Role of Imaging in Differentiation between Malignant and Benign Ovarian Mass

High heterogeneity is a characteristic of ovarian masses and the differential diagnosis of benign and malignant ovarian tumors is of great significance for to choose the treatment planning approach. Clinical symptoms combined with tumor marker tests, sonography (TAS/TVS), computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, etc., can often make the diagnosis of ovarian cancer, but the differential diagnosis of ovarian masses is often challenging for the radiologists and requires further judgment. This problem has been improved by using newer preoperative imaging methods to predict ovarian tumoral subtypes (benign, borderline, or malignant), determining the origin of the tumor( ovary or the adnexa) and metastatic disease evaluation. Ultrasound especially TVS (transvaginal) as first- line imaging modality has the most important role of is the differentiation between benign and malignant status and can be done by a combination of 2D grey-scale imaging, color and spectral Doppler. Recently, diagnostic algorithms to differentiate between benign and malignant ovarian masses have been published, based on scoring systems for ultrasound findings, including Ovarian- Adnexal Reporting and Data System (O-RADS) US risk stratification or IOTA. In recent years, the spiral enhanced CT examination has come to be used in disease diagnosis. although it has a limited ability to tissue characterization (exception of fat and calcifications) due to poor contrast resolution of adnexal structures but It can be used to Preoperative staging and restaging after debulking surgery for malignant neoplasms and imaging of complications from ovarian cancer (such as obstruction) and Peritoneal implants. Compared to other imaging modalities, MRI has superior ability to characterize different soft-tissue types and high contrast resolution and qualitative diagnostic value. Thus, MRI plays an important role in the diagnosis and differential diagnosis of ovarian masses.