From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.).
Radiology. 2022 Jun;303(3):566-575. doi: 10.1148/radiol.210342. Epub 2022 Mar 1.
Background The MRI Ovarian-Adnexal Reporting and Data System (O-RADS) enables risk stratification of sonographically indeterminate adnexal lesions, partly based on time-intensity curve (TIC) analysis, which may not be universally available. Purpose To compare the diagnostic accuracy of visual assessment with that of TIC assessment of dynamic contrast-enhanced MRI scans to categorize adnexal lesions as benign or malignant and to evaluate the influence on the O-RADS MRI score. Materials and Methods The European Adnex MR Study Group, or EURAD, database, a prospective multicenter study of women undergoing MRI for indeterminate adnexal lesions between March 2013 and March 2018, was queried retrospectively. Women undergoing surgery for an adnexal lesion with solid tissue were included. Solid tissue enhancement relative to outer myometrium was assessed visually and with TIC. Contrast material washout was recorded. Lesions were categorized according to the O-RADS MRI score with visual and TIC assessment. Per-lesion diagnostic accuracy was calculated. Results A total of 320 lesions (207 malignant, 113 benign) in 244 women (mean age, 55.3 years ± 15.8 [standard deviation]) were analyzed. Sensitivity for malignancy was 96% (198 of 207) and 76% (157 of 207) for TIC and visual assessment, respectively. TIC was more accurate than visual assessment (86% [95% CI: 81, 90] vs 78% [95% CI: 73, 82]; < .001) for benign lesions, predominantly because of higher specificity (95% [95% CI: 92, 98] vs 76% [95% CI: 68, 81]). A total of 21% (38 of 177) of invasive lesions were rated as low risk visually. Contrast material washout and high-risk enhancement (defined as earlier enhancement than in the myometrium) were highly specific for malignancy for both TIC (97% [95% CI: 91, 99] and 94% [95% CI: 90, 97], respectively) and visual assessment (97% [95% CI: 92, 99] and 93% [95% CI: 88, 97], respectively). O-RADS MRI score was more accurate with TIC than with visual assessment (area under the receiver operating characteristic curve, 0.87 [95% CI: 0.83, 0.90] vs 0.73 [95% CI: 0.68, 0.78]; < .001). Conclusion Time-intensity curve analysis was more accurate than visual assessment for achieving optimal diagnostic accuracy with the Ovarian-Adnexal Reporting and Data System MRI score. Clinical trial registration no. NCT01738789 © RSNA, 2022 See also the editorial by Vargas and Woo in this issue.
背景 MRI 卵巢-附件报告和数据系统 (O-RADS) 能够对超声不确定的附件病变进行风险分层，部分基于时间-强度曲线 (TIC) 分析，但该分析可能并非普遍适用。目的 比较 TIC 评估与视觉评估对动态对比增强 MRI 扫描对附件病变进行分类为良性或恶性的诊断准确性，并评估其对 O-RADS MRI 评分的影响。材料与方法 回顾性检索 2013 年 3 月至 2018 年 3 月间在欧洲附件磁共振研究组 (EURAD) 数据库中接受 MRI 检查以评估不确定附件病变的女性的前瞻性多中心研究数据。纳入因附件实性病变而接受手术的女性。通过视觉和 TIC 评估评估相对于外肌层的实性组织增强情况。记录对比材料洗脱情况。根据 O-RADS MRI 评分进行视觉和 TIC 评估，并对病变进行分类。计算每个病变的诊断准确性。结果 在 244 名女性（平均年龄，55.3 岁 ± 15.8 [标准差]）的 320 个病变（207 个恶性，113 个良性）中进行了分析。恶性病变的敏感性分别为 96%（198/207）和 76%（157/207），TIC 和视觉评估的准确性分别为 86%（95%CI：81，90）和 78%（95%CI：73，82）。TIC 比视觉评估更准确（ <.001），对良性病变的特异性更高（95%CI：92，98）和 76%（95%CI：68，81）。21%（38/177）的侵袭性病变在视觉评估中被评为低风险。TIC 和视觉评估中，对比材料洗脱和高危强化（定义为比肌层更早的强化）对恶性病变均具有高度特异性（TIC 分别为 97%[95%CI：91，99]和 94%[95%CI：90，97]，视觉评估分别为 97%[95%CI：92，99]和 93%[95%CI：88，97]）。TIC 比视觉评估更准确（O-RADS MRI 评分曲线下面积，0.87[95%CI：0.83，0.90]与 0.73[95%CI：0.68，0.78]； <.001）。结论 与视觉评估相比，TIC 分析在实现 Ovarian-Adnexal Reporting and Data System MRI 评分的最佳诊断准确性方面更准确。临床试验注册号 NCT01738789 © RSNA，2022 参见本期 Vargas 和 Woo 的社论。
