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
Department of Radiology,The Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China.
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
