ArticleEuropean radiology2026
Improving diagnostic performance of O-RADS MRI: semi-quantitative intensity curves vs visual assessment of enhancement.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundO-RADS MRI improves differentiation of benign adnexal lesions managed by a gynecologist and malignant lesions managed by a gynecologic oncologist.
objectiveTo compare O-RADS MRI visual assessment (VA) of mass enhancement with a semi-quantitative intensity curve of enhancement (SIC), a modified manual version of the time intensity curve. MATERIALS AND
methodsWe conducted a retrospective MRI review of patients who underwent surgical resection between January 2008 and December 2018 at two referral centers. O-RADS MRI score was assigned by two radiologists with different experience. O-RADS score ≥ 4 was considered suspicious for malignancy. Per-lesion diagnostic accuracy and impact on surgical management were compared between VA and SIC in lesions with solid components. Inter/intra-reader agreement was assessed. Borderline and invasive lesions were considered malignant.
resultsThree hundred forty-one adnexal masses in 321 women (ages 18-89) were assessed; 35.2% (120/341) of the masses were malignant. Ninety-six and two-tenths percent had some solid component (329/341). O-RADS MRI using standard VA had a sensitivity, specificity, and PPV of 0.95 (CI: 0.89-0.98), 0.84 (CI: 0.79-0.89), and 0.77 (CI:0.69-0.83), respectively. Use of SIC improved specificity (0.92 [CI: 0.88-0.95, p = 0.007) and PPV (0.90 [CI: 0.83-0.95], p = 0.002). Including SIC in O-RADS MRI would have reduced the proportion of benign lesions operated by gyneoncologists from 16% [54/341] to 9% [1/341] (p = 0.0001). O-RADS score, SIC, and VA assessment had a moderate to high inter- and intra-reader agreement (Kappa 0.63-0.85).
conclusionO-RADS MRI exhibited high diagnostic performance in triage of adnexal masses. Incorporation of SIC increased the specificity and PPV of O-RADS MRI with high inter- and intra-reader agreement of SIC interpretation. KEY POINTS: Question Differentiation of benign from malignant adnexal masses is important for surgical triage. Findings Integration of semiquantitative intensity curves (SIC) into O-RADS MRI improved specificity when compared to conventional VA. Clinical relevance Integration of SIC into O-RADS MRI improves surgical triage of patients.
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