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Cabedo L, Sebastià C, Munmany M, Fusté P, Gaba L, Saco A, Rodriguez A, Paño B, Nicolau C. O-RADS MRI scoring system: key points for correct application in inexperienced hands. Insights Imaging 2024; 15:107. [PMID: 38609573 PMCID: PMC11014836 DOI: 10.1186/s13244-024-01670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To evaluate the efficacy of the O-RADS MRI criteria in the stratification of risk of malignancy of solid or sonographically indeterminate ovarian masses and assess the interobserver agreement of this classification between experienced and inexperienced radiologists. METHODS This single-centre retrospective study included patients from 2019 to 2022 with sonographically indeterminate or solid ovarian masses who underwent MRI with a specific protocol for characterisation according to O-RADS MRI specifications. Each study was evaluated using O-RADS lexicon by two radiologists, one with 17 years of experience in gynaecological radiology and another with 4 years of experience in general radiology. Findings were classified as benign, borderline, or malignant according to histology or stability over time. Diagnostic performance and interobserver agreement were assessed. RESULTS A total of 183 patients with US indeterminate or solid adnexal masses were included. Fifty-seven (31%) did not have ovarian masses, classified as O-RADS 1. The diagnostic performance for scores 2-5 was excellent with a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 96.2%, and 100%, respectively by the experienced radiologist and 96.1%, 92.0%, 93.9%, and 94.8% by the inexperienced radiologist. Interobserver concordance was very high (Kappa index 0.92). Almost all the misclassified cases were due to misinterpretation of the classification similar to reports in the literature. CONCLUSION The diagnostic performance of O-RADS MRI determined by either experienced or inexperienced radiologists is excellent, facilitating decision-making with high diagnostic accuracy and high reproducibility. Knowledge of this classification and use of assessment tools could avoid frequent errors due to misinterpretation. CRITICAL RELEVANCE STATEMENT Up to 31% of ovarian masses are considered indeterminate by transvaginal US and 32% of solid lesions considered malignant by transvaginal US are benign. The O-RADs MRI accurately classifies these masses, even when used by inexperienced radiologists, thereby avoiding incorrect surgical approaches. KEY POINTS • O-RADS MRI accurately classifies indeterminate and solid ovarian masses by ultrasound. • There is excellent interobserver agreement between experienced and non-experienced radiologists. • O-RADS MRI is a helpful tool to assess clinical decision-making in ovarian tumours.
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Affiliation(s)
- Lledó Cabedo
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain.
| | - Meritxell Munmany
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Pere Fusté
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Lydia Gaba
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adela Rodriguez
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
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Dabi Y, Rockall A, Sadowski E, Touboul C, Razakamanantsoa L, Thomassin-Naggara I. O-RADS MRI to classify adnexal tumors: from clinical problem to daily use. Insights Imaging 2024; 15:29. [PMID: 38289563 PMCID: PMC10828223 DOI: 10.1186/s13244-023-01598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/25/2023] [Indexed: 02/02/2024] Open
Abstract
Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the conclusion that ultrasonography was insufficient to accurately assess adnexal masses and that a standardized MRI criteria could improve these patients' management. The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. The different steps were the following: (1) preliminary work to formalize the issue, (2) physiopathological analysis and finding dynamic parameters relevant to increase MRI performances, (3) construction and internal validation of a score to predict the nature of the lesion, (4) external multicentric validation (the EURAD study) of the score named O-RADS MRI, and (5) communication and education work to spread its use and inclusion in guidelines. Future steps will include studies at patients' levels and a cost-efficiency analysis. Critical relevance statement We present translating radiological research into a clinical application based on a step-by-step structured and systematic approach methodology to validate MR imaging for the characterization of adnexal mass with the ultimate step of incorporation in the latest worldwide guidelines of the O-RADS MRI reporting system that allows to distinguish benign from malignant ovarian masses with a sensitivity and specificity higher than 90%. Key points • The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography.• The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management.• The first developing score named ADNEX MR Score was constructed using multiple easily assessed criteria on MRI to classify indeterminate adnexal lesions following ultrasonography.• The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.
