Krukenberg's tumor of the ovary: MR imaging features

Krukenberg's tumors are metastatic tumors of the ovary. Some of these tumors had hypointense solid components on T2-weighted MR images. The purpose of this study was to evaluate the MR features of Krukenberg's tumors and to compare them with those of other solid ovarian tumors to determine whether hypointense solid components on MR images were characteristic of Krukenberg's tumors. Twelve patients with 21 surgically proven Krukenberg's tumors of the ovary were included in the study; the tumors were bilateral in nine and unilateral in three. The MR images were studied to determine the morphologic characteristics and signal intensity patterns of the tumors (especially the presence or absence of hypointense solid components on T2-weighted images and isointense components on T1-weighted images). MR findings were correlated with histopathologic results. The MR features of 26 additional benign or malignant solid primary ovarian tumors were reviewed for comparison. Of the 21 Krukenberg's tumors, 14 were mostly solid and seven were entirely cystic or mostly cystic on MR images. All had sharp margins, and the oval configuration was preserved in 16. Twelve (57%) of the 21 tumors showed various amounts of hypointense solid components in random distribution or predominantly in the periphery on MR images; pathologically, these components corresponded to areas of dense collagenous stroma. MR imaging also showed that the cystic components within the masses had either well-defined or ill-defined borders. Multiseptation was noted in two masses. Of the 26 additional primary ovarian tumors, only three showed hypointense solid components on MR images. These included thecoma, fibrothecoma, and poorly differentiated adenocarcinoma. Our findings suggest that identification of hypointense solid components within an ovarian mass on T2-weighted MR images is a characteristic, although not specific, finding for Krukenberg's tumors, especially when the tumors are bilateral, have sharp margins, and have an oval configuration.