الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Ovarian masses are the leading indication for gynecologic surgery. Management mainly depends on preoperative assessment to inform women about the surgical route, the feasibility of conservative treatment and the risk of laparotomy following initial laparoscopy. Ultrasonography is the first-line technique for detecting and characterizing adnexal masses but it is less accurate for complex or indeterminate masses, even when combined with color Doppler imaging. MRI can reveal morphologic characteristics as well as signal intensity characteristics. The use of diffusion MRI in addition to conventional MRI was tried by many authors in order to create new aspects to define malignancy and to characterize various pathological entities in different adnexal masses. They believed that ADC measurements are the most important and dependable data that could aid in addressing the nature of the lesion. MRS has been shown to provide information about the contents of organic compound tumors providing details of tumor metabolism that might well assist tumor grading and lead to a better understanding of the biochemical pathways found within a lesion. Our small practical study revealed that the most significant criteria for predicting benignity were low T2 SI within the solid component, low b1000 SI within the solid component, absence of solid portion, absence of ascites or peritoneal implants and absence of papillary projections. Determining the threshold of the ADC for diagnosing cystic ovarian tumors is difficult because of large variance of protein concentrations, viscosity, magnetic susceptibility, and volume of H2O. There is still controversy about the value of MRS study of adnexal masses. Cho peak couldn’t help in differential diagnosis between benign and malignant lesions. High lipid peak in the dermoid cysts was a characteristic finding reflecting a high content of fatty component. NAA signal was detected in dysgerminoma and all 3 cases of mature cystic teratomas denoting the presence of neural element (ectoderm). Finally we recommend further investigation involving a large number of cases and further efforts to elucidate the value of integrating the current imaging modalities with the metabolic information provided by H1MRS, to improve the strategies of noninvasive preoperative diagnosis.