Presacral Masses: Imaging and Pathologic Correlation Guide

Presacral masses are uncommon; ~60% of solid and 10% of cystic lesions are malignant. MRI characterizes composition and enhancement. In cystic lesions, solid enhancing components are the most reliable sign of malignancy.

• For benign-appearing, small, asymptomatic cystic lesions, periodic imaging surveillance may be an alternative to immediate surgery, with intervention reserved for worrisome changes.
• The article provides an imaging-based algorithm to narrow the differential diagnosis and suggests essential elements for the MRI report to guide surgical planning.
• The role of preoperative biopsy is discussed, acknowledging its potential to alter management in select cases.

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