Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eur Radiol. 2024 Sep;34(9):5978-5988. doi: 10.1007/s00330-024-10639-1. Epub 2024 Feb 19.
To evaluate the additional advantages of integrating contrast-enhanced ultrasound (CEUS) into the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) for the characterization of adnexal lesions with solid components.
This prospective multicenter study recruited women suspected of having adnexal lesions with solid components between September 2021 and December 2022. All patients scheduled for surgery underwent preoperative CEUS and US examinations. The lesions were categorized according to the O-RADS US system, and quantitative CEUS indexes were recorded. Pathological results served as the reference standard. Univariable and multivariable analyses were performed to identify risk factors for malignancy in adnexal lesions with solid components. Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance.
A total of 180 lesions in 175 women were included in the study. Among these masses, 80 were malignant and 100 were benign. Multivariable analysis revealed that serum CA-125, the presence of acoustic shadowing, and peak intensity (PI) ratio (PI/PI) of solid components on CEUS were independently associated with adnexal malignancy. The modified CEUS risk stratification model demonstrated superior diagnostic value in assessing adnexal lesions with solid components compared to O-RADS US (AUC: 0.91 vs 0.78, p < 0.001) and exhibited comparable performance to the Assessment of Different NEoplasias in the adnexa (ADNEX) model (AUC 0.91 vs 0.86, p = 0.07).
Our findings underscore the potential value of CEUS as an adjunctive tool for enhancing the precision of diagnostic evaluations of O-RADS US.
The promising performance of the modified CEUS risk stratification model suggests its potential to mitigate unnecessary surgeries in the characterization of adnexal lesions with solid components.
• The additional value of CEUS to O-RADS US in distinguishing between benign and malignant adnexal lesions with solid components requires further evaluation. • The modified CEUS risk stratification model displayed superior diagnostic value and specificity in characterizing adnexal lesions with solid components when compared to O-RADS US. • The inclusion of CEUS demonstrated potential in reducing the need for unnecessary surgeries in the characterization of adnexal lesions with solid components.
评估对比增强超声（CEUS）与卵巢附件报告和数据系统（O-RADS）超声（US）联合应用在具有实性成分的附件病变特征中的额外优势。
本前瞻性多中心研究于 2021 年 9 月至 2022 年 12 月间招募了疑似具有实性成分附件病变的女性患者。所有计划手术的患者均接受术前 CEUS 和 US 检查。根据 O-RADS US 系统对病变进行分类，并记录定量 CEUS 指标。以病理结果为参考标准。采用单变量和多变量分析来确定具有实性成分的附件病变恶性的危险因素。采用受试者工作特征（ROC）曲线分析评估诊断性能。
共纳入 175 例患者的 180 个病灶，其中 80 个为恶性，100 个为良性。多变量分析显示，血清 CA-125、声影的存在和 CEUS 实性成分的峰值强度（PI）比值（PI/PI）与附件恶性肿瘤独立相关。改良 CEUS 风险分层模型在评估具有实性成分的附件病变方面显示出优于 O-RADS US 的诊断价值（AUC：0.91 与 0.78，p<0.001），与附件不同肿瘤评估（ADNEX）模型相当（AUC 0.91 与 0.86，p=0.07）。
本研究结果强调了 CEUS 作为增强 O-RADS US 诊断评估准确性的辅助工具的潜在价值。
改良 CEUS 风险分层模型的良好表现提示其在具有实性成分的附件病变特征评估中具有减少不必要手术的潜力。
·CEUS 对 O-RADS US 在鉴别具有实性成分的良性和恶性附件病变中的附加价值需要进一步评估。
·与 O-RADS US 相比，改良 CEUS 风险分层模型在具有实性成分的附件病变特征评估中具有更高的诊断价值和特异性。
·CEUS 的纳入有可能减少具有实性成分的附件病变特征评估中不必要的手术。
