MRI Evaluation and Characterization of Ovarian Lesions Based on Ovarian-Adnexal Reporting and Data System MRI

Background Managing ovarian lesions requires differentiating between benign and malignant cases. The development of a multiparametric MRI approach combining anatomical and functional criteria has led to the creation of the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI scoring system, which enhances diagnostic accuracy. Objectives To study ovarian lesions and their characteristics, along with their risk stratification based on MRI O-RADS. Methods  A prospective study used the O-RADS MRI criteria to categorize ovarian lesions. Clinical findings and MRI results were compared with histopathological outcomes to assess diagnostic accuracy. Results We identified abdominal pain as the most prevalent clinical finding among our cases (64, 91.43%), followed by a lump in the abdomen (33, 47.5%), dysmenorrhea (33, 47.5%), bleeding per vaginal (15, 21.43%), and weight loss (11, 15.71%). A total of 80 ovarian lesions were examined and characterized on the basis of the O-RADS MRI risk stratification system. Among the 80 ovarian lesions, 54 were histopathologically confirmed ovarian lesions (39 (72.22%) were benign, and 15 (27.77%) were malignant). The most common benign lesions were ovarian serous cystadenoma (28.20%) and ovarian mucinous cystadenoma (20.51%), while the most common malignant lesions were serous carcinoma (33.33%) and mucinous carcinoma (20%). Using the O-RADS MRI scoring system, we categorized six lesions (7.5%) as O-RADS 1 (all benign), 34 lesions (42.50%) as O-RADS 2 (32 benign and 2 malignant), 24 lesions (30%) as O-RADS 3 (23 benign and 1 malignant), seven lesions (8.75%) as O-RADS 4 (four benign and three malignant), and nine lesions (11.25%) as O-RADS 5 (all malignant). Our findings revealed significant differences in the size of lesions, the presence of thick septa, high T2-weighted signal intensity within solid tissue, and patterns of solid component enhancement and wall irregularity between malignant and benign lesions. The MRI cut-off score of ≥4 for malignancy demonstrated a sensitivity of 94.59%, a specificity of 97.5%, an accuracy of 97.62%, a positive predictive value of 94.5%, and a negative predictive value of 97.5%. The positive likelihood ratio was 32.7, while the negative likelihood ratio was 0.025. These results affirm the high diagnostic accuracy of the O-RADS MRI scoring system in distinguishing benign from malignant ovarian lesions. Conclusion The O-RADS MRI score is a highly accurate tool for differentiating between benign and malignant ovarian lesions. Its application can significantly enhance the management and treatment outcomes for patients with adnexal masses. The study confirms the scoring system's high sensitivity, specificity, and overall diagnostic accuracy.