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Affiliation(s)
- Yohann Dabi
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Cyril Touboul
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Leo Razakamanantsoa
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Isabelle Thomassin-Naggara
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
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Moradi B, Rahmani M, Aghasi M, Yarandi F, Malek M, Hosseini A, Ghafouri K, Hasan Zadeh Tabatabaei MS, Shirali E, Riahi Samani P, Firouznia S. Modified MR scoring system for assessment of sonographically indeterminate ovarian and adnexal masses in the absence of dynamic contrast-enhanced. Br J Radiol 2024; 97:150-158. [PMID: 38263830 PMCID: PMC11027275 DOI: 10.1093/bjr/tqad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/30/2023] [Accepted: 10/25/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES Dynamic contrast-enhanced (DCE) MRI is not available in all imaging centres to investigate adnexal masses. We proposed modified magnetic resonance (MR) scoring system based on an assessment of the enhancement of the solid tissue on early phase postcontrast series and diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) map and investigated the validity of this protocols in the current study. MATERIALS AND METHODS In this cross-sectional retrospective study, pelvic MRI of a total of 245 patients with 340 adnexal masses were studied based on the proposed modified scoring system and ADNEX MR scoring system. RESULTS Modified scoring system with the sensitivity of 87.3% and specificity of 94.6% has an accuracy of 92.1%. Sensitivity, specificity, and accuracy of ADNEX MR scoring system is 96.6%, 91%, and 92.9%, respectively. The area under the receiver operating characteristic curve for the modified scoring system and ADNEX MR scoring system is 0.909 (with 0.870-0.938 95% confidence interval [CI]) and 0.938 (with 0.907-0.961 95% CI), respectively. Pairwise comparison of these area under the curves showed no significant difference (P = .053). CONCLUSIONS Modified scoring system is less sensitive than the ADNEX MR scoring system and more specific but the accuracy is not significantly different. ADVANCES IN KNOWLEDGE According to our study, MR scoring system based on subjective assessment of the enhancement of the solid tissue on early phase postcontrast series and DWI with ADC map could be applicable in imaging centres that DCE is not available.
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Affiliation(s)
- Behnaz Moradi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Maryam Aghasi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, 141973141, Iran
| | - Fariba Yarandi
- Department of Gynecologic Oncology, Women Yas Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Mahrooz Malek
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Ashrafsadat Hosseini
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Kimia Ghafouri
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), School of Medicine, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mahgol Sadat Hasan Zadeh Tabatabaei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), School of Medicine, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Elham Shirali
- Department of Gynecologic Oncology, Women Yas Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Payam Riahi Samani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Sina Firouznia
- Second Faculty of Medicine, Charles University, Prague, 116 36, Czech Republic
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Nougaret S, Lakhman Y, Bahadir S, Sadowski EA, Thomassin-Naggara I, Reinhold C. Ovarian-Adnexal Reporting and Data System for Magnetic Resonance Imaging (O-RADS MRI): Genesis and Future Directions. Can Assoc Radiol J 2023; 74:370-381. [PMID: 36250435 PMCID: PMC11058407 DOI: 10.1177/08465371221121738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Imaging plays an important role in characterizing and risk-stratifying commonly encountered adnexal lesions. Recently, the American College of Radiology (ACR) released the Ovarian-Adnexal Reporting and Data System (O-RADS) for ultrasound and subsequently for magnetic resonance imaging (MRI). The goal of the recently developed ACR O-RADS MRI risk stratification system is to improve the quality of imaging reports as well as the reproducibility of evaluating adnexal lesions on MRI. This review focuses on exploring this new system and its future refinements.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute (ICM), Montpellier, France
- Montpellier Cancer Research institute (IRCM), INSERM U1194, University of Montpellier, Montpellier, France
| | - Yulia Lakhman
- Departments of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Suzan Bahadir
- Department of Radiology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Elizabeth A. Sadowski
- Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252
| | - Isabelle Thomassin-Naggara
- Service d’Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center (MUHC)
- Department of Obstetrics and Gynecology, McGill University Health Center (MUHC)
- Co-Director Augmented Intelligence Precision Laboratory (AIPHL), MUHC Research Institute, Department of Radiology, 1001 Decarie Boul.Montreal, Quebec, H4A 3J1
