The value of MRI in differentiating ovarian clear cell carcinoma from other adnexal masses with O-RADS MRI scores of 4-5

Lingling Lin ¹, Le Fu ¹, Huawei Wu ²

⁰Department of Radiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.

Insights Into Imaging +

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January 29, 2025

View abstract on PubMed

Summary

This study developed a comprehensive model combining clinical and MRI features to effectively distinguish ovarian clear cell carcinoma (CCC) from other adnexal masses. The model improves diagnostic accuracy, aiding in personalized treatment planning for ovarian cancer.

Area Of Science

Radiology
Oncology
Medical Imaging

Background

Ovarian clear cell carcinoma (CCC) presents diagnostic challenges, particularly when indistinguishable from other adnexal masses.
Accurate preoperative identification of CCC is crucial for effective treatment planning and improving patient outcomes.
The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI risk stratification system aids in evaluating adnexal masses.

Purpose Of The Study

To evaluate the effectiveness of combining clinical and MRI features in differentiating ovarian CCC from adnexal masses categorized as O-RADS MRI scores of 4-5.
To develop and validate predictive models for ovarian CCC using integrated clinical and imaging data.

Main Methods

Retrospective analysis of 221 patients with indeterminate adnexal masses on ultrasound, with preoperative MRIs assessed using O-RADS.
Development of four prediction models (clinical, tumor marker, MRI features, and comprehensive) using training and test sets.
Statistical comparison of clinical and MRI features between CCC and non-CCC groups, with model performance assessed by AUC and decision curve analysis.

Main Results

Significant differences were observed in clinical (parity, endometriosis) and MRI features (T1WI signal, unilocular, nodule growth pattern, ADC value) between CCC and non-CCC groups.
The comprehensive model integrating clinical and MRI features demonstrated superior performance (AUC 0.92) compared to clinical-only (AUC 0.66) and tumor marker models (AUC 0.78) in the test set.
High interobserver agreement (kappa > 0.85) was achieved for all evaluated MRI features.

Conclusions

A comprehensive model incorporating clinical and MRI characteristics effectively differentiates ovarian CCC from adnexal masses with O-RADS MRI scores of 4-5.
This integrated approach enhances CCC prediction accuracy, offering improved clinical applicability for individualized treatment strategies.
Preoperative identification of ovarian CCC is vital for optimizing management, especially considering its distinct imaging characteristics and treatment sensitivities.

Keywords:

Clear cell carcinoma Differential diagnosis MRI Ovarian-adnexal reporting and data system MRI risk stratification system Ovary

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