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Ovaries

The ovaries are paired female gonads located in the pelvis, responsible for producing ova (eggs) and secreting reproductive hormones. They are almond-shaped structures that change in size and appearance throughout life, being most active during reproductive years and undergoing involution after menopause. They are crucial both as endocrine glands and as the site of gamete maturation.

Synonyms

  • Female gonads

  • Ovarian glands

  • Reproductive glands (female)

Location and Relations

  • Location: Situated in the lateral pelvic wall within the ovarian fossa, one on each side of the uterus

  • Anterior relations: Broad ligament and ovarian vessels

  • Posterior relations: Ureter and internal iliac vessels

  • Superior relations: Loops of small intestine or sigmoid colon

  • Inferior relations: Pelvic floor muscles and surrounding connective tissue

Structure

  • Surface: Covered by a layer of cuboidal epithelium (“germinal epithelium”) and underlying tunica albuginea

  • Cortex: Contains ovarian follicles at various stages of development

  • Medulla: Contains connective tissue, blood vessels, lymphatics, and nerves

  • Hilum: Entry site for vessels and nerves at the attachment to the mesovarium

Function

  • Production and release of ova (oogenesis)

  • Secretion of reproductive hormones: estrogen, progesterone, inhibin, relaxin

  • Regulation of the menstrual cycle

  • Support of early pregnancy through corpus luteum activity

Clinical Significance

  • Common site for cysts (follicular, corpus luteum, dermoid cysts)

  • Primary and secondary ovarian tumors (benign or malignant)

  • Involved in gynecologic emergencies such as ovarian torsion, rupture, or hemorrhage

  • Hormonal disorders such as polycystic ovarian syndrome (PCOS) involve ovarian dysfunction

  • Ovarian pathology is key in infertility evaluation and management

MRI Appearance

T1-weighted images:

  • Ovaries show low-to-intermediate signal intensity

  • Small cysts appear as low signal intensity structures

  • Hemorrhagic cysts appear as bright foci

T2-weighted images:

  • Ovaries show intermediate signal intensity

  • Follicles and cysts appear bright

  • Endometriomas show shading (variable signal intensities)

STIR (Short Tau Inversion Recovery):

  • Normal ovarian tissue shows intermediate signal

  • Cysts and edema appear bright

  • Pathology (e.g., inflammation, torsion) shows increased signal

T1 Fat-Sat Post-Contrast:

  • Normal ovarian stroma enhances moderately and uniformly

  • Cysts show no internal enhancement but may have enhancing walls

  • Tumors and solid components enhance variably, depending on vascularity

CT Appearance

Non-Contrast CT:

  • Ovaries appear as soft tissue density structures in the adnexa

  • Cysts appear as well-defined low-density lesions

  • Hemorrhagic cysts may show hyperdensity

Post-Contrast CT:

  • Ovarian stroma enhances homogeneously

  • Cysts show thin rim enhancement

  • Solid or neoplastic masses show heterogeneous enhancement

  • Abscesses show rim enhancement with central low density

MRI image

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MRI image

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