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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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Wu M, Tang Q, Cai S, Zhu L, Lin C, Guan Y, Rao S, Zhou J. Accuracy and reproducibility of the O-RADS MRI risk stratification system based on enhanced non-DCE MRI in the assessment of adnexal masses. Eur J Radiol 2023; 159:110670. [PMID: 36584564 DOI: 10.1016/j.ejrad.2022.110670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Evaluation of the diagnostic performance and reproducibility of the Ovarian-Adnexal Reporting and Data System (O-RADS) Magnetic Resonance Imaging (MRI) risk stratification system based on enhanced non-dynamic contrast-enhanced (non-DCE) MRI in the diagnosis of adnexal masses. METHODS Patients who underwent conventional pelvic enhanced non-DCE MRI examination within one month prior to surgery formed the study population. Two experienced radiologists independently evaluated the images and assigned a score according to the O-RADS MRI risk stratification system. One of the radiologists reviewed the images and reassigned the scores after three months. Intra- and inter-observer agreement was evaluated with the k coefficient value. The adnexal masses that attained scores between 1 and 3 were considered benign, while those with scores of 4 or 5 were considered malignant. Analyses were conducted to determine the sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curve, which were then used for evaluating the diagnostic efficacy of the developed system based on enhanced non-DCE MRI scan. The reference standard was histology. RESULTS A total of 308 patients (mean age: 42.09 ± 12.42 years, age range: 20-84 years) were enrolled in the study. Among the 362 adnexal masses from the included patients, there were 320 benign masses and 42 malignant masses. In the case of three readers, there were no malignant tumors scored 1-2. The O-RADS MRI score ≥ 4 was associated with malignancy resulted in a good diagnostic efficacy with the areas under the curve (AUC) values of 0.918 (95 % CI, 0.864-0.972), 0.905 (95 % CI, 0.842-0.968), and 0.882 (95 % CI, 0.815-0.950), the sensitivity values of 90.5 % (95 % CI, 87.5-93.5 %), 85.7 % (95 % CI, 82.1-89.3 %), and 83.3 % (95 % CI, 79.5-87.2 %), and the specificity values of 93.1 % (95 % CI, 90.5-95.7 %), 95.3 % (95 % CI, 93.1-97.5 %), and 93.1 % (95 % CI, 90.5-95.7 %) obtained for the three readers, respectively. Excellent intra-observer agreement and inter-observer agreement were observed with the k values of 0.883 (95 % CI, 0.814-0.952) and 0.848 (95 % CI, 0.770-0.926), respectively. CONCLUSIONS The O-RADS MRI risk stratification system based on enhanced non-DCE MRI scans exhibited high accuracy and reproducibility in the prediction of adnexal masses malignancy. Enhanced non-DCE MRI scan may offer an alternative diagnostic tool when DCE is not possible.
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Affiliation(s)
- Minrong Wu
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China
| | - Qiying Tang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China
| | - Songqi Cai
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenlin Road, Shanghai, Xuhui District, 200032, People's Republic of China
| | - Liuhong Zhu
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China
| | - Chong Lin
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China
| | - Yingying Guan
- Department of Pathology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenlin Road, Shanghai, Xuhui District, 200032, People's Republic of China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China; Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenlin Road, Shanghai, Xuhui District, 200032, People's Republic of China; Department of Radiology, Xiamen Clinical Research Center for Cancer Therapy, 668 Jinhu Road, Huli District, Xiamen City 361015, Fujian Province, People's Republic of China.
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MRI Appearance of a Giant Ovarian Sero-mucinous Cystadenofibroma Mimicking Ascites. A Case Report and Brief Literature Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Abstract
Introduction: Giant ovarian cystadenofibromas are rare, mostly benign tumors. In the early stages, they are asymptomatic; however, as they grow in size, they begin to produce symptoms, most often due to the compressive effects they exert on surrounding structures. In the early stages, they are frequently diagnosed by ultrasonography, but complicated cases or cystadenofibromas that reach giant dimensions are ideally evaluated by magnetic resonance imaging (MRI) to establish a therapeutic surgical decision that is as safe as possible for the patient.
Case report: We present the case of a 49-year-old perimenopausal patient without vaginal bleeding or other gynecological symptoms who presented to the hospital with abdominal pain and abdominal distension with increasing intensity. Ultrasound examination revealed the presence of a high volume of fluid in the abdomen, and MRI and histopathological examination confirmed the diagnosis of a giant left ovarian type III seromucinous cystadenofibroma. The patient was treated surgically, with favorable postoperative evolution.
