Keep it Simple in the Adnexa: US and MRI (2025)-W7-COB03-2025

Video Transcription

Video Summary

The presenters review how O-RADS standardizes terminology and risk stratification for adnexal (ovarian/adnexal) lesions to improve communication and patient management. Ultrasound is the first-line test and is very good at excluding malignancy, but in general radiology populations the positive predictive value is only ~30% for indeterminate lesions. MRI serves as a problem-solving tool that can downgrade many O-RADS US 4–5 lesions, reducing unnecessary referral to gynecologic oncology and surgery, while still identifying true cancers.<br /><br />Key ultrasound “classic benign” lesions include: periovarian cyst, hydrosalpinx, peritoneal inclusion cyst, hemorrhagic cyst, dermoid, and endometrioma (usually O-RADS 2 unless ≥10 cm for some ovarian lesions). Benign-leaning cystic features are unilocular/bilocular appearance, smooth walls/septa, and no solid component. Suspicious cystic features include multilocularity, irregular walls/septa, and solid components/papillary projections (≥4 papillary projections → O-RADS 5). Solid lesions are assessed by shadowing (reassuring), contour (irregular = O-RADS 5), and Doppler color score (high flow is concerning); ascites/peritoneal nodules upgrade risk.<br /><br />For MRI, readers confirm a true lesion, characterize fluid, and identify enhancing solid tissue. “Dark T2 + dark DWI” solid lesions are usually benign (e.g., fibroma). Malignancy risk is driven by enhancement curves (DCE) and peritoneal disease; lipid-containing lesions are usually benign dermoids unless large enhancing solid tissue suggests immature teratoma. Cases illustrate upgrading/downgrading and clarifying lesion origin (e.g., pedunculated fibroid).

Keywords

O-RADS

adnexal lesion risk stratification

ovarian ultrasound

indeterminate adnexal mass

MRI problem-solving

papillary projections

Doppler color score

dynamic contrast-enhanced MRI

peritoneal disease