基于磁共振成像的卵巢附件报告和数据系统在附件包块诊断中的价值
Value of MRI-Based Ovarian-Adnexal Reporting and Data System for the Diagnosis of Adnexal Masses.
作者信息
Zhang Shan, Li Tao, Huang Zeng-Fa, DU Xin-Yu, Tang Rui-Yao, Wang Wan-Peng, Wang Xi, Xie Wei, Wang Xiang, Zhang Shu-Tong
机构信息
Department of Radiology,The Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China.
出版信息
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2024 Dec;46(6):909-917. doi: 10.3881/j.issn.1000-503X.16176.
Objective To assess the value of the MRI-based ovarian-adnexal reporting and data system (O-RADS MRI) for the diagnosis of adnexal masses. Methods A total of 407 patients who underwent dynamic contrast enhancement (DCE)-MRI and pathological examination (gold standard) at the Department of Radiology,Central Hospital of Wuhan between May 2017 and December 2022 were enrolled in this study.Two radiologists performed the O-RADS MRI scoring of adnexal masses according to MRI features and calculated the malignancy rate of adnexal masses by O-RADS MRI score,enhancement type,and mass type.Moreover,receiver operating characteristic curves were established to further evaluate the diagnostic values of O-RADS MRI score,enhancement type,and mass type for adnexal masses. Results A total of 502 adnexal masses were identified in the 407 patients enrolled in this study,including 364 benign masses and 138 malignant masses (including junctional masses).Radiologist 1 reported the malignancy rates of 0,0,5.4%,80.0%,and 89.7% and radiologist 2 reported the malignancy rates of 0,0,5.8%,86.2%,and 83.0% for the adnexal masses with the O-RADS MRI scores of 1-5,respectively.With O-RADS MRI ≥4 indicating malignant masses,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,false negative rate,and false positive rate were 94.2%,93.6%,93.8%,84.9%,97.7%,2.3%,and 15.1% for radiologist 1 and 93.4%,93.6%,93.6%,85.4%,97.4%,3.6%,and 14.6% for radiologist 2,respectively.The malignancy rates of the adnexal masses presenting no enhancement,cystic wall enhancement,type Ⅰ curve,type Ⅱ curve,and type Ⅲ curve were 0,1.3%,5.7%,81.2%,and 89.0% as reported by radiologist 1 and 0,1.2%,11.3%,87.6%,and 80.0% as reported by radiologist 2,respectively.The malignancy rates of the adnexal masses that were cystic lesions,cystic segregated lesions,solid lesions,cystic solid lesions,and cystic solid segregated lesions were 0,7.1%,38.7%,79.1%,and 89.8% as reported by radiologist 1 and 0,8.1%,37.8%,72.4%,and 89.6% as reported by radiologist 2,respectively.With type Ⅱ and type Ⅲ curves as the criteria for malignancy,the sensitivity of radiologists 1 and 2 was lower for cystic segregated lesions,both at 50.0%.For the masses containing solid components,radiologists 1 and 2 demonstrated low specificity,which was 57.7% and 56.5%,respectively.False-positive masses contained solid components and were mostly fibroadenomas or adnexal leiomyomas,while false-negative masses were mostly junctional cystadenomas with no or few solid components. Conclusions The O-RADS MRI risk stratification has a high diagnostic value for adnexal masses.Further evaluation and refinement are needed to reduce the false-positive rate.
目的 评估基于磁共振成像（MRI）的卵巢附件报告和数据系统（O-RADS MRI）对附件包块的诊断价值。方法 选取2017年5月至2022年12月在武汉市中心医院放射科接受动态对比增强（DCE）-MRI检查及病理检查（金标准）的407例患者纳入本研究。两名放射科医生根据MRI特征对附件包块进行O-RADS MRI评分，并根据O-RADS MRI评分、强化类型及包块类型计算附件包块的恶性率。此外，绘制受试者工作特征曲线，进一步评估O-RADS MRI评分、强化类型及包块类型对附件包块的诊断价值。结果 本研究纳入的407例患者共发现502个附件包块，其中良性包块364个，恶性包块138个（包括交界性包块）。放射科医生1报告O-RADS MRI评分为1-5分的附件包块恶性率分别为0、0、5.4%、80.0%、89.7%，放射科医生2报告的恶性率分别为0、0、5.8%、86.2%、83.0%。以O-RADS MRI≥4提示恶性包块，放射科医生1的敏感度、特异度、准确度、阳性预测值、阴性预测值、假阴性率及假阳性率分别为94.2%、93.6%、93.8%、84.9%、97.7%、2.3%、15.1%，放射科医生2分别为93.4%、93.6%、93.6%、85.4%、97.4%、3.6%、14.6%。放射科医生1报告无强化、囊壁强化、Ⅰ型曲线、Ⅱ型曲线及Ⅲ型曲线的附件包块恶性率分别为0、1.3%、5.7%、81.2%、89.0%，放射科医生2分别为0、1.2%、11.3%、87.6%、80.0%。放射科医生1报告囊性病变、囊性分隔病变、实性病变、囊实性病变及囊实性分隔病变的附件包块恶性率分别为0、7.1%、38.7%、79.1%、89.8%，放射科医生2分别为0、8.1%、37.8%、72.4%、89.6%。以Ⅱ型和Ⅲ型曲线作为恶性标准，放射科医生1和2对囊性分隔病变的敏感度均较低，均为50.0%。对于含有实性成分的包块，放射科医生1和2的特异度较低，分别为57.7%和
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