Ovarian Masses and O-RADS

A Systematic Approach to Evaluating and Characterizing Adnexal Masses With Ultrasound

Ana Mitchell, MD; Austin Kwong, MD; Simran Sekhon, MD; John P McGahan, MD, FACR


Appl Radiol. 2021;50(3):24-31. 

In This Article

Germ Cell Tumors

Dermoid cysts and teratomas are classified as germ cell tumors (Table 4), account for 15–20% of all ovarian neoplasms and are rarely malignant. Teratomas may be mature or immature. Dermoid cysts are mature cystic teratomas that may have components from 3 germ-cell layers that predominantly include mature ectoderm elements.

Ultrasound and CT features of dermoids include cystic components, fatty elements, hair, and/or calcifications (Figure 2). Thus, a hyperechoic component with acoustic shadowing in a predominantly cystic mass on ultrasound is highly predictive of a dermoid cyst. These cysts can also demonstrate a variety of other sonographic features, including a hyperechoic component with acoustic shadowing, hyperechoic lines and dots, or floating echogenic spherical structures. A Rokitansky nodule is a solid mass of sebaceous material projecting into the lumen of the mass. Most cases require no further evaluation upon identification of classic ultrasound or CT features of O-RADS 2 lesions.