Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses

Abstract

PURPOSEWe aimed to evaluate the ADNEX MR scoring system for the prediction of adnexal mass malignancy, using a simplified magnetic resonance imaging (MRI) protocol. METHODSIn this prospective study, 200 patients with 237 adnexal masses underwent MRI between February 2014 and February 2016 and were followed until February 2017. Two radiologists calculated ADNEX MR scores using an MRI protocol with a simplified dynamic study, not a high temporal resolution study, as originally proposed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the area under the receiver operating characteristic curve were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >12 months of follow-up. RESULTSOf 237 lesions, 79 (33.3%) were malignant. The ADNEX MR scoring system, using a simplified MRI protocol, showed 94.9% (95% confidence interval [CI], 87.5%-98.6%) sensitivity and 97.5% (95% CI, 93.6%-99.3%) specificity in malignancy prediction; it was thus highly accurate, like the original system. The level of interobserver agreement on simplified scoring was high (κ = 0.91). CONCLUSIONIn a tertiary cancer center, the ADNEX MR scoring system, even based on a simplified MRI protocol, performed well in the prediction of malignant adnexal masses. This scoring system may enable the standardization of MRI reporting on adnexal masses, thereby improving communication between radiologists and gynecologists.You may cite this article as: Pereira PN, Sarian LO, Yoshida A, et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses. Diagn Interv Radiol 2018; 24:63-71. A dnexal masses are frequent findings in pelvic and abdominal imaging studies, such as those conducted with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) (1). Preoperative evaluation of these lesions and determination of the risk of malignancy are critical to define treatment. A lesion with a low risk of malignancy can be followed or treated with minimally invasive surgery performed by a general gynecologist. When the risk of malignancy is significant, the patient should be referred to a tertiary center for treatment by a multidisciplinary team that includes an oncologic gynecologist (2, 3).Every year, about 240 000 women worldwide are diagnosed with ovarian cancer. The 5-year survival rate is less than 45%, and ovarian cancer is responsible for about 150 000 deaths annually. Thus, it is the seventh most common cancer and the eighth most common cause of cancer death among women (4).US is the first-line modality for the assessment of suspected adnexal masses, with very accurate results (5). However, US examination yields indeterminate findings in approximately 20% of adnexal masses (6-8). Exophytic and large tumors, fatty components, clots that mimic vegetation, and fibrous tumors have morphologic characteristics that are difficult to interpret with US. Other imaging methods (e...

State of the art in abdominal MRI structured reporting: a review

“…In 2013, a standardized reporting system for ovarian mass characterization on MRI was proposed [42]. The validity of this five-category ADNEX MR SCORING system was subsequently verified by independent study groups also confirming that it might lead to the standardization of MRI reporting for ovarian masses [43][44][45]. Very recently, the MRI working group for the Ovarian-Adnexal Imaging-Reporting and Data System (O-RADS) confirmed with a prospective multicenter study the performance of the ADNEX MR SCORING system (now called the O-RADS MRI score), that represents the current standard in the field [46].…”

The accuracy of pelvic magnetic resonance imaging in the diagnosis of ovarian malignancy in Iraqi patients in comparison with histopathology

“…Our validity results of MRI are lower than results of Guerra et al (17) study in Portugal which revealed MRI sensitivity of 98%, specificity of 93%, +ve predictive value of 92%, -ve predictive value of 98% and accuracy of 95% in the diagnosis of malignant adnexal masses. In Brazil, Pereira et al (18) conducted a study on 237 women with adnexal masses using ADNEX MR scoring which showed that MRI sensitivity and specificity in the diagnosis of malignancy were 94.9% and 97.5%, respectively. The MRI is shown to have high sensitivity in diagnosing malignant adnexal mass approaching 96.6% while the specificity is between 83.7% -94.0% (19,20).…”

The Role of Diffusion-weighted MRI and Follow-up Contrast-enhanced MRI in Correlation with the Adnexa MR Scoring System in the Diagnosis of Uterine Appendage Tumors

“…Комплексная МРТ позволяет отнести к доброкачественным ОЯ, которые по данным рутинной МРТ были ложно диагностированы как ЗОЯ, что является серьезной проблемой в клинике и приводит к выбору неадекватных стратегий и тактики лечения [29].…”

“…На базе системы AMRSS было проведено проспективное исследование 200 пациенток (237 ОЯ) с упрощенным протоколом ДМРТКУ (с низким временным разрешением в 30, 60, 90, 120 и 150 с при высоком пространственном разрешении), в ходе которого два радиолога анализировали категории ADNEX MR по следующим пяти барьерным критериям [29]:…”

“…Для ЗОЯ чувствительность составила 94,9%, точность -96,62%. Прогностическая ценность положительного и отрицательного результатов -94,8 и 97,4% соответственно [29]. Таким образом, AMRSS показала достаточную эффективность при оценке вероятности ЗОЯ.…”