Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France.
Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France.
Eur Radiol. 2022 Sep;32(9):5943-5953. doi: 10.1007/s00330-022-08644-3. Epub 2022 Mar 24.
To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy.
The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy.
The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADC of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, CI [0.938-0.973].
Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses.
• O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.
测试卵巢附件报告数据系统 (O-RADS) MRI 在描述具有囊性成分的附件肿块方面的性能，并测试与囊性成分相关的新的特定 MRI 特征，以提高 O-RADS MRI 评分对根据病变恶性风险进行分层的能力。
回顾性查询 EURopean ADnexal 研究 (EURAD) 数据库，以确定具有囊性成分的附件肿块。1 名初级医师和 13 名放射科医师对每个病例进行了独立的盲法阅片，评估内容包括病变的整体大小、形态外观、囊腔数量、是否存在增厚的壁、增厚的分隔、T1 加权/T2 加权/弥散加权图像上的囊性成分的信号强度、平均表观扩散系数和 O-RADS MRI 评分。进行单变量和多变量逻辑回归分析，以确定预测恶性肿瘤的显著特征。
最终纳入了 585 名患者的 779 个盆腔肿块，这些患者均接受了盆腔 MRI 以描述附件肿块。组织学检查作为参考标准。O-RADS MRI 评分的诊断性能为 0.944，CI [0.922-0.961]。与恶性肿瘤相关的显著标准包括 O-RADS MRI 评分≥4、囊性成分的 ADC 值>1.69、囊腔数量>3、病变大小>75mm、存在增厚的壁以及低 T1 加权、高 T2 加权和低弥散加权信号强度的囊性成分。多变量分析表明，O-RADS MRI 评分≥4 结合囊性成分的平均 ADC 值>1.69、大小>75mm 和低扩散加权信号显著提高了诊断性能，达到 0.958，CI [0.938-0.973]。
囊性成分分析可能会提高 O-RADS MRI 评分在附件囊性肿块中的诊断性能。
O-RADS MRI 评分结合特定的囊性特征（接收者操作特征曲线下面积，AUROC = 0.958）可提高 O-RADS MRI 评分在预测该队列中恶性肿瘤的诊断性能（AUROC = 0.944）。
改善恶性肿瘤预测的囊性特征包括平均 ADC 值>1.69（OR = 7）；囊腔数量≥3（OR = 5.16）；病变大小>75mm（OR = 4.40）；存在增厚的壁（OR = 3.59）；高 T2 加权信号强度评分 4 或 5（OR = 3.30）；低 T1 加权信号强度评分 1、2 或 3（OR = 3.45）；和低弥散加权信号强度（OR = 2.12）。
评分 O-RADS MRI 4 级且囊性成分 ADC 值<1.69 与低弥散加权信号相关的具有囊性成分的附件病变几乎没有恶性肿瘤风险（0%）。
