BENIGN AND MALIGNANT GYNECOLOGIC DISEASE - CLINICAL IMPORTANCE OF FLUID AND PERITONEAL ENHANCEMENT IN THE PELVIS AT MR-IMAGING

PURPOSE: To correlate magnetic resonance (MR) imaging findings of pelv ic fluid, peritoneal enhancement, and peritoneal nodules with the pres ence of benign or malignant pelvic disease. MATERIALS AND METHODS: Pel vic MR imaging findings in 87 women (mean age, 46 years) who subsequen tly underwent surgery were retrospectively reviewed. Phased-array mult icoil, axial spin-echo T1-weighted MR images and axial fast spin-echo T2-weighted images were obtained. The largest pelvic fluid pocket was measured on the T2-weighted images in three orthogonal dimensions. Per itoneal enhancement and nodules were evaluated on gadolinium-enhanced MR images in 54 women.RESULTS: Pelvic fluid was shown in 21 of 25 pati ents with malignant neoplasms and 48 of 62 patients with benign disord ers. Larger fluid pockets were associated with malignancy rather than with benign disorders, but there was substantial overlap. Use of perit oneal enhancement to diagnose peritoneal spread of tumor had a sensiti vity, specificity, accuracy, and positive predictive value of 92% (11 of 12), 86% (36 of 42), 87% (47 of 54), and 65% (11 of 17), respective ly. Use of peritoneal nodules for peritoneal spread had a higher speci ficity (90% [38 of 42]) and positive predictive value (69% [nine of 13 ]), although the sensitivity was lower (75% [nine of 12]). CONCLUSION: Large peritoneal fluid pockets are moderately predictive of malignanc y or peritoneal spread of tumor. Peritoneal enhancement and enhancing peritoneal nodules are more sensitive and more specific.