O-RADS MRI After Initial Ultrasound for Adnexal Lesions: AJR Expert Panel Narrative Review.

The O-RADS ultrasound (US) and MRI risk stratification systems were developed by an international group of experts in adnexal imaging to aid radiologists in assessing adnexal lesions. The goal of imaging is to help appropriately triage patients with adnexal lesions. Ultrasound is the first-line imaging modality for the assessment, while MRI can be used as a problem-solving tool. Both ultrasound and MRI can accurately characterize benign lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoids, avoiding unnecessary or inappropriate surgery. In patients with a lesion that does not meet criteria for one of these benign diagnoses, MRI can further characterize the lesion with an improved specificity for cancer and the ability to provide a probable histologic subtype in the presence of certain MRI features. This allows for personalized treatment, including avoiding overly extensive surgery or allowing for fertility-sparing procedures for suspected benign, borderline, or low-grade tumors. When MRI findings indicate a risk of an invasive cancer, women can be expeditiously referred to a gynecologic oncologic surgeon. This narrative review provides expert opinion on the utility of multiparametric MRI when using the O-RADS US and MRI management systems.

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