الفهرس 
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Abstract
Adnexal masses are a commonly encountered gynecological problem.
Appropriate preoperative evaluation to discriminate between benign and malignant adnexal masses help guide gynecologists to refer women with suspected malignancies to a gynecologic oncologist for appropriatetherapy and optimal debulking, which is known to improve survival rate.
Ovarian cancer represents the second most common cancer of the female genital tract and the first cause of death due to gynecologic cancer. It is the most silent and deadly gynecological malignancies, because of the lack of clear symptoms and signs until its advanced stages.
Adnexal masses are more common in the reproductive age. Benign masses are more common than malignant. Epithelial tumors are more common than non-epithelial tumors. Cystadenoma is the most common cystic benign tumor. Fibromas and thecomas are the most common solid benign tumors.
MRI is useful in characterization of adnexal masses that are not completely evaluated by ultrasound. Contrast MRI has a high diagnostic accuracy for benign and malignant adnexal masses. characterization of adnexal masses by using Contrast MRI is contraindicated in patients with high serum creatinine levels, low glomerular filtration rate or history of allergy. Also, it needs more time and high cost.
Non-contrast MRI may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible. It can save time, decrease total cost of the study and avoid side effects of contrast.
Our study aimed to find out if the Non-Contrast MRI with Non-Contrast Scoring system can be substituted for Contrast MRI. So, we considered Contrast MRI that assessed by O-RADS as the gold standard to compare the sensitivity and specificity of Non-Contrast MRI using Non-Contrast MRI Scoring System with those of Contrast MRI using O-RADS.
The Non-Contrast Scoring System is a simple 5- point scoring system which aimed to be a practical qualitative score using morphological assessment and basic comparison of tumoral signal intensities on T2, DWI and ADC map with reference to standard tissues.
The study included thirty patients referred to MRI unit with adnexal lesion which was discovered on MRI or discovered on ultrasound in Ain Shams University Hospitals (inpatient ward and outpatient clinic). Each patient was subjected to pelvic MRI with contrast.
The study was performed by four readers. Two readers reported Non-Contrast MRI study using Non-Contrast MRI Scoring System and two readers reported Contrast MRI study using O-RADS. The readers of the Non-Contrast MRI study were blinded from the contrast MRI study. All readers were not aware of the results of each other. Comparison of reader 1 who assessed Non-Contrast MRI with reader 2 who assessed Contrast MRI & comparison of reader 3 who assessed Non-Contrast MRI with reader 4 who assessed Contrast MRI was done. Then, comparison between two readers of Non-Contrast MRI study (readers 1,3) and comparison between two readers of Contrast MRI study (readers 2,4) was done for inter-reader agreement.
Results revealed that there was no statistically significant difference found between contrast & non-contrast MRI. This indicates that Non-Contrast MRI has high accuracy and excellent inter-reader agreement for characterization of adnexal masses. So, Non-Contrast MRI can be a safe alternative method when contrast use is contraindicated.