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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

Published:September 07, 2022DOI:https://doi.org/10.1016/j.acra.2022.07.019

      Rationale and Objectives

      Evaluate the impact of adding mean apparent diffusion coefficient (ADCmean) measurements to the Ovarian-Adnexal Imaging Reporting and Data System MRI (O-RADS MRI) scoring for adnexal lesion characterization using a combined O-RADS MRI/ADCmean reading approach.

      Materials and Methods

      This prospective study included 90 women who underwent pelvic MRI for adnexal lesions diagnosis and characterization. Two readers scored the adnexal lesions using the O-RADS MRI scoring independently and in consensus. A third reader calculated ADCmean measurements. The final diagnoses were determined by histo-pathology (n = 77) or follow-up imaging (n = 13). Areas under the curves (AUCs) and diagnostic performance metrics were calculated for the O-RADS MRI scoring, ADCmean, and combined O-RADS MRI/ADCmean thresholds. P-value <0.05 was significant.

      Results

      116 adnexal lesions (71 benign, 45 malignant) were analyzed. The optimal thresholds to predict malignant adnexal lesions were O-RADS MRI score >3 and ADCmean value ≤1.08 × 10−3 mm2/s (AUC 0.926 and 0.823; sensitivity 97.7% and 95.5%; specificity 87.3% and 68%; positive predictive value (PPV) 83% and 66.2%; positive likelihood ratio (PLR) 7.7 and 3.08, respectively). Compared to the O-RADS MRI scoring, a combined threshold of O-RADS MRI >3/ADCmean ≤1.08 × 10−3 mm2/s, yielded a reduction of false positives, a significant increase in the specificity (97.1%, p = 0.005), PPV (95.4%, p = 0.002), and PLR (33.1, p <0.0001), and non-significant change in the AUC (0.953, p = 0.252), and sensitivity (93.3%, p = 0.467).

      Conclusion

      The diagnostic performance of O-RADS MRI scoring to characterize adnexal lesions could be improved by adding the ADCmean values through reducing false positives, increasing specificity, and maintaining good sensitivity.

      Key Words

      Abbreviations:

      ACR (American College of Radiology), ADCmean (mean apparent diffusion coefficient.), AUC (area under the curve), CE (contrast-enhanced), DWI (diffusion-weighted imaging), ICC (intra-class correlation), k (kappa score), MRI (Magnetic resonance imaging), O-RADS (Ovarian-Adnexal Imaging-Reporting and Data System), ROC (receiver operating characteristic), ROI (region of interest), SI (Signal intensity), T2W (T2-weighted), T1W (T1-weighted), US (ultrasound)
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