Table 4.

Chart summarizes the typical imaging features of the different ovarian lesions

Group	Lesion	Findings	T2	T1	Gd-T1	Mean age
Cystic unilocular	Functional cysts	follicles (diameter <20 mm), dominant follicles (diameter 20–25 mm), follicular cysts, corpus luteum cysts.	high	low corpus luteum may show high signal	no enhancement corpus luteum may enhance	reproductive age
	Serous cystadenoma	often bilateral, thin regular wall (<3 mm) no internal septations, papillary projections or solid components	high	low	no enhancement
	Cystadenofibroma	sometimes: purely cystic lesion more often: complex cystic appearance with thick septa and solid components	high fibrous stroma: low signal intensity	low	no enhancement
Cystic multilocular	Endometriosis	haemorrhagic content	intermediate to low shading sign	high	no enhancement	reproductive age
	Mucinous cystadenoma	thin regular wall, several septations, no solid components monolateral	variable signal intensity (stained glass appearance)		no enhancement
	Borderline tumours	septa, papillary projections	intermediate	intermediate	enhancement of septa and papillary projections	45 younger patients than malignant ovarian cancer
Cystic and solid	Mature cystic teratoma	complex, heterogeneous appearance fat-tissue content	fat-tissue: high fat-tissue: low on fat-saturated sequences teeth: low signal intensity		variable	35
	Struma ovarii (monodermal teratoma)	complex mass with cystic spaces of variable signal intensity and solid areas thyroid tissue: thyrotoxicosis	cystic spaces with both high and low signal intensity cystic spaces with low signal intensity because of the colloid of the struma		enhancement of the cystic wall and solid components	50
	Ovarian metastasis	more often bilateral with a cystic and solid or a predominant solid morphological appearance from stomach, colon, breast, lung, contralateral ovary	intermediate to high	low to intermediate	enhancement of the cystic wall and solid components
	Serous cystadenocarcinoma	complex multilocular masses, thick and irregular walls, septations, solid components and papillary projections frequently bilateral	cystic: high solid: low	cystic: low to intermediate solid: intermediate	enhancement of walls, septations, solid components and papillary projections	60
	Mucinous cystadenocarcinoma	complex multilocular masses, thick and irregular walls, septations, solid components and papillary projections	cystic: high solid: low mucinous: variable	cystic: low to intermediate solid: intermediate mucinous: variable	enhancement of walls, septations, solid components and papillary projections
	Endometrioid adenocarcinoma	complex masses with solid and cystic components associated with endometriosis	haemorrhagic areas: intermediate	haemorrhagic areas: high	enhancement of walls and solid components	50–60
	Yolk sac tumour	mixed cystic and solid mass	haemorrhagic areas: intermediate	haemorrhagic areas: high	bright dot sign: foci of enhancement, dilated vessels	15–25
	Granulosa cell tumours	mixed cystic and solid mass hyperestrogenism, endometrial hyperplasia	cystic: high haemorrhagic: high solid: intermediate	cystic: low haemorrhagic: high solid: intermediate	enhancement of walls and solid components	60
Predominantly solid	Brenner tumour	fibrous content, calcifications	low	low to intermediate	no enhancement	50–70
	Dysgerminoma	lobulated lesion with fibrovascular septa, surrounded by a fibrotic capsule	solid component: intermediate to high septa: low	low to intermediate	enhancement of solid components and septa	25
	Fibrothecomas	fibrous tissue theca cells with lipidic content	low to intermediate	low to intermediate	minimal enhancement	60
	Fibromas	prominent fibrosis with abundant collagen content	low	low	moderate enhancement	60
	Thecomas	mainly lipidic content of theca cells	intermediate	intermediate lipidic content: low at chemical-shift (out of phase)	minimal enhancement	60
	Sertoli-Leydig cell tumours	solid mass or mixed cystic and solid mass 1/3 patients: signs of androgen activity	solid component: low scattered cystic areas: high	solid component: intermediate	enhancement of solid components	25–30