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Manganaro L, Ciulla S, Celli V, Ercolani G, Ninkova R, Miceli V, Cozzi A, Rizzo SM, Thomassin-Naggara I, Catalano C. Impact of DWI and ADC values in Ovarian-Adnexal Reporting and Data System (O-RADS) MRI score. LA RADIOLOGIA MEDICA 2023; 128:565-577. [PMID: 37097348 PMCID: PMC10181975 DOI: 10.1007/s11547-023-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/27/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Introduce DWI and quantitative ADC evaluation in O-RADS MRI system and observe how diagnostic performance changes. Assess its validity and reproducibility between readers with different experience in female pelvic imaging. Finally, evaluate any correlation between ADC value and histotype in malignant lesions. MATERIALS AND METHODS In total, 173 patients with 213 indeterminate adnexal masses (AMs) on ultrasound were subjected to MRI examination, from which 140 patients with 172 AMs were included in the final analysis. Standardised MRI sequences were used, including DWI and DCE sequences. Two readers, blinded to histopathological data, retrospectively classified AMs according to the O-RADS MRI scoring system. A quantitative analysis method was applied by placing a ROI on the ADC maps obtained from single-exponential DWI sequences. AMs considered benign (O-RADS MRI score 2) were excluded from the ADC analysis. RESULTS Excellent inter-reader agreement was found in the classification of lesions according to the O-RADS MRI score (K = 0.936; 95% CI). Two ROC curves were created to determine the optimal cut-off value for the ADC variable between O-RADS MRI categories 3-4 and 4-5, respectively, 1.411 × 10-3 mm2/sec and 0.849 × 10-3 mm2/sec. Based on these ADC values, 3/45 and 22/62 AMs were upgraded, respectively, to score 4 and 5, while 4/62 AMs were downgraded to score 3. ADC values correlated significantly with the ovarian carcinoma histotype (p value < 0.001). CONCLUSION Our study demonstrates the prognostic potential of DWI and ADC values in the O-RADS MRI classification for better radiological standardisation and characterisation of AMs.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valentina Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Italy
| | - Stefania Maria Rizzo
- Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Via Buffi 13, 6900, Lugano, Switzerland
- Service of Radiology, Imaging Institute of Southern Switzerland, Clinica Di Radiologia EOC, 6900, Lugano, Switzerland
| | - Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Rizzo S, Cozzi A, Dolciami M, Del Grande F, Scarano AL, Papadia A, Gui B, Gandolfo N, Catalano C, Manganaro L. O-RADS MRI: A Systematic Review and Meta-Analysis of Diagnostic Performance and Category-wise Malignancy Rates. Radiology 2022; 307:e220795. [PMID: 36413127 DOI: 10.1148/radiol.220795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background US-indeterminate adnexal lesions remain an important indication for gynecologic surgery. MRI can serve as a problem-solving tool through the use of the Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) MRI lexicon, which is based on the ADNEX MR scoring system. Purpose To perform a systematic review and meta-analysis of the diagnostic performance of pelvic MRI interpreted using the ADNEX or O-RADS MRI stratification systems to characterize US-indeterminate adnexal lesions and of the category-wise malignancy rates. Materials and Methods A systematic literature search from May 2013 (publication of the ADNEX MR score) to September 2022 was performed. Studies reporting the use of pelvic MRI interpreted with the ADNEX or O-RADS MRI systems to characterize US-indeterminate adnexal lesions, with pathologic examination and/or follow-up as the reference standard, were included. Summary estimates of diagnostic performance were obtained with the bivariate random-effects model, while category-wise summary malignancy rates of O-RADS MRI 2, 3, 4, and 5 lesions were obtained with a random-effects model. Effects of covariates on heterogeneity and diagnostic performance were investigated through meta-regression. Results Thirteen study parts from 12 studies (3731 women, 4520 adnexal lesions) met the inclusion criteria. Diagnostic performance meta-analysis for 4012 lesions found a 92% summary sensitivity (95% CI: 88, 95) and a 91% summary specificity (95% CI: 89, 93). The meta-analysis of malignancy rates for 3641 lesions showed summary malignancy rates of 0.1% (95% CI: 0, 1) among O-RADS MRI 2 lesions, 6% (95% CI: 3, 9) among O-RADS MRI 3 lesions, 60% (95% CI: 52, 67) among O-RADS MRI 4 lesions, and 96% (95% CI: 92, 99) among O-RADS MRI 5 lesions. Conclusion Pelvic MRI interpreted with the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI lexicon had high diagnostic performance for the characterization of US-indeterminate adnexal lesions. Summary estimates of malignancy rates in the O-RADS MRI 4 and O-RADS MRI 5 categories were higher than predicted ones. © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Lee and Kang in this issue.
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Affiliation(s)
- Stefania Rizzo
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Andrea Cozzi
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Miriam Dolciami
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Filippo Del Grande
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Angela L Scarano
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Andrea Papadia
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Benedetta Gui
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Nicoletta Gandolfo
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Carlo Catalano
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Lucia Manganaro
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
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