Incidental Adnexal Lesions: CT Diagnosis and Interreader Agreement

Background The management of incidental adnexal lesions encountered at CT depends on the diagnosis, but little evidence supports CT diagnosis of most adnexal lesion types. Purpose To evaluate the interreader agreement and CT diagnosis of incidentally discovered adnexal lesions. Materials and Methods This institutional review board-approved, multi-institutional, multireader retrospective study conducted from January 1, 2022, to June 30, 2023, included patients who had malignant ovarian lesions with metastases (n = 8) and without metastases (n = 8), simple cysts (n = 6), dermoids (n = 9), hydrosalpinx (n = 5), benign cystadenomas and/or cystadenofibromas (n = 10), hemorrhagic cysts (n = 8), endometriomas (n = 6), ovarian fibromas (n = 5), leiomyomas (n = 5), and peritoneal inclusion cysts (n = 5) detected at CT. Nine members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel, blinded to the final diagnosis, independently reviewed the CT images and used the American College of Radiology white paper to determine the most likely diagnosis. A 2 × 2 factorial random-effects model was used to calculate the mean adjusted accuracy and disparity among the readers. Interreader agreement was calculated using a Gwet AC1 test. Results In total, 75 patients (mean age, 50 years ± 16 [SD]) were included. The mean adjusted accuracy and interreader agreement were highest for dermoids (99% and 0.97, respectively), malignant ovarian lesions with metastases (94% and 0.90), and simple cysts (86% and 0.64). The mean adjusted accuracy for all other lesion types was less than 72%, with fair to moderate interreader agreement. Overall, readers more accurately diagnosed malignant lesions (82%) than benign lesions (52%) (P < .001). Readers recorded a benign diagnosis when a malignant lesion was present 28% of the time (20 of 72) (P < .001) when there were no metastases. Conclusion Readers' mean adjusted accuracy was greatest for dermoids, malignant ovarian lesions with metastases, and simple cysts at CT, with substantial to almost perfect interreader agreement; all other lesions were challenging, and a substantial number of malignant ovarian lesions were misdiagnosed as benign. © RSNA, 2026.