Abstract
ObjectiveTo determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses.Methods and materialsTwo hundred ninety-one patients (350 adnexal masses) who underwent gynecological MRI at our institution between the 1st of January 2008 and the 31st of December 2018 were reviewed. A random subset (102 patients with 121 masses) was chosen to evaluate the reproducibility and repeatability of readers’ assessments. Readers evaluated non-contrast MRI scans retrospectively, assigned a 5-point score for the risk of malignancy and gave a specific diagnosis. The reference standard for the diagnosis was histopathology or at least one-year imaging follow-up. Diagnostic accuracy of the non-contrast MRI score was calculated. Inter- and intra-reader agreement was analyzed with Cohen’s kappa statistics.ResultsThere were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (к = 0.73, 95% confidence interval [CI] 0.58–0.86) whilst the intra-reader agreement was excellent (к = 0.81, 95% CI 0.70–0.88). The non-contrast MRI score value of ≥ 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90–0.96).ConclusionAdnexal mass characterization on MRI without the administration of contrast medium has a high accuracy and excellent inter- and intra-reader agreement. Our results suggest that non-contrast studies may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible.Key Points• A non-contrast pelvic MRI protocol may allow the characterization of adnexal masses with high accuracy.• The non-contrast MRI score may be used in clinical practice for differentiating benign from malignant adnexal lesions when the lack of intravenous contrast medium precludes analysis with the O–RADS MRI score.
Highlights
The accurate characterization of adnexal masses is critical to guide appropriate patient management
Receiver operating characteristic (ROC) analysis of non-contrast MRI score for prediction of malignancy in adnexal masses revealed that the pre-defined cut-off score ≥ 4 is associated with malignancy: sensitivity 84.9%, specificity 95.9%, accuracy 94.2% and positive likelihood ratio (PLR) 21
This study evaluated the accuracy of characterizing adnexal masses using a non-contrast MRI protocol
Summary
The accurate characterization of adnexal masses is critical to guide appropriate patient management. In 2013, Thomassin-Naggara et al published the ADNEX MR scoring system for risk stratification in adnexal masses [10]. This score proposes a uniform dynamic contrastenhanced (DCE) MRI protocol and standardized interpretation to be used across centers. The O–RADS MRI score was found to have a sensitivity of 93% and specificity of 91% for stratifying the risk of malignancy in adnexal masses [11].
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