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Background <p>The Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) can assess the behavior of ovarian masses through high-resolution anatomical sequences, diffusion-weighted imaging, and dynamic contrast-enhanced studies using plotted time-intensity curves. Accurate O-RADS MRI categorization requires experience with the O-RADS lexicon and associated descriptors.</p> Objectives <p>To assess the effects of adding the mean apparent diffusion coefficient (ADC) to the O-RADS MRI score for adnexal lesion characterization.</p> Methods <p>Sixty-six patients with seventy-two ovarian lesions, identified on preliminary pelvic ultrasound examination and categorized as O-RADS 3, 4, or 5, underwent dynamic MRI with diffusion-weighted imaging and ADC mapping. The reported results were compared with either the histopathology of the lesions or clinical follow-up.</p> Results <p>O-RADS MRI alone achieved high sensitivity (95.1%) but moderate specificity (61.5%). ADC values improved sensitivity (97.6%) but reduced specificity to 38.5%, creating a diagnostic trade-off between detecting more malignancies and misclassifying benign lesions.</p> Conclusions <p>Apparent diffusion coefficient integration with O-RADS MRI improves sensitivity at the expense of specificity, representing a key clinical trade-off. This study advances prior ADC-O-RADS literature by explicitly quantifying this effect in a real-world cohort and clarifying the limited reliability of ADC in benign and borderline adnexal lesions.</p>

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Adding apparent diffusion coefficient to the ovarian-adnexal reporting and data system MRI: a trade-off between sensitivity and specificity

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月5日

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  • Eman Badawy,
  • Esraa Abdelwahab,
  • Lamiaa Adel,
  • Mohamed A. Shalaby,
  • Manar Alaa El Din Osman Maher

摘要

Background

The Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) can assess the behavior of ovarian masses through high-resolution anatomical sequences, diffusion-weighted imaging, and dynamic contrast-enhanced studies using plotted time-intensity curves. Accurate O-RADS MRI categorization requires experience with the O-RADS lexicon and associated descriptors.

Objectives

To assess the effects of adding the mean apparent diffusion coefficient (ADC) to the O-RADS MRI score for adnexal lesion characterization.

Methods

Sixty-six patients with seventy-two ovarian lesions, identified on preliminary pelvic ultrasound examination and categorized as O-RADS 3, 4, or 5, underwent dynamic MRI with diffusion-weighted imaging and ADC mapping. The reported results were compared with either the histopathology of the lesions or clinical follow-up.

Results

O-RADS MRI alone achieved high sensitivity (95.1%) but moderate specificity (61.5%). ADC values improved sensitivity (97.6%) but reduced specificity to 38.5%, creating a diagnostic trade-off between detecting more malignancies and misclassifying benign lesions.

Conclusions

Apparent diffusion coefficient integration with O-RADS MRI improves sensitivity at the expense of specificity, representing a key clinical trade-off. This study advances prior ADC-O-RADS literature by explicitly quantifying this effect in a real-world cohort and clarifying the limited reliability of ADC in benign and borderline adnexal lesions.