Conclusion: Giant cystadenofibromas are rare clinical entities that must always be considered in the differential diagnosis of an abdominopelvic pathology in middle-aged female patients and should ideally be investigated by MRI to accurately define their origin, characteristics, and local invasion.
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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: 11] [Impact Index Per Article: 5.5] [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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9
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Cui L, Xu H, Zhang Y. Diagnostic Accuracies of the Ultrasound and Magnetic Resonance Imaging ADNEX Scoring Systems For Ovarian Adnexal Mass: Systematic Review and Meta-Analysis. Acad Radiol 2022; 29:897-908. [PMID: 34217614 DOI: 10.1016/j.acra.2021.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/01/2022]
Abstract
We conducted a meta-analysis of IOTA (international ovarian tumor analysis) ADNEX (Assessment of Different NEoplasias in the adneXa) as ultrasound system and MRI (magnetic resonance imaging) ADNEX scoring systems as MR system to assess their diagnostic test accuracy for differentiating benign from malignant adnexal masses of the ovary. We performed an electronic search for relevant publications in the English language up to February 2021 using PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, and Google scholar databases and search engines. We computed the pooled sensitivity, pooled specificity, and summary receiver operating characteristics curve (SROC) using the statistical software STATA (Version 13, College Station, TX, StataCorp LP). Based on 11 studies using IOTA-ADNEX, we observed pooled sensitivity, specificity, area under curve, and diagnostic odds ratio were 96% (95% CI, 94% to 97%), 79% (95% CI, 70% to 86 %), 97% (95% CI, 95% to 98%), and 88 (95% CI, 43 to 180). Based on five studies using MR-ADNEX scoring system the pooled sensitivity, specificity, area under curve and diagnostic odds ratio were 91 % (95% CI, 87% to 94 %), 95% (95% CI, 92% to 97 %), 98% (95% CI, 96% to 99%), and 189 (95% CI, 90 to 396) respectively. Our meta-analysis results demonstrate that the MR-ADNEX scoring system had higher specificity however bit lower sensitivity compared to the IOTA-ADNEX scoring system for discriminating benign from malignant ovarian tumors.
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10
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Sadowski EA, Thomassin-Naggara I, Rockall A, Maturen KE, Forstner R, Jha P, Nougaret S, Siegelman ES, Reinhold C. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022; 303:35-47. [PMID: 35040672 PMCID: PMC8962917 DOI: 10.1148/radiol.204371] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
MRI plays an important role as a secondary test or problem-solving modality in the evaluation of adnexal lesions depicted at US. MRI has increased specificity compared with US, decreasing the number of false-positive diagnoses for malignancy and thereby avoiding unnecessary or over-extensive surgery in patients with benign lesions or borderline tumors, while women with possible malignancies can be expeditiously referred for oncologic surgical evaluation. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee is an international collaborative effort formed under the direction of the American College of Radiology and includes a diverse group of experts on adnexal imaging and management who developed the O-RADS MRI risk stratification system. This scoring system assigns a probability of malignancy based on the MRI features of an adnexal lesion and provides information to facilitate optimal patient management. The widespread implementation of a codified reporting system will lead to improved interpretation agreement and standardized communication between radiologists and referring physicians. In addition, it will allow for high-quality multi-institutional collaborations-an important unmet need that has hampered the performance of high-quality research in this area in the past. This article provides guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Katherine E Maturen
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Rosemarie Forstner
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Stephanie Nougaret
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Evan S Siegelman
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
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11
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Aslan S, Tosun SA. Diagnostic accuracy and validity of the O-RADS MRI score based on a simplified MRI protocol: a single tertiary center retrospective study. Acta Radiol 2021; 64:377-386. [PMID: 34839677 DOI: 10.1177/02841851211060413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adnexal masses (AM) are a common gynecological problem. It is important to use a reliable imaging method in the differentiation of benign and malignant AMs. PURPOSE To assess the accuracy and validity of the O-RADS magnetic resonance imaging (MRI) score for characterizing AM using a simplified MRI protocol. MATERIAL AND METHODS The study population comprised 332 women who underwent MRI due to the detection of indeterminate AM on ultrasonography between January 2018 and June 2020. An experienced radiologist calculated the O-RADS MRI score into five categories, using an MRI protocol with a simplified dynamic study. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >24 months of follow-up. RESULTS Of 237 AMs, 28 (11.9%) were malignant. The malignancy rates of AMs with scores of 1, 2, 3, 4, and 5 were 0% (0/12), 0% (0/111), 1.2% (1/77), 50% (10/20), and 100% (17/17), respectively. The O-RADS MRI score showed 96.3% sensitivity, 95.2% specificity, and 95.3% accuracy in malignancy prediction. The AUC for the differentiation of benign and malignant masses were 0.983. False positivity rate was high in cases with an O-RADS MRI score of 4 (50%). CONCLUSION The O-RADS MRI score, based on a simplified MRI protocol, has high accuracy and validity in distinguishing benign from malignant sonographically indeterminate AMs. Its use in clinical practice can classify the malignancy risks of masses and prevent unnecessary surgery in benign lesions.
