Female pelvic masses encompass a wide spectrum of pathologies arising from the uterus, cervix, ovaries, fallopian tubes, urinary bladder, bowel, and supporting pelvic structures. Accurate characterization of these lesions is crucial for determining appropriate management and surgical planning.

Ultrasonography remains the first-line imaging modality because of its accessibility, low cost, and absence of ionizing radiation. Nevertheless, ultrasound may be limited by patient habitus, bowel gas interference, operator dependency, and restricted field of view. Complex adnexal lesions, large pelvic masses, and malignant neoplasms often require further evaluation.

Magnetic Resonance Imaging (MRI) has emerged as the preferred problem-solving modality due to its superior soft tissue contrast, multiplanar imaging capability, and excellent tissue characterization. MRI facilitates accurate determination of lesion origin, internal architecture, local extension, vascular involvement, lymph node status, and metastatic disease.

The present study evaluates the role of MRI in female pelvic masses and correlates imaging findings with histopathological diagnosis.

Study Design

Retrospective observational study.

 Study Population

Female patients presenting with clinically suspected pelvic masses and referred for MRI evaluation.

 Inclusion Criteria

• Female patients with clinically suspected pelvic masses.
• Patients undergoing both ultrasonography and MRI evaluation.

 Exclusion Criteria

• Non-genitourinary pelvic masses.
• Contraindications to MRI examination.

 MRI Protocol

MRI examinations were performed using a 1.5 Tesla scanner. Imaging sequences included:

• Axial T1-weighted imaging
• Axial, sagittal and coronal T2-weighted imaging
• Fat-suppressed sequences
• Post-contrast sequences when indicated

 Lesions were evaluated for:

• Site of origin
• Size
• Morphology
• Internal consistency
• Presence of fat
• Hemorrhagic components
• Septations
• Mural nodules
• Local invasion
• Lymphadenopathy
• Ascites
• Peritoneal implants
• Distant metastases

Histopathological examination was considered the reference standard wherever available.

 Statistical Analysis

Data were analyzed using SPSS version 20.0. Descriptive statistics were expressed as frequency and percentage.

Age Distribution

Most pelvic masses were observed in women older than 45 years.

Table 1. Distribution of Pelvic Masses According to Internal Consistency

 Distribution of Adnexal Lesions

Table 2. Distribution of Adnexal Masses

 Anatomical Origin of Lesions

Table 3. Anatomical Distribution of Pelvic Lesions

Ovarian lesions represented the most common pelvic masses.

 MRI Characteristics

• Adnexal lesions were predominantly cystic.
• Uterocervical lesions were predominantly solid.
• Complex cystic ovarian masses demonstrated a higher incidence of malignancy.
• MRI accurately identified lesion origin in over 90% of cases.
• MRI provided additional diagnostic information in nearly half of cases.

Additional MRI Findings

MRI demonstrated superior diagnostic accuracy compared with ultrasonography in determining lesion origin and tissue characterization. The multiplanar capability of MRI enabled confident identification of adnexal, uterine, and cervical lesions even in large masses with distorted anatomy.

Adnexal lesions represented the most common category of pelvic masses. Benign lesions outnumbered malignant lesions; however, increasing lesion complexity, mural nodularity, thick septations, and solid components were strongly associated with malignancy.

 MRI showed particular value in identifying:

• Dermoid cysts through fat detection
• Endometriomas through T2 shading
• Hemorrhagic cysts through characteristic signal patterns
• Ovarian torsion through twisted pedicle visualization
• Malignant ovarian neoplasms through enhancement characteristics and local invasion

In uterocervical lesions, MRI accurately demonstrated myometrial invasion, cervical extension, parametrial infiltration, and lymph node involvement, making it superior for preoperative staging.

These findings are consistent with previous studies reporting MRI sensitivity approaching 95–100% and specificity ranging from 88–100% for characterization of female pelvic masses.

Limitations

• Single-center retrospective design.
• Limited sample size.
• Histopathological confirmation was unavailable in all cases.

Long-term follow-up data were not available.

MRI is an indispensable imaging modality in the evaluation of female pelvic masses. Its superior soft tissue resolution, multiplanar imaging capability, and excellent tissue characterization enable accurate determination of lesion origin, differentiation between benign and malignant lesions, and precise staging of pelvic malignancies. MRI significantly improves diagnostic confidence and contributes to optimal patient management and surgical planning.

MRI is an indispensable imaging modality in the evaluation of female pelvic masses. Its superior soft tissue resolution, multiplanar imaging capability, and excellent tissue characterization enable accurate determination of lesion origin, differentiation between benign and malignant lesions, and precise staging of pelvic malignancies. MRI significantly improves diagnostic confidence and contributes to optimal patient management and surgical planning.

Figure Legends

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