Victoria Assouline1,2, Yohann Dabi3,4, Aurélie Jalaguier-Coudray5, Sanja Stojanovic6, Ingrid Millet7,8, Caroline Reinhold9, Marc Bazot10,3, Isabelle Thomassin-Naggara10,3. 1. Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France. victoria_assouline@hotmail.fr. 2. Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France. victoria_assouline@hotmail.fr. 3. Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France. 4. Service de gynécologie et obstétrique, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France. 5. Institut Paoli Calmettes, Marseille, France. 6. Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia. 7. Department of Radiology, Lapeyronie Hospital, Montpellier, France. 8. Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France. 9. Department of Medical Imaging, McGill University Health Centre, Montreal, Canada. 10. Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean 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, 95%CI [0.938-0.973]. CONCLUSION: Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. KEY POINTS: • 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.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean 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, 95%CI [0.938-0.973]. CONCLUSION: Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. KEY POINTS: • 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.
Authors: K Togashi; K Nishimura; K Itoh; I Fujisawa; T Sago; S Minami; Y Nakano; H Itoh; K Torizuka; H Ozasa Journal: Radiology Date: 1987-03 Impact factor: 11.105
Authors: M A Ghossain; J N Buy; C Lignères; M Bazot; K Hassen; L Malbec; D Hugol; J B Truc; Y Decroix; P Poitout Journal: Radiology Date: 1991-12 Impact factor: 11.105
Authors: Isabelle Thomassin-Naggara; Edouard Poncelet; Aurelie Jalaguier-Coudray; Adalgisa Guerra; Laure S Fournier; Sanja Stojanovic; Ingrid Millet; Nishat Bharwani; Valerie Juhan; Teresa M Cunha; Gabriele Masselli; Corinne Balleyguier; Caroline Malhaire; Nicolas F Perrot; Elizabeth A Sadowski; Marc Bazot; Patrice Taourel; Raphaël Porcher; Emile Darai; Caroline Reinhold; Andrea G Rockall Journal: JAMA Netw Open Date: 2020-01-03