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Affiliation(s)
- Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Sebnem Alanya Tosun
- Department of Obstetrics and Gynecology, Giresun University Faculty of Medicine, Giresun, Turkey
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12
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Lin Y, Hsieh CY, Huang YL, Chen K, Huang YT, Wu RC, Huang HJ, Chou HH, Chao A, Lai CH, Lin G. Magnetic Resonance Spectroscopy for Risk Stratification of Sonographically Indeterminate Ovarian Neoplasms: Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11101847. [PMID: 34679545 PMCID: PMC8534853 DOI: 10.3390/diagnostics11101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10-3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Ching-Yi Hsieh
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan 33382, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Diagnostic Radiology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Ren-Chin Wu
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Angel Chao
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200
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Rao S, Smith DA, Guler E, Kikano EG, Rajdev MA, Yoest JM, Ramaiya NH, Tirumani SH. Past, Present, and Future of Serum Tumor Markers in Management of Ovarian Cancer: A Guide for the Radiologist. Radiographics 2021; 41:1839-1856. [PMID: 34597221 DOI: 10.1148/rg.2021210005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The ability to accurately detect early ovarian cancer and subsequently monitor treatment response is essential to improving survival for patients with ovarian malignancies. Several serum tumor markers (STMs)-including cancer antigen 125 (CA-125), human epididymis protein 4 (HE4), cancer antigen 19-9 (CA 19-9), and carcinoembryonic antigen (CEA)-have been used as a noninvasive method of identifying ovarian cancer in conjunction with imaging. Although current guidelines do not recommend use of STMs as screening tools for ovarian cancer, these markers have clinical utility in both diagnosis and surveillance for women with ovarian cancer. CA-125 is the most commonly used STM; its level may be elevated in several types of ovarian cancer, including epithelial cell tumors, carcinosarcoma, teratomas, and secondary ovarian malignancies. An elevated level of CA 19-9 is associated with clear cell tumors, teratomas, and secondary malignancies. CEA is most commonly associated with mucinous ovarian cancers. Finally, HE4 is being increasingly used to identify certain subtypes of epithelial ovarian cancers, particularly serous and endometrioid tumors. Diagnosis of ovarian cancers relies on a combination of CA-125 levels and US findings, which include a large adnexal mass or high-risk features, including septa and increased vascularity. CT is preferred for staging and is used along with PET and STM monitoring for surveillance. Increasingly, MRI is being used to characterize ovarian lesions that are indeterminate at US or CT. The future of STM testing involves development of "liquid biopsies," in which plasma samples are analyzed for evidence of tumors, including circulating tumor DNA or tumor cells and tumor micro-RNA. When combined with traditional imaging techniques, liquid biopsies may lead to earlier diagnosis and improved survival. An invited commentary by Shinagare is available online. ©RSNA, 2021.
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Affiliation(s)
- Sanjay Rao
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Daniel A Smith
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Ezgi Guler
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Elias G Kikano
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Maharshi A Rajdev
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Jennifer M Yoest
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Nikhil H Ramaiya
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Sree Harsha Tirumani
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
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14
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Eom SY, Rha SE. [Adnexal Masses: Clinical Application of Multiparametric MR Imaging & O-RADS MRI]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1066-1082. [PMID: 36238388 PMCID: PMC9432352 DOI: 10.3348/jksr.2021.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Abstract
Incidental adnexal masses considered indeterminate for malignancy are commonly observed on ultrasonography. Multiparametric MRI is the imaging modality of choice for the evaluation of sonographically indeterminate adnexal masses. Conventional MRI enables a confident pathologic diagnosis of various benign lesions due to accurate tissue characterization of fat, blood, fibrous tissue, and solid components. Additionally, functional imaging sequences, including perfusion- and diffusion-weighted imaging, improve the diagnostic efficacy of conventional MRI in differentiating benign from malignant adnexal masses. The ovarian-adnexal reporting and data system (O-RADS) MRI was recently designed to provide consistent interpretations in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. In this review, we describe the clinical application of multiparametric MRI for the evaluation of adnexal masses and introduce the O-RADS MRI risk stratification system.
