Post-ovarian cystectomy imaging appearances for borderline ovarian tumors: Pearls and pitfalls

The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound and MRI lexicon guidelines have standardized preoperative assessment of adnexal masses and improved communication with clinicians. However, in premenopausal women who have undergone ovarian cystectomy, post-operative ovarian appearances may mimic indeterminate or suspicious lesions, posing interpreting challenges. This illustrative educational case series highlights characteristic post-operative imaging features following cystectomy for borderline ovarian tumors (BOTs), emphasizing some common pearls and pitfalls. The cases underscore that while O-RADS is validated for preoperative adnexal assessment, post-operative ovaries constitute a recognized gray zone where familiarity with these imaging nuances is crucial for accurate interpretation.