Share this content in WeChat
Clinical value and research progress of MRI risk stratification in the Ovarian-Adnexal Reporting and Data System
JIN Junjie  DENG Xijia  ZHANG Jiuquan 

Cite this article as: JIN J J, DENG X J, ZHANG J Q. Clinical value and research progress of MRI risk stratification in the Ovarian-Adnexal Reporting and Data System[J]. Chin J Magn Reson Imaging, 2023, 14(4): 193-197, 202. DOI:10.12015/issn.1674-8034.2023.04.034.

[Abstract] The differential diagnosis between benign and malignant ovarian adnexal masses has a major impact on gynaecological management strategies and patient outcomes. Although ultrasound can correctly classify most ovarian adnexal lesions, 10%-30% of ovarian adnexal lesions can not be clearly diagnosed by ultrasound. MRI can provide more accurate diagnosis for ultrasonic uncertain lesions, thus improving the clinical management and prognosis of patients. In 2022, the American Academy of Radiology (ACR) released the guidelines of the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI risk stratification system, which is used to accurately evaluate ovarian accessory lesions. However, as a novel approach, this risk stratification system presents challenges: a standardized MRI protocol as well as specialized perfusion curve analysis software need to be developed, in addition, specialized training of radiologists may be necessary for the clinical use of O-RADS MRI. Further prospective cohort studies are needed in the future to develop clinical management recommendations for each O-RADS MRI risk category. Currently, there is a lack of a systematic summary of the research progress related to O-RADS MRI, and in this review, we will summarize the research progress on O-RADS MRI in terms of its proposal, clinical significance and application value, relevant research hot spots, deficiencies and future directions, in order to help radiologists apply this risk stratification system in their clinical work and try to find potential boosting points for this risk stratification system, which in turn continuously increases its differential diagnostic efficacy.
[Keywords] ovarian-adnexal mass;benign and malignancy;Ovarian-Adnexal Reporting and Data System;magnetic resonance imaging;dynamic contrast-enhanced;time-intensity curves;differential diagnosis

JIN Junjie   DENG Xijia   ZHANG Jiuquan*  

Department of Radiology, Chongqing University Cancer Hospital, Chongqing 400030, China

Corresponding author: Zhang JQ, E-mail:

Conflicts of interest   None.

Received  2022-10-16
Accepted  2023-02-23
DOI: 10.12015/issn.1674-8034.2023.04.034
Cite this article as: JIN J J, DENG X J, ZHANG J Q. Clinical value and research progress of MRI risk stratification in the Ovarian-Adnexal Reporting and Data System[J]. Chin J Magn Reson Imaging, 2023, 14(4): 193-197, 202. DOI:10.12015/issn.1674-8034.2023.04.034.

SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2015[J]. CA A Cancer J Clin, 2015, 65(1): 5-29. DOI: 10.3322/caac.21254.
JOHANSEN G, DAHM-KÄHLER P, STAF C, et al. A Swedish Nationwide prospective study of oncological and reproductive outcome following fertility-sparing surgery for treatment of early stage epithelial ovarian cancer in young women[J/OL]. BMC Cancer, 2020, 20(1): 1009 [2022-10-19]. DOI: 10.1186/s12885-020-07511-y.
SADOWSKI E A, ROCKALL A G, MATUREN K E, et al. Adnexal lesions: imaging strategies for ultrasound and MR imaging[J]. Diagn Interv Imaging, 2019, 100(10): 635-646. DOI: 10.1016/j.diii.2018.06.003.
PATEL-LIPPMANN K K, SADOWSKI E A, ROBBINS J B, et al. Comparison of international ovarian tumor analysis simple rules to society of radiologists in ultrasound guidelines for detection of malignancy in adnexal cysts[J]. AJR Am J Roentgenol, 2020, 214(3): 694-700. DOI: 10.2214/AJR.18.20630.
FROYMAN W, LANDOLFO C, DE COCK B, et al. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study[J]. Lancet Oncol, 2019, 20(3): 448-458. DOI: 10.1016/S1470-2045(18)30837-4.
MEYS E M, KAIJSER J, KRUITWAGEN R F, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis[J]. Eur J Cancer, 2016, 58: 17-29. DOI: 10.1016/j.ejca.2016.01.007.
LEVINE D. O-RADS US: a retrospective assessment of prediction of malignancy in a high-risk setting[J]. Radiology, 2022, 304(1): 121-122. DOI: 10.1148/radiol.213128.
HACK K, GANDHI N, BOUCHARD-FORTIER G, et al. External validation of O-RADS US risk stratification and management system[J]. Radiology, 2022, 304(1): 114-120. DOI: 10.1148/radiol.211868.
MOKRY T, MLYNARSKA-BUJNY A, KUDER T A, et al. Ultra-high-b-value kurtosis imaging for noninvasive tissue characterization of ovarian lesions[J]. Radiology, 2020, 296(2): 358-369. DOI: 10.1148/radiol.2020191700.
SAIDA T, MORI K, HOSHIAI S, et al. Diagnosing ovarian cancer on MRI: a preliminary study comparing deep learning and radiologist assessments[J/OL]. Cancers, 2022, 14(4): 987 [2022-10-12]. DOI: 10.3390/cancers14040987.
THOMASSIN-NAGGARA I, AUBERT E, ROCKALL A, et al. Adnexal masses: development and preliminary validation of an MR imaging scoring system[J]. Radiology, 2013, 267(2): 432-443. DOI: 10.1148/radiol.13121161.
DILKS P, NARAYANAN P, REZNEK R, et al. Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?[J]. Eur Radiol, 2010, 20(9): 2176-2183. DOI: 10.1007/s00330-010-1795-6.
MOHAGHEGH P, ROCKALL A G. Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques[J]. Radiographics, 2012, 32(6): 1751-1773. DOI: 10.1148/rg.326125520.
BERNARDIN L, DILKS P, LIYANAGE S, et al. Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation[J]. Eur Radiol, 2012, 22(4): 880-890. DOI: 10.1007/s00330-011-2331-z.
THOMASSIN-NAGGARA I, DARAÏ E, CUENOD C A, et al. Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors[J]. J Magn Reson Imaging, 2008, 28(1): 111-120. DOI: 10.1002/jmri.21377.
TIMMERMAN D, VAN CALSTER B, TESTA A, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group[J]. Am J Obstet Gynecol, 2016, 214(4): 424-437. DOI: 10.1016/j.ajog.2016.01.007.
SADOWSKI E A, THOMASSIN-NAGGARA I, ROCKALL A, et al. O-RADS MRI risk stratification system: guide for assessing adnexal lesions from the ACR O-RADS committee[J]. Radiology, 2022, 303(1): 35-47. DOI: 10.1148/radiol.204371.
CHEN H, YANG B W, QIAN L, et al. Deep learning prediction of ovarian malignancy at US compared with O-RADS and expert assessment[J]. Radiology, 2022, 304(1): 106-113. DOI: 10.1148/radiol.211367.
WU M L, ZHANG M, CAO J Y, et al. Predictive accuracy and reproducibility of the O-RADS US scoring system among sonologists with different training levels[J/OL]. Arch Gynecol Obstet, 2022 [2022-10-31]. DOI: 10.1007/s00404-022-06752-5.
PEREIRA P N, SARIAN L O, YOSHIDA A, et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses[J]. Diagn Interv Radiol, 2018, 24(2): 63-71. DOI: 10.5152/dir.2018.17378.
THOMASSIN-NAGGARA I, ROCKALL A. Editorial for "validity and reproducibility of ADNEX MR SCORING system in diagnosis of sonographically indeterminate adnexal masses"[J]. J Magn Reson Imaging, 2021, 53(2): 640-641. DOI: 10.1002/jmri.27327.
PEREIRA P N, SARIAN L O, YOSHIDA A, et al. Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of a magnetic resonance scoring (ADNEX MR scoring system)[J]. Abdom Radiol (NY), 2020, 45(10): 3218-3229. DOI: 10.1007/s00261-019-02207-9.