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Thomassin-Naggara I, Belghitti M, Milon A, Abdel Wahab C, Sadowski E, Rockall AG. O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort. Eur Radiol 2021; 31:9588-9599. [PMID: 34041567 DOI: 10.1007/s00330-021-08054-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/18/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To retrospectively review the causes of categorization errors using O-RADS-MRI score and to determine the presumptive causes of these misclassifications. METHODS EURAD database was retrospectively queried to identify misclassified lesions. In this cohort, 1194 evaluable patients with 1502 pelvic masses (277 malignant / 1225 benign lesions) underwent standardized MRI to characterize adnexal masses with histology or 2 years' follow-up as a reference standard. An expert radiologist reviewed cases with two junior radiologists and lesions termed misclassified if malignant lesion was scored ≤ 3, a benign lesion was scored ≥ 4, the site of origin was incorrect, or a non-adnexal mass was incorrectly categorized as benign or malignant. RESULTS There were 139 / 1502 (9.2%) misclassified masses in 116 women including 109 adnexal and 30 non-adnexal masses. False-negative cases corresponded to 16 borderline or invasive malignant adnexal masses rated score ≤ 3 (16 / 139, 11.5%). False-positive cases corresponded to 88 benign masses were rated score 4 (67 / 139, 48.2%) or 5 (18 / 139,12.9%) or considered suspicious non-adnexal lesions (3 / 139, 2.2%). Misclassifications were only due to origin error in 12 adnexal masses (8 benign, 4 malignant) (8.6%, 12 / 139) and 23 non-adnexal masses (18 benign, 5 malignant,16.5%, 23 / 139) perceived respectively as non-adnexal and adnexal masses. Interpretive error (n = 104), failure to recognize technical insufficient exams (n = 9), and perceptual errors (n = 4) were found. Most interpretive was due to misinterpretation of solid tissue or incorrect assignment of mass origin. Eighty-four out of 139 cases were correctly reclassified by the readers with strict adherence to the score rules. CONCLUSION Most errors were due to misinterpretation of solid tissue or incorrect assignment of mass origin. KEY POINTS • Prospective assignment of O-RADS-MRI score resulted in misclassification of 9.25% of sonographically indeterminate pelvic masses. • Most errors were interpretive (74.8%) due to misinterpretation of solid tissue as defined by the lexicon or incorrect assignment of mass origin. • Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139).
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Affiliation(s)
- I Thomassin-Naggara
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France. .,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France.
| | - M Belghitti
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - A Milon
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - C Abdel Wahab
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - E Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA
| | - A G Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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Sadowski EA, Maturen KE, Rockall A, Reinhold C, Addley H, Jha P, Bharwani N, Thomassin-Naggara I. Ovary: MRI characterisation and O-RADS MRI. Br J Radiol 2021; 94:20210157. [PMID: 33929901 DOI: 10.1259/bjr.20210157] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ultrasound has a high specificity for the diagnosis of a benign lesion in cases of classic appearing simple cyst, hemorrhagic cyst, endometrioma and dermoid. However, ultrasound can sometimes be limited for definitive characterisation and risk stratification of other types of lesions, including those with echogenic content that may appear solid, with or without blood flow. Frequently, MRI can be used to further characterise these types of lesions, due to its ability to distinguish solid tissue from non-tissue solid components such as fat, blood, or debris. Incorporating the MR imaging into the evaluation of adnexal lesions can improve diagnostic certainty and guide clinical management potentially avoiding inappropriate surgery for benign lesions and expediting appropriate treatment for malignant lesions, particularly in the females with sonographically indeterminate adnexal lesions.
