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• Clinical Article •
Value of MRI combining with clinical indicators in optimizing the risk stratification of O-RADS MRI Score 4
LI Caihong  LI Yi  LIU Liu  ZHOU Yin  YANG Yaying  MAO Yun 

Cite this article as: LI C H, LI Y, LIU L, et al. Value of MRI combining with clinical indicators in optimizing the risk stratification of O-RADS MRI Score 4[J]. Chin J Magn Reson Imaging, 2024, 15(11): 103-109. DOI:10.12015/issn.1674-8034.2024.11.016.


[Abstract] Objective To investigate the value of MRI characteristics combined with clinical indicators [carbohydrate antigen 125 (CA125), menopausal status, age] in optimizing the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI score 4 mass risk stratification and whether it can improve the diagnostic performance of the O-RADS MRI scoring system.Materials and Methods Totally 57 ovarian adnexal masses scored 4 according to O-RADS MRI were retrospectively analyzed. All masses underwent preoperative pelvic MRI enhancement imaging and were confirmed by histopathology. They were evaluated by two experienced radiologists and determined through consultation when the results were inconsistent. The pathological results were used as the gold standard to analyze the differences of MRI and clinical indicators in the O-RADS MRI score 4 group of benign and malignant masses. The classification and regression tree (CART) was employed to construct a model for statistically significant indicators for the further subdivision of the O-RADS MRI 4 mass. Receiver operating characteristic (ROC) analysis was used to evaluate the prediction accuracy of the decision tree model. To evaluate the diagnostic effect of O-RADS MRI scoring system before and after O-RADS MRI score 4 mass optimization, and compare the difference of area under the curve (AUC). The consistency of the optimized prediction results among different viewers was calculated.Results (1) Among 57 O-RADS MRI score 4 masses, 22 masses were benign, and 35 masses were malignant. Solid tissue showed hypointense on T2WI was more common in benign mass well (P<0.001). Papillary projections and irregularly thickened cyst wall or septations were more frequent in malignant mass (P<0.001, P=0.008). The CA125 level in malignant mass was often greater than 35 U/mL (P<0.05). The AUC of the decision tree model for predicting benign and malignant tumors was 0.984 (95% CI: 0.908-1.000), with a sensitivity of 97.1%, specificity of 90.9% and accuracy of 94.7%. (2) The AUC of the O-RADS MRI scoring system increased from 0.838 to 0.945 (P<0.001) in the whole population after optimizing the O-RADS MRI 4 mass with the decision tree model; In premenopausal women, the AUC increased from 0.818 to 0.934 (P<0.001). In postmenopausal women, the AUC increased from 0.871 to 0.962 (P=0.008). There was excellent agreement between the optimized predictions among physicians with different experience levels (Kappa=0.887, 0.869).Conclusion In this study, a predictive model developed based on solid tissue MRI features combined with CA125 levels helped optimize the risk stratification of O-RADS MRI score 4 mass and significantly improved the diagnostic performance of the O-RADS MRI scoring system, especially in premenopausal women.
[Keywords] ovarian-adnexal mass；Ovarian-Adnexal Reporting and Data System；benign and malignant lesions；differential diagnosis；magnetic resonance imaging

LI Caihong1   LI Yi1   LIU Liu1   ZHOU Yin1   YANG Yaying2, 3, 4, 5   MAO Yun1*  

1 Department of Radiology, the First Hospital of Chongqing Medical University, Chongqing400016, China

2 Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing400016, China

3 Pathology Diagnostic Center, Chongqing Medical University, Chongqing400016, China

4 Clinical Pathology Research Laboratory, Chongqing Medical University, Chongqing400016, China

5 Department of Pathology, the First Hospital of Chongqing Medical University, Chongqing400016, China

Corresponding author: MAO Y, E-mail: maoyun1979@163.com

Conflicts of interest   None.

Received  2024-08-02
Accepted  2024-11-10
DOI: 10.12015/issn.1674-8034.2024.11.016
Cite this article as: LI C H, LI Y, LIU L, et al. Value of MRI combining with clinical indicators in optimizing the risk stratification of O-RADS MRI Score 4[J]. Chin J Magn Reson Imaging, 2024, 15(11): 103-109. DOI:10.12015/issn.1674-8034.2024.11.016.

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