Page 140 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Ovarian cyst differentiation score

1. Introduction To solve this problem, this study proposed an
innovative solution: To construct a scoring system
Endometriosis, a chronic inflammatory condition based on CT imaging features and clinical features. By
influenced by estrogen, significantly diminishes the selecting imaging and clinical factors that are important
quality of life for many women. It is marked by common for differential diagnosis, and assigning corresponding
1-3
symptoms such as infertility and pelvic pain, with 30 – 50% scores to these factors, the system can achieve quantitative
of those affected experiencing infertility and an increased evaluation of the two diseases. This approach is designed
risk of early miscarriage. Post-surgical recurrence rates to simplify and optimize the diagnostic process, allowing
3-6
are high, reaching 21.5% within 2 years and 40 – 50% within doctors to stratify risks more quickly and accurately,
5 years. The condition presents in three primary forms: reducing subjectivity and uncertainty in the diagnostic
7
Peritoneal endometriosis, ovarian endometriotic cysts, and process.
8,9
deep infiltrating endometriosis. Ovarian endometriotic
cysts, the most prevalent type, are characterized by cystic This study aims to develop and validate a scoring system
masses on the ovaries. However, ovarian cystic masses based on CT and clinical features, to provide a powerful
10
can also include benign cystadenomas, which are the tool for improving diagnostic efficiency and accuracy by
most frequent type. 11,12 The imaging features of these simplifying and optimizing the clinical diagnostic process
lesions often overlap, complicating diagnosis due to their of ovarian endometriotic cysts and ovarian cystadenomas.
distinct treatment protocols. Ovarian endometriotic Through this study, we hope to provide clinicians with a
cysts typically require comprehensive, age- and stage- more convenient and reliable diagnosis method, thereby
specific management, including early empirical drug improving the diagnosis and treatment experience of
therapy and long-term post-operative medication to patients.
prevent recurrence. In contrast, ovarian cystadenomas 2. Methods
9
are primarily managed through surgical excision to
alleviate symptoms caused by the masses. Endometriosis 2.1. Research sample
12
often presents with atypical symptoms, and its definitive A retrospective analysis was performed on a cohort
diagnosis relies on laparoscopic examination, which is comprising 151 patients from the Second Affiliated
invasive and frequently delayed. Early diagnosis, therefore, Hospital of Zhejiang University School of Medicine
hinges on imaging examinations, presenting a significant (referred to as Hospital 1), pathologically confirmed
challenge for radiologists. to have either ovarian endometriotic cysts (n = 68) or

Ultrasound is the preferred diagnostic method for ovarian ovarian cystadenomas (n = 83) between March 2012 and
endometriotic cysts but can be limited by gastrointestinal June 2021. This group served as the training cohort. The
gas and operator expertise, which potentially impact inclusion criteria for this study were as follows: (1) patients
the imaging accuracy. 13,14 Magnetic resonance imaging with pathologically confirmed of ovarian endometriotic
(MRI), known for its excellent soft tissue resolution, is also cysts or ovarian cystadenomas, (2) patients whose image
widely used but is costly and time-consuming. High signal quality meets diagnostic requirements, (3) patients with
intensity on T1-weighted MRI is a key indicator of ovarian no history of malignant tumors, and (4) patients who did
endometriotic cysts. 10,13,15 However, this can also result not experience cyst rupture. Due to incomplete clinical
from hemorrhages or mucoid fluid, leading to potential data, nine patients were excluded from the analysis
misdiagnoses with mucinous cystadenomas, which have (Figure 1). To validate our findings, a separate cohort
a misdiagnosis rate of nearly 22%. With rapid scanning was assembled from 51 patients at the Affiliated Jinhua
16
and broad coverage, computed tomography (CT) is often Hospital of Wenzhou Medical University (Hospital 2),
the first choice of imaging modality for patients presenting confirmed to have ovarian endometriotic cysts (n = 20)
with abdominal pain, enabling detection of ovarian cystic or ovarian cystadenomas (n = 31) between January 2019
lesions. However, radiologists often face challenges in and August 2023.
differentiating ovarian endometriotic cysts from ovarian
cystadenomas on CT, resulting in delayed diagnoses and 2.2. CT acquisition
treatment. Although studies have explored CT features Routine plain scans were performed on all subjects in
of benign ovarian cystic lesions, such as the utility of CT the supine position using multi-slice spiral CT scanners,
texture analysis in distinguishing benign ovarian cysts including the SOMATOM Definition Flash (Siemens
12
and the multi-slice spiral CT manifestations of benign Healthcare) and the Philips Medical Systeme 64 (Philips
11
adnexal lesions, the findings are overly complex and lack Healthcare). Scanning parameters were as follows: tube
quantifiable feature assessment. voltage 120 kV, tube current 180 mAs, slice thickness

Volume 9 Issue 2 (2025) 132 doi: 10.36922/ejmo.8507