The best test for general evaluation of the ovaries is an ultrasound. Ultrasound is quick, does not expose you to radiation and is often cheaper than many other tests. Other tests like CT or MRI provide valuable information as well. Often CT may be the first test done for evaluation of pelvic symptoms. This may discover an abnormality which than leads to an ultrasound.
Pelvic ultrasound is the most common test ordered for evaluation of the ovaries. This test evaluates the ovaries by placing the ultrasound probe on the abdomen. There is also a component of a pelvic ultrasound where the probe is inserted into the vagina. This allows a close detailed look at the ovaries. The test is done by a specially trained technologist. The radiologist interprets the test and provides a report to your doctor.
The most common abnormality of the ovaries I see are cysts. These can be normal or physiologic and usually resolve on their own. Some cysts can cause symptoms, especially when they are larger. Cysts can look complex or have blood inside them. Some cysts can even cause bleeding into the pelvis. Rarely, this may require surgery. Cysts that are complex looking will need follow up to make sure they are not cancerous.
Benign and malignant cancers are also often detected. These are often cysts with varying complexity inside. This means that there can be nodules along the wall. Septations or linear bands crossing the cyst. An internal consistency that does not look like simple fluid. The cysts that have blood flow inside the complex components become more concerning for cancer. Dermoid cysts are very common. These have different components inside like fat, calcium, hair and vein teeth.
A twisted or torsed ovary is another reason for ultrasound to be ordered. Ultrasound is able to detect blood flow to the ovary. A torsed ovary will have reduced blood flow and become swollen. Often this will present with sudden pain. A twisted ovary needs to be treated surgically to prevent complications.
An abscess of the ovary from pelvic inflammatory disease is another abnormality that ultrasound is good at picking up. This will look like a complex fluid filled mass involving the ovary and tube. Often the clinical history will support an inflammatory condition, with fevers, pain and vaginal discharge.
MRI of the pelvis and ovaries is often done for specific reasons and is not usually the first test done to evaluate the ovaries. MRI is often done to better evaluate a cyst or mass found on ultrasound. CT is not very good at looking at ovaries. CT may identify ovarian abnormalities on a test done for a different reasons. Ultrasound is often done after CT when an abnormality is discovered.
The best or first test done to look at the ovaries is an ultrasound. It allows a detailed view of the ovaries and any abnormalities. It can exclude cancer. It can rule out acute conditions like a twisted ovary. It’s good at detecting inflammatory conditions like abscesses. Sometimes MRI may be needed to take a closer look at something found in the ovary. Most commonly a cyst or mass of the ovary.