Medical Radiology and Radiation Safety. 2026. Vol. 71. № 1
DOI:10.33266/1024-6177-2026-71-1-82-89
Najah Raham Rashid1, Yusur Muhammad Said Thabit Al-Rawi1,
Khaleel Akeash Hadi2
Adnexal Masses Insight: The Role of the Diffusion-Weighted MRI
1 Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq
2 X-Ray Institute, Baghdad Medical City, Baghdad, Iraq
Contact person: Khaleel Akeash Hadi, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Abstract
Background: Making the distinction between malignant and benign tumors is an important step in the management of adnexal masses. With the differentiation ability among benign and malignant lesions and the magnetic resonance imaging role in treatment response evaluation. At the molecular level, diffusion-weighted magnetic resonance imaging provides a cellularity quantitative functional assessment.
Purpose: To assess Diffusion-Weighted Magnetic Resonance Imaging’s diagnostic potential in the preoperative evaluation of adnexal mass by contrasting it with histopathological analysis.
Methods: A prospective study conducted in Radiology Unit during a period of two years from February 2023 to February 2025. It involved 74 women diagnosed with adnexal mass by ultrasound without knowing its type of nature whether its malignant or benign and then referred to the MRI unit before the operation for adnexal lesions characterization which detected on ultrasound.
Results: The malignant lesions had significantly lower mean ADC value was than in benign lesions. ADC value < 0.89 ×10‒3 mm²/sec. is predictive for malignant lesion. Sensitivity of MRI was 78.6 %, specificity was 89.1 % and accuracy was 85.1 %. Positive predictive value was 81.5 % while negative predictive value was 87.2 %.
Conclusion: Magnetic Resonance Weighted with weight image when it comes to diagnosing and characterizing adnexal masses, imaging it is a legitimate and trustworthy method. To distinguish between different kinds of adnexal lesions, it can enhance the diagnostic usefulness of MR criteria. Based on imaging characteristics, it can help distinguish malignant from benign lesions and is particularly useful in describing the tissue composition of the tumor.
Keywords: MRI, DWI, restriction, adnexal
For citation: Najah Raham Rashid, Yusur Muhammad Said Thabit Al-Rawi, Khaleel Akeash Hadi. Adnexal Masses Insight: The Role of the Diffusion-Weighted MRI. Medical Radiology and Radiation Safety. 2026;71(1):82–89. DOI:10.33266/1024-6177-2026-71-1-82-89
References
1. Salvador S, Scott S, Glanc P, Eiriksson L, Jang J-H, Sebastianelli A, et al. Guideline No. 403: Initial Investigation and Management of Adnexal Masses. Journal of Obstetrics and Gynaecology Canada. 2020;42;8:1021-9.e3.
2. Vázquez-Manjarrez S.E., Rico-Rodriguez O.C., Guzman-Martinez N., Espinoza-Cruz V., Lara-Nuñez D. Imaging and Diagnostic Approach of the Adnexal Mass: what the Oncologist Should Know. Chinese Clinical Oncology. 2020;9;5:69.
3. Ladke P., Mitra K., Dhok A., Ansari A., Dalvi V. Magnetic Resonance Imaging in the Diagnosis of Female Adnexal Masses: Comparison with Histopathological Examination. Cureus. 2023;15;7:e42392.
4. Sadowski E.A., Thomassin-Naggara I., Rockall A., Maturen K.E., Forstner R., Jha P., et al. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology. 2022;303;1:35-47.
5. Atri M., Alabousi A., Reinhold C., Akin E.A., Benson C.B., Bhosale P.R., et al. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, no Acute Symptoms. Journal of the American College of Radiology. 2019;16;5:S77-S93.
6. Awais A., Sarfraz S., Saleem F., Sajjad S., Tariq T., Aruj Agn. The Diagnostic Accuracy of Dynamic MRI in Diagnosis of Complex Adnexal Masses. Age (Years). 2021;40:40.
7. Setiawati R., Suarnata M.S., Rahardjo P., Filippo D.G., Guglielmi G. Correlation of Quantitative Diffusion Weighted MR Imaging between benign, Malignant Chondrogenic and Malignant Non-Chondrogenic Bone Tumors with Histopathologic Type. Heliyon. 2021;7;3:e06402.
8. McDermott M.C., Wildberger J.E., Bae K.T. Critical But Commonly Neglected Factors that Affect Contrast Medium Administration in CT. Insights into Imaging. 2024;15;1:219.
9. Srirambhatla A., Hosamani R.D., Nandury E.C. The Role of Diffusion-Weighted Imaging in the Evaluation of Adnexal Lesions. Pol J Radiol. 2022;87:e469-e77.
10. Sahu S.A., Shrivastava D. A Comprehensive Review of Screening Methods for Ovarian Masses: Towards Earlier Detection. Cureus. 2023;15;11:e48534.
11. Ali R.F., Nassef H.H., Ibrahim A.M., Chalabi N.A.M., Mohamed A.M. The Role of Diffusion Weighted Imaging in Suspected Cases of Ovarian Cancer. Egyptian Journal of Radiology and Nuclear Medicine. 2020;51;1:97.
12. Liberto J.M., Chen S.Y., Shih I.M., Wang T.H., Wang T.L., Pisanic T.R. Current and Emerging Methods for Ovarian Cancer Screening and Diagnostics: a Comprehensive Review. Cancers (Basel). 2022;14:12.
13. Shebreya N., Dawlat A., Keriakos N. Role of DWI MRI as a Recent Modality in Differentiation between Benign from Malignant Ovarian Tumors. The Medical Journal of Cairo University. 2020;88:1699-706.
14. Li X-r., Cheng L-q., Liu M., Zhang Y-j., Wang J-d., Zhang A-l., et al. DW-MRI ADC Values can predict Treatment Response in Patients with locally Advanced Breast Cancer Undergoing Neoadjuvant Chemotherapy. Medical Oncology. 2012;29:425-31.
15. Gangadhar K., Mahajan A., Sable N., Bhargava P. Magnetic Resonance Imaging of Pelvic Masses: a Compartmental Approach. Seminars in Ultrasound, CT and MRI. 2017 Jun;38;3:213-230. Doi: 10.1053/j.sult.2016.11.004.
16. El Ameen N.F., Eissawy M.G., Mohsen L.A.M., Nada O.M., Beshreda G.M. MR diffusion Versus MR Perfusion in Patients with Ovarian Tumors; how far Could we Get? Egyptian Journal of Radiology and Nuclear Medicine. 2020;51:1-11.
17. Ahmad K.A., Abdrabou A. The Significance of Added ADC Value to Conventional MR Imaging in Differentiation between benign and Malignant Ovarian Neoplasms. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45;3:997-1002.
18. Jaafer LS. Role of MRI Diffusion Weighted Imaging in Differentiation between Benign and Malignant Ovarian Masses. AL-Kindy College Medical Journal. 2017;13;2:26-33.
19. Bonde A., Andreazza Dal Lago E., Foster B., Javadi S., Palmquist S., Bhosale P. Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article. Cancers. 2022;14;18:4468.
20. Okuyama K., Tsuchiya M., Debnath K.C., Islam S., Yanamoto S. Desmoplastic Reaction in the Microenvironment of Head and Neck and other Solid Tumors: the Therapeutic Barrier. Ther Adv Med Oncol. 2025;17:17588359251317144.
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.11.2025. Accepted for publication: 25.12.2025.