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Affiliation(s)
- Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Katherine E Maturen
- Department of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Helen Addley
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Priyanka Jha
- Department of Radiology, University of California San Francisco, San francisco, CA, USA
| | - Nishat Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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17
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Sahin H, Panico C, Ursprung S, Simeon V, Chiodini P, Frary A, Carmo B, Smith J, Freeman S, Jimenez-Linan M, Bolton H, Haldar K, Ang JE, Reinhold C, Sala E, Addley H. Non-contrast MRI can accurately characterize adnexal masses: a retrospective study. Eur Radiol 2021; 31:6962-6973. [PMID: 33725187 PMCID: PMC8379126 DOI: 10.1007/s00330-021-07737-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Objective To determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses. Methods and materials Two hundred ninety-one patients (350 adnexal masses) who underwent gynecological MRI at our institution between the 1st of January 2008 and the 31st of December 2018 were reviewed. A random subset (102 patients with 121 masses) was chosen to evaluate the reproducibility and repeatability of readers’ assessments. Readers evaluated non-contrast MRI scans retrospectively, assigned a 5-point score for the risk of malignancy and gave a specific diagnosis. The reference standard for the diagnosis was histopathology or at least one-year imaging follow-up. Diagnostic accuracy of the non-contrast MRI score was calculated. Inter- and intra-reader agreement was analyzed with Cohen’s kappa statistics. Results There were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (к = 0.73, 95% confidence interval [CI] 0.58–0.86) whilst the intra-reader agreement was excellent (к = 0.81, 95% CI 0.70–0.88). The non-contrast MRI score value of ≥ 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90–0.96). Conclusion Adnexal mass characterization on MRI without the administration of contrast medium has a high accuracy and excellent inter- and intra-reader agreement. Our results suggest that non-contrast studies may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible. Key Points • A non-contrast pelvic MRI protocol may allow the characterization of adnexal masses with high accuracy. • The non-contrast MRI score may be used in clinical practice for differentiating benign from malignant adnexal lesions when the lack of intravenous contrast medium precludes analysis with the O–RADS MRI score. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07737-9.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridgeshire, Cambridge, CB2 0QQ, UK.
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.
| | - Camilla Panico
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Universita Cattolicá del Sacro Cuore, Rome, Italy
| | - Stephan Ursprung
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridgeshire, Cambridge, CB2 0QQ, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Mental, Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Department of Mental, Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Amy Frary
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Bruno Carmo
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Janette Smith
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Sue Freeman
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | | | - Helen Bolton
- Gynaecological Oncology, Addenbrooke's Hospital, Cambridge, UK
- SGRN, Surgical Gynaecological Oncology Research Network, UK
| | | | - Joo Ern Ang
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Caroline Reinhold
- Department of Medical Imaging, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
- Augmented Intelligence Precision Laboratory (AIPHL), McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Evis Sala
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridgeshire, Cambridge, CB2 0QQ, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Helen Addley
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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18
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Stanzione A, Boccadifuoco F, Cuocolo R, Romeo V, Mainenti PP, Brunetti A, Maurea S. State of the art in abdominal MRI structured reporting: a review. Abdom Radiol (NY) 2021; 46:1218-1228. [PMID: 32936418 PMCID: PMC7940284 DOI: 10.1007/s00261-020-02744-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
In the management of several abdominal disorders, magnetic resonance imaging (MRI) has the potential to significantly improve patient's outcome due to its diagnostic accuracy leading to more appropriate treatment choice. However, its clinical value heavily relies on the quality and quantity of diagnostic information that radiologists manage to convey through their reports. To solve issues such as ambiguity and lack of comprehensiveness that can occur with conventional narrative reports, the adoption of structured reporting has been proposed. Using a checklist and standardized lexicon, structured reports are designed to increase clarity while assuring that all key imaging findings related to a specific disorder are included. Unfortunately, structured reports have their limitations too, such as risk of undue report simplification and poor template plasticity. Their adoption is also far from widespread, and probably the ideal balance between radiologist autonomy and report consistency of has yet to be found. In this article, we aimed to provide an overview of structured reporting proposals for abdominal MRI and of works assessing its value in comparison to conventional free-text reporting. While for several abdominal disorders there are structured templates that have been endorsed by scientific societies and their adoption might be beneficial, stronger evidence confirming their imperativeness and added value in terms of clinical practice is needed, especially regarding the improvement of patient outcome.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesca Boccadifuoco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Reinhold C, Rockall A, Sadowski EA, Siegelman ES, Maturen KE, Vargas HA, Forstner R, Glanc P, Andreotti RF, Thomassin-Naggara I. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J Am Coll Radiol 2021; 18:713-729. [PMID: 33484725 DOI: 10.1016/j.jacr.2020.12.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
MRI is used in the evaluation of ovarian and adnexal lesions. MRI can further characterize lesions seen on ultrasound to help decrease the number of false-positive lesions and avoid unnecessary surgery in benign lesions. Currently, the reporting of ovarian and adnexal findings on MRI is inconsistent because of the lack of standardized descriptor terminology. The development of uniform reporting descriptors can lead to improved interpretation agreement and communication between radiologists and referring physicians. The Ovarian-Adnexal Reporting and Data Systems MRI Committee was formed under the direction of the ACR to create a standardized lexicon for adnexal lesions with the goal of improving the quality and consistency of imaging reports. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon.
