Thread by @monikahye

Oy vey, the ovary! @EinsteinRads simplifies the approach to simple adnexal cysts.

Benign-appearing Incidental Adnexal Cysts at US, CT, and MR: Putting It All Together
doi.org/10.1148/rg.210…
@cookyscan1 @RadioGraphics @peterwangmd @otto07758644
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Three major consensus papers were published between 2019 and 2020: the SRU Consensus Update on Adnexal Cysts, the O-RADS US Consensus Guideline, and the Management for Incidental Adnexal Findings on CT and MRI (ACR White Paper).

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Most simple adnexal cysts do not require follow-up. The updated SRU guidelines provide thresholds for follow-up of 3-5 cm for postmenopausal and 5-7 cm for premenopausal patients. If a cyst decreases in size on follow-up, continued imaging is usually unnecessary.

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Compared to SRU, O-RADS is more comprehensive, providing a standardized lexicon of ultrasound descriptors and detailed risk stratification of more complex adnexal masses.

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Increased use of CT and MRI has unsurprisingly led to increased detection of adnexal cysts. The White Paper tried to align guidelines for CT and MRI with prior ultrasound studies.

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Here is a flow chart of recommendations for incidental simple-appearing adnexal cysts on CT/MRI that are > 1 cm and < 10 cm.

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Updated SRU and O-RADS guidelines provide similar follow-up and management recommendations for simple adnexal cysts. These are aligned with CT/MRI by the ACR White Paper.

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In summary, adnexal lesions are common and usually benign. Imaging plays an important role in risk-stratification. Simple adnexal cysts often do not require imaging follow-up.

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Thanks for tuning in! What’s your approach when encountering incidental adnexal lesions?

doi.org/10.1148/rg.210…

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