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24-03-2022 | Magnetic Resonance Imaging | Urogenital

How to improve O-RADS MRI score for rating adnexal masses with cystic component?

Authors: Victoria Assouline, Yohann Dabi, Aurélie Jalaguier-Coudray, Sanja Stojanovic, Ingrid Millet, Caroline Reinhold, Marc Bazot, Isabelle Thomassin-Naggara, EURAD study group

Published in: European Radiology | Issue 9/2022

Abstract

Objectives

To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy.

Methods

The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy.

Results

The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, _95%CI [0.922–0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADC_mean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, _95%CI [0.938–0.973].

Conclusion

Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses.

Key Points

• O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort.

• Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12).

• An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.

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Title: How to improve O-RADS MRI score for rating adnexal masses with cystic component?
Authors: Victoria Assouline
Yohann Dabi
Aurélie Jalaguier-Coudray
Sanja Stojanovic
Ingrid Millet
Caroline Reinhold
Marc Bazot
Isabelle Thomassin-Naggara
EURAD study group
Publication date: 24-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: European Radiology / Issue 9/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08644-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How to improve O-RADS MRI score for rating adnexal masses with cystic component?

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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