Dabi Yohann, Rockall Andrea, Sadowski Elisabeth, Touboul Cyril, Razakamanantsoa Leo, Thomassin-Naggara Isabelle
APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France.
Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
Insights Imaging. 2024 Jan 30;15(1):29. doi: 10.1186/s13244-023-01598-0.
Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the conclusion that ultrasonography was insufficient to accurately assess adnexal masses and that a standardized MRI criteria could improve these patients' management. The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. The different steps were the following: (1) preliminary work to formalize the issue, (2) physiopathological analysis and finding dynamic parameters relevant to increase MRI performances, (3) construction and internal validation of a score to predict the nature of the lesion, (4) external multicentric validation (the EURAD study) of the score named O-RADS MRI, and (5) communication and education work to spread its use and inclusion in guidelines. Future steps will include studies at patients' levels and a cost-efficiency analysis. Critical relevance statement We present translating radiological research into a clinical application based on a step-by-step structured and systematic approach methodology to validate MR imaging for the characterization of adnexal mass with the ultimate step of incorporation in the latest worldwide guidelines of the O-RADS MRI reporting system that allows to distinguish benign from malignant ovarian masses with a sensitivity and specificity higher than 90%. Key points • The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography.• The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management.• The first developing score named ADNEX MR Score was constructed using multiple easily assessed criteria on MRI to classify indeterminate adnexal lesions following ultrasonography.• The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.
18%至35%的附件包块在超声检查后仍无法明确分类，这导致了不必要的手术和不恰当的处理。这一发现得出结论，即超声检查不足以准确评估附件包块，标准化的MRI标准可改善对这些患者的处理。这项工作的目的是展示从识别临床问题到评分的日常应用以及将其纳入最新国际指南的不同步骤。不同步骤如下：（1）使问题形式化的初步工作；（2）生理病理分析并找到与提高MRI性能相关的动态参数；（3）构建并内部验证用于预测病变性质的评分；（4）对名为O-RADS MRI的评分进行外部多中心验证（EURAD研究）；（5）开展传播其应用并将其纳入指南的沟通和教育工作。未来的步骤将包括患者层面的研究和成本效益分析。关键相关性声明 我们基于逐步结构化和系统化的方法学，展示将放射学研究转化为临床应用，以验证MR成像用于附件包块特征化，最终步骤是将其纳入O-RADS MRI报告系统的最新全球指南，该系统能够以高于90%的敏感性和特异性区分卵巢良性和恶性包块。要点 • 最初的诊断测试准确性研究显示了仅使用超声对附件包块进行术前评估的局限性。• 研究了技术发展（DCE/DWI）以及动态MRI在准确预测良性或恶性病变性质以改善处理方面的价值。• 首个开发的名为ADNEX MR Score的评分是利用MRI上多个易于评估的标准构建的，用于对超声检查后不确定的附件病变进行分类。• 多中心附件研究对该评分进行了外部验证，创建了O-RADS MR评分，并使其纳入国际指南以供日常使用。
