Adnexal masses: a compendium of established radiological signs

Priyanka Prajapati, Nabih Nakrour, Anuradha S Shenoy-Bhangle, Dheeman Futela, Mukesh G Harisinghani

Abdom Radiol (NY). 2025 Jul;50(7):3293-3304. doi: 10.1007/s00261-024-04669-y. Epub 2024 Dec 22.
Abstract
Adnexal masses are frequently encountered in general practice. Whether employing CT, US, or MRI, imaging plays a pivotal role in guiding appropriate treatment for patients with adnexal masses, potentially minimizing the need for surgery in benign cases and expediting the management of those with suspected malignancy. Accurately distinguishing benign from malignant adnexal masses can be challenging due to the confined pelvic space and the proximity of organs, making it difficult to determine their organ of origin or to distinguish tissue characteristics and imaging features. Radiologists have identified a myriad of classic adnexal imaging signs that are pathognomonic of certain diagnoses. Often named analogously to familiar objects, such as the "boba sign," familiarity with these signs can contribute to an accurate diagnosis, avoiding additional imaging tests. This pictorial review is a compendium of known radiological signs of adnexal pathologies, reiterating their role in making an accurate diagnosis, and guiding the next steps in management.