European Radiology:如何提高附件肿块囊性成分的O-RADS MRI评分?

2022-08-02 shaosai MedSci原创

O-RADS MRI分类改善了附件肿块的诊断一致性,同时也可以为临床更好地诊断附件肿块的来源提供了极高的准确率。

卵巢附件报告和数据系统(O-RADS)MRI分类是一个结合了形态学特征和组织分析(T2加权、T1加权、扩散加权序列上的信号强度和时间强度曲线评估)的五分法评分系统,对恶性肿瘤的诊断具有较高的阳性(93%)和阴性(91%)预测值。该分类的目的是改善附件肿块的诊断一致性(O-RADS 2或3预测为良性,而O-RADS 4或5预测为恶性),同时也可以为临床更好地诊断附件肿块的来源提供了极高的准确率。

最近的一项研究表明,大约80%的错误分类的肿块含有囊性成分,这强调了有囊性成分的肿块制定额外标准的重要性然而据我们所知,很少有研究使用专门用于囊性成分分析的MRI特征附件肿块进行评估

近日,发表在European Radiology杂志的一项研究评估了O-RADS MRI在评估有囊性成分的附件肿块中的表现,并分析了与囊性成分相关的特定MRI特征的诊断价值和可重复性以及其对改善O-RADS MRI风险评分以预测恶性肿瘤的附加价值。

本研究对欧洲附件研究(EURAD)数据库进行了回顾性查询以确定有囊性成分的附件肿块。一名初级和13名放射科医生病理诊断有疑惑的病例进行了独立评估。对每个病变评估了大小、形态外观、病灶数量、是否有增厚的壁、增厚的分格、T1加权/T2加权/弥散加权的囊性成分的信号强度、表观弥散系数的平均值和O-RADS MRI评分。进行单变量和多变量的逻辑回归分析以确定预测恶性肿瘤的重要特征。 

最终的队列包括585名有779个盆腔肿块的患者,每位患者均接受了盆腔MRI检查以确定附件肿块的特征,并以组织学作为参考标准。O-RADS MRI评分的诊断性能为0.944,95%CI [0.922-0.961]。与恶性肿瘤相关的重要标准包括:O-RADS MRI评分≥4分、囊性成分的ADC均值>1.69、位置数>3、病变大小>75毫米、存在厚壁以及囊性成分的低T1加权、高T2加权和低扩散加权信号强度。多变量分析表明,O-RADS MRI评分≥结合囊性成分的ADC平均值>1.69、大小>75毫米、以及囊性成分的低弥散加权信号可显著提高诊断性能,最高可达0.958,95%CI [0.938-0.973]。 


 归类为O-RADS 3的附件肿块示例。(a)轴向T2加权MR图像、(b) 轴向T1加权MR图像、(c) 矢状T2加权图像,显示一个多囊性卵巢肿块,信号混杂。e 扩散加权图像(b = 1000 s/mm2)显示与子宫内膜相比信号强度相同或更低。f ADC图显示值为1.51 mm2/s(< 1.69 mm2/s)。白圈代表感兴趣的区域。卵巢肿块最初被归类为O-RADS MRI 3,并且有两个特征强化了良性的可能性。最终诊断为良性(粘液性囊腺瘤)

本研究表明,O-RADS MRI评分结合了病变大小并分析ADC值和囊性成分的弥散加权信号强度,可以显著改善有囊性成分的良性和恶性附件肿块的鉴别诊断。

原文出处:

Victoria Assouline,Yohann Dabi,Aurélie Jalaguier-Coudray,et al.How to improve O-RADS MRI score for rating adnexal masses with cystic component?DOI:10.1007/s00330-022-08644-3

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    2023-07-11 wolongzxh
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    2023-06-17 feather89
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    2023-03-08 江川靖瑶
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    2022-08-04 cnxcy