ADNEX磁共振成像评分系统在超声检查不确定的附件包块诊断中的有效性和可重复性
Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses.
作者信息
Basha Mohammad Abd Alkhalik, Abdelrahman Hossam M, Metwally Maha Ibrahime, Alayouty Nader Ali, Mohey Nesreen, Zaitoun Mohamed M A, Almassry Hosam Nabil, Yousef Hala Y, El Sammak Ahmed A, Aly Sameh Abdelaziz, Algazzar Hesham Youssef, Farag Mohamed Abd El-Aziz Mohamed, Mosallam Walid, Abo Shanab Waleed S, Ibrahim Safaa A, Mohamed Ekramy A, Mohamed Abd El Motaleb, Afifi Amira Hamed Mohamed, Harb Ola A, Azmy Taghreed M
机构信息
Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Department of Radio-Diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt.
出版信息
J Magn Reson Imaging. 2021 Jan;53(1):292-304. doi: 10.1002/jmri.27285. Epub 2020 Jul 26.
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 T -weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T -WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm ; and dynamic contrast-enhanced perfusion T -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.
背景
超声检查结果不确定的附件包块（AM）的诊断是临床实践中的一项重大挑战。早期检测和特征描述增加了治疗前进行准确影像评估的必要性。
目的
评估ADNEX磁共振成像（MR）评分系统在超声检查结果不确定的AM诊断中的有效性和可重复性。
研究类型
一项前瞻性多中心研究。
研究对象
共有531名女性（平均年龄44±11.2岁；范围21 - 79岁），患有572个超声检查结果不确定的AM。
场强/序列：1.5T/对比前T加权成像（WI）快速自旋回波（FSE）（同相位和反相位，有和没有脂肪抑制）；T - WI FSE；扩散加权成像单激发回波平面成像，b值为0和1000 s/mm²；以及动态对比增强灌注T - WI肝脏容积加速采集（LAVA）。
评估
所有MRI检查由三名放射科医生进行评估，根据ADNEX MR评分系统将AM分为五个等级。等级1：无AM；2：良性AM；3：可能为良性AM；4：不确定AM；5：可能为恶性AM。组织病理学和影像随访用作评估ADNEX MR评分系统检测卵巢恶性肿瘤有效性的标准参考。
统计检验
四格表检验、kappa统计量（κ）和受试者操作特征（ROC）曲线。
结果
共有136个（23.8%）AM为恶性，436个（76.2%）为良性。在分类为等级2的350个AM中，1个（0.3%）为恶性；在分类为等级3的62个AM中，6个（9.7%）为恶性；在分类为等级4的73个AM中，43个（58.9%）为恶性；在分类为等级5的87个AM中，86个（98.9%）为恶性。预测恶性AM的最佳截断值为等级>3，敏感性和特异性分别为92.9%和94.9%。ADNEX MR评分的阅片者间一致性非常好（κ = 0.861）。
数据结论
本研究支持ADNEX MR评分系统在超声检查结果不确定的AM诊断中具有较高的有效性和可重复性。
证据水平
1 技术效能阶段：2。
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