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Affiliation(s)
- Caroline Reinhold
- Codirector, Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Center, McGill University, Montreal, Canada.
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London and Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Evan S Siegelman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine E Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, Michigan
| | | | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria
| | - Phyllis Glanc
- University of Toronto, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Rochelle F Andreotti
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Imagerie, Paris, France
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Boisselier A, Jalaguier-Coudray A, Mahjoub-Villard R, Thomassin-Naggara I. Classification O-RADS US et IRM. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Basha MAA, Abdelrahman HM, Metwally MI, Alayouty NA, Mohey N, Zaitoun MMA, Almassry HN, Yousef HY, El Sammak AA, Aly SA, Algazzar HY, Farag MAEAM, Mosallam W, Abo Shanab WS, Ibrahim SA, Mohamed EA, Mohamed AEM, Afifi AHM, Harb OA, Azmy TM. Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses. J Magn Reson Imaging 2020; 53:292-304. [PMID: 32715577 DOI: 10.1002/jmri.27285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. PURPOSE To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. STUDY TYPE A prospective multicenter study. POPULATION In all, 531 women (mean age, 44 ± 11.2 years; range, 21-79 years) with 572 sonographically indeterminate AM. FIELD STRENGTH/SEQUENCE 1.5T/precontrast T1 -weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T2 -WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm2 ; and dynamic contrast-enhanced perfusion T1 -WI liver acquisition with volume acceleration (LAVA). ASSESSMENT All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. STATISTICAL TESTS Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. RESULTS In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861). DATA CONCLUSION The current study supports the high validity and reproducibility of the ADNEX MR Scoring system for the diagnosis of sonographically indeterminate AM. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
| | - Hossam M Abdelrahman
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Maha Ibrahime Metwally
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nesreen Mohey
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hosam Nabil Almassry
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El Sammak
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-Diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | | | - Walid Mosallam
- Department of Radio-Diagnosis, Faculty of Human Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed S Abo Shanab
- Department of Radio-Diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ekramy A Mohamed
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Abd El Motaleb Mohamed
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ola A Harb
- Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Taghreed M Azmy
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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22
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Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AG. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA Netw Open 2020; 3:e1919896. [PMID: 31977064 PMCID: PMC6991280 DOI: 10.1001/jamanetworkopen.2019.19896] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. OBJECTIVE To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. MAIN OUTCOMES AND MEASURES The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). RESULTS A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients). CONCLUSIONS AND RELEVANCE In this study, the O-RADS MRI score was accurate when stratifying the risk of malignancy in adnexal masses.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
| | - Edouard Poncelet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | - Laure S. Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia and Montenegro
| | - Ingrid Millet
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Nishat Bharwani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Teresa M. Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Gabriele Masselli
- Department of Radiology, Umberto I Hospital, Sapienza University Roma, Rome, Italy
| | | | | | | | - Elizabeth A. Sadowski
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- University of Wisconsin, Madison, Wisconsin
| | - Marc Bazot
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
| | - Patrice Taourel
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Institute national de la santé et de la recherche médicale, Joint Research Unit 1153, Paris, France
| | - Emile Darai
- Service de Gynecologie et Obstetrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Hôpitaux Univesitaires Est Parisien, Paris, France
- Faculté de Médecine Pierre et Marie Curie, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Medical Imaging, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea G. Rockall
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
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