Annals of medicine and surgery (2012) · 2025
MRI O-RADS: redefining diagnostic accuracy in characterization of ovarian lesions with histopathology as the benchmark.
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Sangi Zainab Nazir, Naz Nasreen, Asad Samita, Qureshi Aneeqa, Fareed Mumtaz, Hyder Syed Muhammad Shahnawaz, Yasir Ammar-E
Аннотация
BACKGROUND: Adnexal lesions are a common gynecological concern requiring accurate distinction between benign and malignant types for optimal clinical management. The Ovarian-Adnexal Reporting and Data System for magnetic resonance imaging (MRI) (O-RADS MRI) aim to standardize risk assessment and enhance diagnostic precision.
OBJECTIVE: To evaluate the diagnostic accuracy of MRI using O-RADS MRI criteria, with histopathology as the gold standard.
METHODS: This descriptive cross-sectional study was conducted from January to June 2025 at the Dow Institute of Radiology, Dow University of Health Sciences (DUHS), Karachi, Pakistan. Women aged 18-65 years undergoing contrast-enhanced MRI for ultrasound-detected ovarian lesions, with available histopathology, were included. Patients with prior surgery, chemotherapy, radiotherapy, pregnancy, lactation, other malignancies, or inconclusive histopathology were excluded. O-RADS MRI scores were assigned by an experienced radiologist. Diagnostic metrics including sensitivity, specificity, predictive values, likelihood ratios, overall accuracy, and area under the curve (AUC) were calculated.
RESULTS: Among 145 patients (62.76% premenopausal, 37.24% postmenopausal), O-RADS categories 3 (32.41%) and 4 (31.03%) were most frequent. Benign lesions predominated in premenopausal women (60.44%), while malignant lesions were more common in postmenopausal women (66.67%). Common benign lesions included hemorrhagic cysts (14.48%), endometriomas (9.66%), and serous cystadenomas (6.90%), while serous cystadenocarcinoma (14.48%) was the most frequent malignancy. Using O-RADS ≥4 as the threshold for malignancy, sensitivity was 93.10%, specificity 79.31%, positive predictive value 75.00%, negative predictive value 94.52%, overall accuracy 84.83%, and AUC 0.921. Redefining O-RADS categories 3-5 as positive markedly reduced diagnostic accuracy to 56.42% and sensitivity to 66.67.
CONCLUSION: The O-RADS MRI scoring system demonstrated excellent diagnostic accuracy in distinguishing benign from malignant ovarian lesions, supporting its role in clinical decision-making and risk stratification.
OBJECTIVE: To evaluate the diagnostic accuracy of MRI using O-RADS MRI criteria, with histopathology as the gold standard.
METHODS: This descriptive cross-sectional study was conducted from January to June 2025 at the Dow Institute of Radiology, Dow University of Health Sciences (DUHS), Karachi, Pakistan. Women aged 18-65 years undergoing contrast-enhanced MRI for ultrasound-detected ovarian lesions, with available histopathology, were included. Patients with prior surgery, chemotherapy, radiotherapy, pregnancy, lactation, other malignancies, or inconclusive histopathology were excluded. O-RADS MRI scores were assigned by an experienced radiologist. Diagnostic metrics including sensitivity, specificity, predictive values, likelihood ratios, overall accuracy, and area under the curve (AUC) were calculated.
RESULTS: Among 145 patients (62.76% premenopausal, 37.24% postmenopausal), O-RADS categories 3 (32.41%) and 4 (31.03%) were most frequent. Benign lesions predominated in premenopausal women (60.44%), while malignant lesions were more common in postmenopausal women (66.67%). Common benign lesions included hemorrhagic cysts (14.48%), endometriomas (9.66%), and serous cystadenomas (6.90%), while serous cystadenocarcinoma (14.48%) was the most frequent malignancy. Using O-RADS ≥4 as the threshold for malignancy, sensitivity was 93.10%, specificity 79.31%, positive predictive value 75.00%, negative predictive value 94.52%, overall accuracy 84.83%, and AUC 0.921. Redefining O-RADS categories 3-5 as positive markedly reduced diagnostic accuracy to 56.42% and sensitivity to 66.67.
CONCLUSION: The O-RADS MRI scoring system demonstrated excellent diagnostic accuracy in distinguishing benign from malignant ovarian lesions, supporting its role in clinical decision-making and risk stratification.