Pitfalls of MRI

• Hydrosalpinx and peritoneal inclusion cysts can be mistaken for cystic ovarian masses. Hydrosalpinx has a characteristic thin-

walled convoluted tubular structure most apparent on the T2W sagittal images. Peritoneal inclusion cysts typically have an extra-ovarian location remote from the peritoneal cul-de-sac, the expected location of ascites.

• No MR imaging characteristics are specific for malignant epithelial tumours. As described above certain features are suggestive of malignancy but thick walls and septations can also be seen in endometriosis, abscess, peritoneal cysts and benign neoplasms.

• Clot or debris in benign cystic masses such as haemorrhagic cysts can be mistaken for papillary projections but the use of

Gdchelate should eliminate this error, as genuine papillary projections will show enhancement.

• Metastases to the ovary result in a solid or partially cystic mass, which can be mistaken for a primary ovarian carcinoma.

These typically arise from stomach or colon cancer when they are known as Krukenberg tumours.

• Peritoneal or bowel wall inflammation will enhance and appear identical to peritoneal or serosal tumour on Gd-enhanced images.

• In acute bowel obstruction, it is difficult to differentiate intestinal and mesenteric enhancement secondary to bowel obstruction from recurrent disease.

• Like all imaging techniques, MRI has a poor sensitivity for the detection of peritoneal deposits and the majority of deposits are not seen. Calcified deposits are particularly difficult to detect with MRI.

• Normal post-surgical appearances can be mistaken for disease. A haematoma within the medial end of the divided round ligament, or the normal post-operative vaginal vault can be confused with deposits of disease. Peritoneal thickening and enhancement at the site of the abdominal incision can also lead to confusion and be misinterpreted as peritoneal disease deposits.

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