Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Ultrasound Obstet Gynecol. 2021 Mar;57(3):478-487. doi: 10.1002/uog.22090.
To validate prospectively the ADNEX magnetic resonance (MR) scoring system to assess adnexal masses and to evaluate a new, modified ADNEX MR scoring system that incorporates diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping.
Between January 2015 and September 2018, 323 consecutive women with adnexal masses diagnosed on transvaginal ultrasound (TVS) underwent standardized MR imaging (MRI) including diffusion and dynamic contrast-enhanced sequences. Of these, 131 underwent subsequent surgery. For interpretation of the MRI examinations, we applied the five-category ADNEX MR scoring system, along with a modified scoring system including DWI with ADC mapping. For both scoring systems, a score was given for all adnexal masses. Histological diagnosis was considered as the gold standard and lesions were classified as benign or malignant. The difference between the predictive values for diagnosing malignancy of the classical and modified scoring systems was assessed on the basis of the areas under the receiver-operating-characteristics (AUC) curves. The sensitivity and specificity for diagnosing malignancy of each score were also calculated.
Among the 131 women with adnexal mass(es) diagnosed on TVS who underwent MRI and subsequent surgery, the surgery revealed 161 adnexal masses in 126 women; five women had no mass. Histological examination confirmed 161 adnexal masses, of which all had been detected on MRI: 32 malignant tumors, 15 borderline tumors, which were classified as part of the malignant group (n = 47), and 114 benign lesions. The AUC for prediction of a malignant lesion was 0.938 (95% CI, 0.902-0.975) using the classical ADNEX MR scoring system and 0.974 (95% CI, 0.953-0.996) using the modified scoring system. Pairwise comparison of these AUCs revealed a significant difference (P = 0.0032). The sensitivity and specificity for diagnosing malignancy with an ADNEX MR score of 4 or more were 95.5% and 86.6%, respectively, using the classic scoring system, and 95.7% and 93.3%, respectively, using the modified scoring system.
DWI with ADC mapping could be integrated into the ADNEX MR scoring system to improve specificity, thereby potentially optimizing clinical management by avoiding unnecessary surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
前瞻性验证 ADNEX 磁共振（MR）评分系统以评估附件肿块，并评估一种新的改良 ADNEX MR 评分系统，该系统将扩散加权成像（DWI）与表观扩散系数（ADC）图相结合。
2015 年 1 月至 2018 年 9 月，323 例经阴道超声（TVS）诊断为附件肿块的连续女性患者接受了标准化的磁共振成像（MRI）检查，包括扩散和动态对比增强序列。其中 131 例随后进行了手术。对于 MRI 检查的解释，我们应用了五分类 ADNEX MR 评分系统，以及包含 DWI 和 ADC 图的改良评分系统。对于这两种评分系统，对所有附件肿块进行了评分。组织学诊断被认为是金标准，并将病变分为良性或恶性。基于受试者工作特征（ROC）曲线下面积（AUC）评估经典和改良评分系统诊断恶性肿瘤的预测值之间的差异。还计算了每个评分的诊断恶性肿瘤的敏感性和特异性。
在经 TVS 诊断为附件肿块并随后进行 MRI 和手术的 131 例女性中，手术发现 126 例女性的 161 个附件肿块；5 例女性无肿块。组织学检查证实 161 个附件肿块，均在 MRI 上检测到：32 个恶性肿瘤，15 个交界性肿瘤，被归类为恶性肿瘤组（n = 47），114 个良性病变。使用经典 ADNEX MR 评分系统预测恶性病变的 AUC 为 0.938（95%CI，0.902-0.975），使用改良评分系统为 0.974（95%CI，0.953-0.996）。这些 AUC 的两两比较显示有显著差异（P = 0.0032）。使用经典评分系统，当 ADNEX MR 评分≥4 时，诊断恶性肿瘤的敏感性和特异性分别为 95.5%和 86.6%，使用改良评分系统分别为 95.7%和 93.3%。
ADC 图的 DWI 可以与 ADNEX MR 评分系统相结合，以提高特异性，从而通过避免不必要的手术来优化临床管理。 © 2020 年国际妇产科超声学会。
