O-RADS MRI Risk Stratification (Adnexal Lesion)
ACR O-RADS MRI (2022)Assigns the ACR O-RADS MRI score (0–5) to a sonographically indeterminate adnexal lesion from its composition, fluid and lipid content, and the DCE time-intensity curve (or non-DCE early enhancement) of any solid tissue, with the associated malignancy PPV and management pathway.
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- The following information is still needed: technical adequacy of the MRI examination.
How this tool works
The O-RADS MRI system (ACR, 2022) adapts the ADNEX MR scoring approach. Lesions without enhancing solid tissue are almost certainly benign (score 2), with specific exceptions: unilocular cysts containing proteinaceous, hemorrhagic, or mucinous fluid and multilocular cysts are low risk (score 3). Solid tissue that is homogeneously dark on both T2 and DWI remains score 2. Other solid tissue is graded by its enhancement kinetics: a low-risk DCE curve is score 3, an intermediate-risk curve is score 4, and a high-risk curve is score 5. When DCE is not feasible, enhancement of solid tissue at 30–40 seconds relative to myometrium separates score 4 (≤ myometrium) from score 5 (> myometrium). A large volume of enhancing solid tissue within a lipid-containing lesion is score 4, and peritoneal, mesenteric, or omental disease places the study in score 5. Category PPVs are <0.5%, ~5%, ~50%, and ~90% for scores 2–5.
References
- Sadowski EA, Thomassin-Naggara I, et al. O-RADS MRI Risk Stratification System (ACR O-RADS Committee), Radiology 2022
- Thomassin-Naggara I, et al. O-RADS MRI score, JAMA Network Open 2020
- Radiopaedia: O-RADS MRI classification
Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.
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