if menarche unknown, recommandations may be applied if patient is ≥ 16 years old)

​​

  • Patient menopausal status

    • If known, include it in the report

    • If unknown,

      • < 50 years old = pre-menopausal

      • ≥ 50 years old = post-menopausal

​​

  • Exclusion

    • Lesions ≤ 1 cm

    • Stable lesions for ≥ 2 ans

    • Women with high genetic risks for ovarian neoplasms

    • Lesions potentially symptomatic (ex: pain)

Definition

  • Simple cyst

    • CT: -10- to 20 HU (take multiple ROI samples)

    • MRI: hyper T2 (compare with other known adjacent cystic structure like the bladder), hypo T1, without enhancement

    • Round ou oval

    • Imperceptible and smooth wall

    • No solid component

​​

  • Limited evaluation

    • Artefacts (ex: metallic prosthesis)

    • No I.V. contrast administered

    • Partial anatomic coverage

​​

  • Complete caractérisation on MRI

    • T2-weighted sequence 

    • T1-weighted pre- and post-contrast

    • Complete anatomical coverage of the lesion which is seen on ≥ 2 orthogonal planes

Important Notes

  • If symptomatic (for all lesion size)

    • DDx: hemorrhage, rupture, torsion

    • Consider consultation in gynecology

Additional notes

  • Adnexal cysts may be variable evolution²

    • 14% of menopausal women have at least one adnexal cyst

    • 32% resolve on follow up

    • 8% have new cyst on follow up

​​

  • No increase risk of ovarian cancer in patients with adnexal cysts

    • Cyst on CT = no increased risk of cancer 

    • Reason for recommended follow-up for some cysts:  1) risk of mischaracterization on ultrasound et 2) cystadenomas (benign neoplasm) may progress and become symptomatic

Figures

Figure 1 - ACR.jpg

Figure 1. ACR 2020 original summarized recommandations for incidental adnexal findings on CT or MRI

Table 1. ACR 2020 summarized recommandations for management of incidental adnexal findings

References

  1. Patel, Maitray D., et al. “Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee.” Journal of the American College of Radiology, vol. 17, no. 2, Feb. 2020, pp. 248–254. doi:org/10.1016/j.jacr.2019.10.008.

  2. ​Greenlee RT, Kessel B, Williams CR, Riley TL, Ragard LR, Hartge P, Buys SS, Partridge EE, Reding DJ. Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial. Am J Obstet Gynecol. 2010 Apr;202(4):373.e1-9. doi: 10.1016/j.ajog.2009.11.029.

  3. Levine D, Patel MD, Suh-Burgmann EJ, Andreotti RF, Benacerraf BR, Benson CB, Brewster WR, Coleman BG, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow MM, Hur HC, Marnach ML, Pavlik E, Platt LD, Puscheck E, Smith-Bindman R, Brown DL. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology. 2019 Nov;293(2):359-371. doi: 10.1148/radiol.2019191354.

bottom of page