Validity of using ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk assessment of adnexal lesions

Abstract Background Adnexal masses are a common occurrence in women. Accurate preoperative differentiation between benign and malignant lesions is critical to avoid both overtreatment and undertreatment. Aim of the study This study aimed to validate the accuracy of ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk stratification of ovarian/adnexal lesions. Methods This study included 50 female patients (age 13–71, mean 45.9 ± 14.7) with 81 ovaries evaluated—69 with histopathology and 12 with follow-up. Lesions were classified as physiological (25.9%), benign (33.3%), borderline (7.4%), and malignant (33.3%), with 24% showing bilateral involvement. For analysis, physiological and benign lesions ( n = 48) were grouped as non-malignant and borderline and malignant lesions ( n = 33) as malignant. Results The O-RADS MRI score strongly correlated with diagnosis ( p < 0.001), with scores 1–3 predicting benignity (91.7%) and 4–5 indicating malignancy (87.8%). Sensitivity, specificity, and accuracy were 87.9%, 93.8%, and 91.4%, respectively. Malignancy was significantly associated with larger size, bilaterality, irregular solid components, heterogeneous signal, restricted diffusion, and marked enhancement (all p ≤ 0.01), as well as papillary projections, ascites, and peritoneal involvement. Benign lesions typically showed simple fluid, homogeneous signal, and no solid tissue. Conclusions The findings of this study underscore the utility of O-RADS MRI scoring and multiparametric MRI features in the accurate preoperative assessment and risk stratification of adnexal masses.