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• Clinical Article •
The value of a clinical-multiparametric MRI prediction model based on O-RADS MRI scoring system in differentiating between benign and malignant adnexal masses of the uterus
ZHANG Xiaoqin  LIN Sihong  LIN Zelin  LIN Shaofan  LIN Daiying 

Cite this article as: ZHANG X Q, LIN S H, LIN Z L, et al. The value of a clinical-multiparametric MRI prediction model based on O-RADS MRI scoring system in differentiating between benign and malignant adnexal masses of the uterus[J]. Chin J Magn Reson Imaging, 2025, 16(7): 39-46. DOI:10.12015/issn.1674-8034.2025.07.006.


[Abstract] Objective To develop and validate a clinical-multiparametric MRI predictive model incorporating the ovarian-adnexal reporting and data system (O-RADS) MRI score, and to evaluate its utility in distinguishing benign from malignant adnexal lesions.Materials and Methods A retrospective study was performed to analyze 165 cases of adnexal masses that underwent pelvic MRI plain scan + enhanced examination and were confirmed by pathological histology from 2020 to 2023. The preoperative clinical indicators and imaging characteristics of the patients were collected. The differences in various indicators between benign and malignant mass groups were compared by univariate analysis. Multivariate logistic regression was used to screen out independent risk factors for predicting adnexal malignant masses, and a logistic regression prediction model was constructed and displayed in a nomogram. Receiver operating characteristic (ROC) curve, DeLong test, integrated discrimination improvement index (IDI) and net reclassification index (NRI) were used to evaluate and compare the difference in differential diagnostic performance between the logistic regression model based on O-RADS MRI score and the simple O-RADS MRI score. Calibration curves were drawn to evaluate the calibration ability of the logistic regression model. Decision curve analysis (DCA) was used to evaluate the clinical net benefits of the two models.Results After screening, a total of 165 patients (with 170 masses) were collected. The age ranged from 11 to 87 years old. The median age of the benign group was 49.50 (28.75, 60.75) years old, and the median age of the malignant group was 50.50 (38.75, 62.00) years old. The results of univariate analysis showed that there were significant differences in carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), platelet count (PLT), lesion boundary clarity, O-RADS MRI scores, mean apparent diffusion coefficient (ADCmean) of solid components, and ADC values of cystic fluid between benign and malignant masses (all P < 0.05) . Multifactorial logistic regression analysis showed that increased HE4 level (OR = 1.011, P = 0.028), increased O-RADS MRI score (OR = 3.085, P = 0.001), and decreased ADCmean value (OR = 0.005, P < 0.001) were independent predictors of malignant lesions of adnexal masses. The logistic regression model was established by combining O-RADS MRI score, ADCmean, and HE4. The area under the curve (AUC) for distinguishing benign and malignant adnexal masses was 0.944, the sensitivity was 84.9%, and the specificity was 90.5%, which were better than the simple O-RADS MRI score (AUC was 0.849, sensitivity was 89.5%, and specificity was 81.0%). DeLong test showed that the difference in AUC between the two models was statistically significant (P < 0.001). NRI and IDI showed that the logistic regression model had better differential diagnostic performance for adnexal masses than the O-RADS MRI score, and the difference were statistically significant (P < 0.05). The calibration curves showed that the calibration of the logistic regression model was good; DCA showed that the clinical net yield of the logistic regression model was greater than that of the O-RADS MRI score.Conclusions The logistic regression model constructed by combining O-RADS MRI score, ADCmean and HE4 has high efficacy in the differential diagnosis of benign and malignant adnexal masses, and its differentiation efficiency is better than that of the simple O-RADS MRI score, and can be used to effectively distinguish benign and malignant adnexal masses before surgery.
[Keywords] ovarian-adnexal reporting and data system；adnexal masses；differential diagnosis；prediction model；nomogram；magnetic resonance imaging

ZHANG Xiaoqin   LIN Sihong   LIN Zelin   LIN Shaofan   LIN Daiying*  

MRI Room of Shantou Central Hospital, Shantou 515041, China

Corresponding author: LIN D Y, E-mail: lindaiying917@163.com

Conflicts of interest   None.

Received  2025-03-01
Accepted  2025-06-05
DOI: 10.12015/issn.1674-8034.2025.07.006
Cite this article as: ZHANG X Q, LIN S H, LIN Z L, et al. The value of a clinical-multiparametric MRI prediction model based on O-RADS MRI scoring system in differentiating between benign and malignant adnexal masses of the uterus[J]. Chin J Magn Reson Imaging, 2025, 16(7): 39-46. DOI:10.12015/issn.1674-8034.2025.07.006.

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