Imaging

Teratoma

Preliminary Diagnosis: Teratoma

I. What imaging technique is first-line for this diagnosis

  • Transabdominal or transvaginal ultrasound of the abdomen and pelvis.

II. Describe the advantages and disadvantages of this technique for diagnosis of teratoma.

Advantages

  • Well-validated and well-investigated sonographic features that are diagnostic for teratomas.

  • High sensitivity and very high positive predictive value (100%) when adnexal mass has 2 or more sonographic features known to be associated with teratomas.

  • Cheap and easily accessible.

  • Does not require use of ionizing radiation, and safe in pregnancy and children.

Disadvantages

  • Operator- and viewer-dependent.

  • Certain radiographic features may have overlap with other ovarian conditions, such as endometrioma.

  • Teratomas often have sonographic features that suggest a solid component, which may be mistaken for a solid ovarian mass and suggest malignancy.

  • Unable to fully assess for loco-regional or metastatic disease if malignant.

  • Limited view in obese patients or in patients with unusual abdominal anatomy.

  • Unclear whether transvaginal or transabdominal US is better to assess.

III. What are the contraindications for the first-line imaging technique?

  • There are no major contraindications to ultrasound of the abdomen/pelvis.

IV. What alternative imaging techniques are available?

  • CT of the abdomen and pelvis with IV contrast

  • MRI of the abdomen and pelvis with IV contrast

  • FDG-PET.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of teratoma.

CT of the abdomen and pelvis with IV contrast

Advantages

  • Excellent sensitivity for detection of fat and calcifications, which are present in most teratomas.

  • May be more beneficial in assessing other less common teratoma sub-types such as immature cystic and monodermal teratomas.

  • May provide better anatomy and characterization of teratoma and, if malignant, assess for loco-regional and/or metastatic spread.

  • Not operator-dependent.

Disadvantages

  • More expensive than ultrasound.

  • Limited ability to identify teratomas if fat not present.

  • Involves exposing the patient to ionizing radiation.

  • Involves the use of iodinated contrast.

MRI of the abdomen and pelvis with IV contrast

Advantages

  • Highly sensitive for identifying fat and calcifications, which are present in most teratomas.

  • Use of different MRI techniques increases the ability to distinguish fat (teratoma) from hemorrhagic cysts (endometrioma).

  • Better visualization of the anatomy of the teratoma and surrounding tissue. If malignant, better able to assess for local and metastatic spread.

Disadvantages

  • Requires the use of IV contrast.

  • Expensive

  • Limited accessibility in certain medical centers.

  • Not well-tolerated in obese patients, claustrophobic patients, or those with inability to hold breath.

  • Time-consuming

FDG-PET

Advantages

  • There are no advantages to the use of PET versus the imaging modalities described above.

Disadvantages

  • Expensive and not easily accessible.

  • Not well-studied or well-validated.

  • Limited in its ability to distinguish malignant processes from inflammatory conditions.

  • No reports on the behavior of teratomas with FDG-PET scanning.

VI. What are the contraindications for the alternative imaging techniques?

CT of the abdomen and pelvis with IV contrast

  • Contraindicated in pregnant patients

  • Contraindicated in patients with iodine allergies

  • Contraindicated in patients with renal insufficiency

MRI of the abdomen and pelvis with IV contrast

  • Contraindicated in patients with pacemakers, and patients with other implantable, MRI-incompatible devices

  • Contraindicated in patients with chronic renal failure.

FDG-PET

  • There are no major contraindications to this imaging modality.

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