Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Belgium.
J Magn Reson Imaging. 2022 Jul;56(1):158-170. doi: 10.1002/jmri.28003. Epub 2021 Nov 19.
The ovarian-adnexal reporting and data system-magnetic resonance imaging (O-RADS-MRI) score decreases the incidence of indeterminate adnexal masses from 18% to 31% with ultrasound till 10.8% to 12.5% with MRI. Further improvement of this score may be useful to improve patients' management.
To evaluate the added value of quantitative diffusion-weighted imaging (DWI) in the diagnosis of adnexal masses classified according to the O-RADS-MRI score.
Prospective cohort study with retrospective DWI analysis.
Among 402 recruited patients, surgery was done only in 163 women (median-age: 51 years) with 201 indeterminate adnexal masses, which were included in the final analysis.
FIELD STRENGTH/SEQUENCE: Standardized MRI (1.5 and 3-T) including diffusion and dynamic contrast-enhanced sequences (diffusion-weighted single-shot spin-echo echo-planar imaging) were used.
Two radiologists classified the adnexal masses according to O-RADS-MRI and they were blinded to the pathology report. Two methods of quantitative analysis were applied using region-of-interest apparent-diffusion-coefficient (ROI-ADC) and whole-lesion ADC-histogram (WL-ADC).
Fisher's exact and Mann-Whitney-U tests were used to compare variables among malignant and benign lesions. Receiver-operating-characteristic (ROC) curves were constructed to examine the sensitivity/specificity of each parameter. ROI-ADC and WL-ADC of lesions with O-RADS-MRI score-4 were plotted to identify thresholds of malignant lesions. The improvement of the O-RADS-MRI score after adding these thresholds was assessed by two ROC-curves. A P < 0.05 was considered to be statistically significant.
Fifty-eight of the 201 lesions (28.9%) were malignant. The ROI-ADC and the WL-ADC means of malignant lesions were significantly lower than those of benign lesions. Forty-two lesions (20.9%) had an O-RADS-MRI score-4. In this subgroup, 76% of lesions with ROI-ADC < 1.7 × 10 mm /sec and WL-ADC < 2.6 × 10 mm /sec were malignant, whereas only 11.8% with ROI-ADC ≥ 1.7 × 10 mm /sec or a WL-ADC ≥ 2.6 × 10 mm /sec were malignant. The overall performance of the O-RADS-MRI score combined with these thresholds was improved.
Integrating ADC-thresholds in O-RADS-MRI score-4 may discriminate low-to-intermediate and intermediate-to-high malignancy risk groups.
2 TECHNICAL EFFICACY STAGE: 2.
卵巢-附件报告和数据系统-磁共振成像（O-RADS-MRI）评分通过超声将不确定附件肿块的发生率从 18%降至 10.8%，通过 MRI 将其降至 31%至 12.5%。进一步提高该评分可能有助于改善患者的管理。
评估定量扩散加权成像（DWI）在根据 O-RADS-MRI 评分分类的附件肿块诊断中的附加价值。
前瞻性队列研究，回顾性 DWI 分析。
在招募的 402 名患者中，仅对 163 名女性（中位年龄：51 岁）进行了手术，其中有 201 个不确定的附件肿块，这些肿块被纳入最终分析。
场强/序列：使用标准化 MRI（1.5 和 3-T），包括扩散和动态对比增强序列（扩散加权单次激发自旋回波平面成像）。
两名放射科医生根据 O-RADS-MRI 对附件肿块进行分类，他们对病理报告不知情。使用感兴趣区表观扩散系数（ROI-ADC）和全病变 ADC 直方图（WL-ADC）两种定量分析方法。
使用 Fisher 确切检验和 Mann-Whitney-U 检验比较良恶性病变之间的变量。构建受试者工作特征（ROC）曲线以检查每个参数的灵敏度/特异性。绘制 O-RADS-MRI 评分为 4 的病变的 ROI-ADC 和 WL-ADC 图，以确定恶性病变的阈值。通过两条 ROC 曲线评估添加这些阈值后 O-RADS-MRI 评分的改善。认为 P < 0.05 具有统计学意义。
201 个病变中有 58 个（28.9%）为恶性。恶性病变的 ROI-ADC 和 WL-ADC 平均值明显低于良性病变。42 个病变（20.9%）O-RADS-MRI 评分为 4。在此亚组中，ROI-ADC<1.7×10 毫米/秒和 WL-ADC<2.6×10 毫米/秒的病变 76%为恶性，而 ROI-ADC≥1.7×10 毫米/秒或 WL-ADC≥2.6×10 毫米/秒的病变仅 11.8%为恶性。O-RADS-MRI 评分与这些阈值相结合的整体性能得到了提高。
在 O-RADS-MRI 评分 4 中整合 ADC 阈值可以区分低至中度和中度至高度恶性风险组。
2 技术功效阶段：2.
