The ovaries are almond-shaped structures usually located in the ovarian fossae close to the lateral pelvic sidewall. Their size varies with age. In the adult, the ovary measures up to 3.0 cm in its longest dimension, but atrophies following the menopause reducing to a dimension of less than 2.0 cm.
The ovary is attached to the posterior surface of the broad ligament by a double fold of peritoneum, the mesovarium. Further support is given by the ovarian ligament proper and the suspensory ligament of the ovary that is continuous with the broad ligament attaching to the pelvic sidewall and in which the ovarian vessels and lymphatics run.
Each adult ovary contains approximately 70000 follicles. With each menstrual cycle some of these develop into Graafian follicles, one of which matures and releases an ovum at ovulation, leaving the corpus luteum. Therefore, the ovarian cortex contains immature follicles, Graafian follicles and corpora lutea. MR appearance
The adult ovary appears of intermediate signal intensity on T1W1. On T2W1 the central stroma is of low signal intensity with hyper-intense follicles identified in the high signal intensity peripheral cortex (Figure 3.16). Following intravenous Gd-DTPA, the central ovarian stroma enhances and contrasts with the low signal ovarian follicles.
Sometimes the ovaries can be difficult to locate on MR imaging. If the round ligament is identified and traced posteriorly, the ovaries lie in close proximity to it attached to it by the ovarian ligament. Peripherally located follicular cysts and surrounding small vessels help to differentiate the ovaries from adjacent bowel. Occasionally the ovaries are transposed from the pelvis using the ovarian vessels as a pedicle to an intraperitoneal paracolic or retrocaecal location in order to remove them from a pelvic radiation field. Knowledge of this is important to avoid confusion with metastatic disease.
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