THOMASSIN-NAGGARA I, PONCELET E, JALAGUIER-COUDRAY A, et al. Ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses[J/OL]. JAMA Netw Open, 2020, 3(1): e1919896 [2022-10-31]. DOI: 10.1001/jamanetworkopen.2019.19896.
REINHOLD C, ROCKALL A, SADOWSKI E A, et al. Ovarian-adnexal reporting lexicon for MRI: a white paper of the ACR ovarian-adnexal reporting and data systems MRI committee[J]. J Am Coll Radiol, 2021, 18(5): 713-729. DOI: 10.1016/j.jacr.2020.12.022.
SADOWSKI E A, MATUREN K E, ROCKALL A, et al. Ovary: mri characterisation and O-RADS MRI[J/OL]. Br J Radiol, 2021, 94(1125): 20210157 [2022-10-17]. DOI: 10.1259/bjr.20210157.
PEREIRA P N, YOSHIDA A, SARIAN L O, et al. Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes[J]. Radiol Bras, 2022, 55(3): 137-144. DOI: 10.1590/0100-3984.2021.0050.
AVESANI G, ELIA L, ANGHELONE A G, et al. Features of cystadenofibroma on magnetic resonance imaging: an update using the O-RADS lexicon and considering diffusion-weighted and perfusion imaging[J/OL]. Eur J Radiol, 2022, 154: 110429 [2022-10-15]. DOI: 10.1016/j.ejrad.2022.110429.
HOTTAT N A, BADR D A, VAN PACHTERBEKE C, et al. Added value of quantitative analysis of diffusion-weighted imaging in ovarian-adnexal reporting and data system magnetic resonance imaging[J]. J Magn Reson Imaging, 2022, 56(1): 158-170. DOI: 10.1002/jmri.28003.
XU H, YE L, CHEN Y T. Editorial for "added-value of quantitative analysis of diffusion-weighted imaging in ovarian-adnexal reporting and data system magnetic resonance imaging (O-RADS MRI): a prospective cohort study"[J]. J Magn Reson Imaging, 2022, 56(1): 171-172. DOI: 10.1002/jmri.28011.
ELSHETRY A S F, HAMED E M, FRERE R A F, et al. Impact of adding mean apparent diffusion coefficient (ADCmean) measurements to O-RADS MRI scoring for adnexal lesions characterization: A combined O-RADS MRI/ADCmean approach[J]. Acad Radiol, 2023, 30(2): 300-311. DOI: 10.1016/j.acra.2022.07.019.
LIN Y, HSIEH C Y, HUANG Y L, et al. Magnetic resonance spectroscopy for risk stratification of sonographically indeterminate ovarian neoplasms: preliminary study[J/OL]. Diagnostics (Basel), 2021, 11(10): 1847 [2022-10-26]. DOI: 10.3390/diagnostics11101847.
ASSOULINE V, DABI Y, JALAGUIER-COUDRAY A, et al. How to improve O-RADS MRI score for rating adnexal masses with cystic component?[J]. Eur Radiol, 2022, 32(9): 5943-5953. DOI: 10.1007/s00330-022-08644-3.
CRESTANI A, THEODORE C, LEVAILLANT J M, et al. Magnetic resonance and ultrasound fusion imaging to characterise ovarian masses: a feasibility study[J]. Anticancer Res, 2020, 40(7): 4115-4121. DOI: 10.21873/anticanres.14410.
SAHIN H, PANICO C, URSPRUNG S, et al. Non-contrast MRI can accurately characterize adnexal masses: a retrospective study[J]. Eur Radiol, 2021, 31(9): 6962-6973. DOI: 10.1007/s00330-021-07737-9.
ASLAN S, TOSUN S A. Diagnostic accuracy and validity of the O-RADS MRI score based on a simplified MRI protocol: a single tertiary center retrospective study[J]. Acta Radiol, 2023, 64(1): 377-386. DOI: 10.1177/02841851211060413.
WENGERT G J, DABI Y, KERMARREC E, et al. O-RADS MRI classification of indeterminate adnexal lesions: time-intensity curve analysis is better than visual assessment[J]. Radiology, 2022, 303(3): 566-575. DOI: 10.1148/radiol.210342.
STEIN E B, ROSELAND M E, SHAMPAIN K L, et al. Contemporary guidelines for adnexal mass imaging: a 2020 update[J]. Abdom Radiol (NY), 2021, 46(5): 2127-2139. DOI: 10.1007/s00261-020-02812-z.
SADOWSKI E A, STEIN E B, THOMASSIN-NAGGARA I, et al. O-RADS MRI after initial ultrasound for adnexal lesions: AJR expert panel narrative review[J]. AJR Am J Roentgenol, 2023, 220(1): 6-15. DOI: 10.2214/AJR.22.28084.
LEVINE D. MRI O-RADS: learning about the new risk stratification system[J]. Radiology, 2022, 303(1): 48-50. DOI: 10.1148/radiol.211307.
THOMASSIN-NAGGARA I, BELGHITTI M, MILON A, et al. O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort[J]. Eur Radiol, 2021, 31(12): 9588-9599. DOI: 10.1007/s00330-021-08054-x.
SUN M Y, HU X X, ZHANG F, et al. Introduction of the ovarian-adnexal reporting and data magnetic resonance imaging risk stratification system[J]. Diagn Imaging Interv Radiol, 2022, 31(4): 243-251. DOI: 10.3969/j.issn.1005-8001.2022.04.001.

PREV Research progress of radiomics in endometrial cancer
NEXT Research progress of multimodal imaging technique in high altitude polycythemia

Tel & Fax: +8610-67113815    E-mail: