Obstetrics, Gynecology and Reproduction

Advanced search

О-RADS and ADNEX MR scoring system: standardization of assessment and modern approaches to stratification of ovarian malignancy risks

Full Text:


This article reviews the studies published over the recent 10 years about diagnostic imaging of ovarian lesions (OL). We discuss the current classification systems considering the imaging criteria and the risks of malignancy as well as the ways of optimizing the treatment of patients. There are a number of methods of evaluation and interpretation of diagnostic data obtained using ultrasound as a first line method for OL visualization. To report the results, there is a unified terminology system O-RADS (Ovarian-Adnexal Reporting and Data System) developed specifically for ultrasound examinations. In 2013, the ADNEX MR (adnexal lesions magnetic resonance imaging) scoring system (AMRSS) was developed to standardize magnetic resonance data. That system combines the analysis of both basic-anatomical and functional MR-images and allows one to classify ovarian tumors by the risk of malignancy. Although O-RADS and AMRSS are based on different diagnostic modalities, they complement each other for the diagnostic purpose. In this review, we analyze correlations between the results obtained with these two methods; we also address the possibility of using the above methods in combination in order to pursue a more comprehensive approach to diagnosis of ovarian cancer.

About the Authors

A. E. Solopova
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Health Ministry of Russian Federation
Russian Federation

Alina E. Solopova – MD, PhD, Associate Professor, Leading Researcher, Department of Radiology

Akademika Oparina St., Moscow 117997, Russia.

Scopus Author ID: 24460923200. Researcher ID: P-8659-2015.

A. N. Dudina
Sechenov University
Russian Federation

Anastasiya N. Dudina – 6 th year student, Institute of Children’s Health

8 bild. 2, Trubetskaya St., Moscow 119991, Russia.


1. Ranaee M., Yazdani Sh., Modarres S.R., Rajabi-Moghaddam M. Two cases of clear cell ovarian cancer in young patients. Caspian J Intern Med. 2016;7(3):228–31.

2. Webb P.M., Jordan S.J. Epidemiology of epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol. 2017;41:3–14. DOI: 10.1016/j.bpobgyn.2016.08.006.

3. Brun J.L., Fritel X., Aubard Y. et al; Collège National des Gynécologues Obstétriciens Français. Management of presumed benign ovarian tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2014;183:52–8. DOI: 10.1016/j.ejogrb.2014.10.012.

4. Buys S.S., Partridge E., Black A. et al; PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305(22):2295–303. DOI: 10.1001/jama.2011.766.

5. Gilbert L., Basso O., Sampalis J. et al; DOvE Study Group. Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project. Lancet Oncol. 2012;13(3):285–91. DOI: 10.1016/S1470-2045(11)70333-3.

6. Menon U., Gentry-Maharaj A., Hallett R. et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009;10(4):327–40. DOI: 10.1016/S1470-2045(09)70026-9.

7. Kadan Y., Fiascone S., McCourt C. et al. Predictive factors for the presence of malignant transformation of pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol. 2015;185:23–7. DOI: 10.1016/j.ejogrb.2014.11.029.

8. Sölétormos G., Duffy M.J., Othman Abu Hassan S. et al. Clinical use of cancer biomarkers in epithelial ovarian cancer: updated guidelines from the European Group on Tumor Markers. Int J Gynecol Cancer. 2016;26(1):43–51. DOI: 10.1097/IGC.0000000000000586.

9. Huchon C., Bats A.S., Bensaïd C. et al. Adnexal masses management: a prospective multicentric observational study. Gynecol Obstet Fertil. 2008;36(11):1084–90. (In French). DOI: 10.1016/j.gyobfe.2008.08.014.

10. Coccia M.E., Rizzello F., Romanelli C., Capezzuoli T. Adnexal masses: what is the role of ultrasonographic imaging? Arch Gynecol Obstet. 2014;290(5):843–54. DOI: 10.1007/s00404-014-3327-0.

11. Timmerman D., Ameye L., Fischerova D. et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341:c6839. DOI: 10.1136/bmj.c6839.

12. Timmerman D., Van Calster B., Testa A. et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016;214(4):424–37. DOI: 10.1016/j.ajog.2016.01.007.

13. Anthoulakis C., Nikoloudis N. Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. Gynecol Oncol. 2014;132(3):661–8. DOI: 10.1016/j.ygyno.2013.10.022.

14. Khiewvan B., Torigian D.A., Emamzadehfard S. et al. An update on the role of PET/CT and PET/MRI in ovarian cancer. Eur J Nucl Med Mol Imaging. 2017;44(6):1079–91. DOI: 10.1007/s00259-017-3638-z.

15. Burges A., Schmalfeldt B. Ovarian cancer: diagnosis and treatment. Dtsch Arztebl Int. 2011;108(38):635–41. DOI: 10.3238/arztebl.2011.0635.

16. Iyer V.R., Lee S.I. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol. 2010;194(2):311–21. DOI: 10.2214/AJR.09.3522.

17. Kyriazi S., Kaye S.B., de Souza N.M. Imaging ovarian cancer and peritoneal metastases—current and emerging techniques. Nat Rev Clin Oncol. 2010;7(7):381–93. DOI: 10.1038/nrclinonc.2010.47.

18. Lalwani N., Prasad S.R., Vikram R. et al. Histologic, molecular, and cytogenetic features of ovarian cancers: implications for diagnosis and treatment. Radiographics. 2011;31(3):625–46. DOI: 10.1148/rg.313105066.

19. Mohaghegh P., Rockall A.G. Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques. Radiographics. 2012;32(6):1751–73. DOI: 10.1148/rg.326125520.

20. Thomassin-Naggara I., Cuenod C.A., Darai E. et al. Dynamic contrastenhanced MR imaging of ovarian neoplasms: current status and future perspectives. Magn Reson Imaging Clin N Am. 2008;16(4):661–72. DOI: 10.1016/j.mric.2008.07.012.

21. Medeiros L.R., Freitas L.B., Rosa D.D. et al. Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review. Am J Obstet Gynecol. 2011;20(1):67.e1–10. DOI: 10.1016/j.ajog.2010.08.031.

22. Bazot M., Nassar-Slaba J., Thomasin-Naggara I. et al. MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors: correlation with final histology. Eur Radiol. 2006;16(12):2687–99. DOI: 10.1007/s00330-006-0163-z.

23. Thomassin-Naggara I., Aubert E., Rockall A. et al. Adnexal masses: development and preliminary validation of an MR imaging scoring system. Radiology. 2013;267(2):432–43. DOI: 10.1148/radiol.13121161.

24. Thomassin-Naggara I., Toussaint I., Perrot N. et al. Characterization of complex adnexal masses: value of adding perfusion- and diffusionweighted MR imaging to conventional MR imaging. Radiology. 2011;258(3):793–803. DOI: 10.1148/radiol.10100751.

25. Vargas H.A., Barrett T., Sala E. MRI of ovarian masses. J Magn Reson Imaging. 2013;37(2):265–81. DOI: 10.1002/jmri.23721.

26. Forstner R., Thomassin-Naggara I., Cunha T.M. et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 2017;27(2):2248–57.

27. DOI: 10.1007/s00330-016-4600-3.

28. Allen B.C., Hosseinzadeh K., Qasem S.A. et al. Practical approach to MRI of female pelvic masses. AJR Am J Roentgenol. 2014;202(6):1366–75. DOI: 10.2214/AJR.13.12023.

29. Andreotti R.F., Timmerman D., Benacerraf B.R. et al. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian- Adnexal Reporting and Data System Committee. J Am Coll Radiol. 2018;15(10):1415–29. DOI: 10.1016/j.jacr.2018.07.004.

30. An J.Y., Unsdorfer K.M.L., Weinreb J.C. BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS, O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems. Radiographics. 2019;39(5):1435–6. DOI: 10.1148/rg.2019190087.

31. Sasaguri K., Yamaguchi K., Nakazono T. et al. External validation of ADNEX MR SCORING system: a single-centre retrospective study. Clin Radiol. 2019;74(2):131–9. DOI: 10.1016/j.crad.2018.10.014.

32. Sadowski E.A., Rockall A.G., Maturen K.E. et al. Adnexal lesions: Imaging strategies for ultrasound and MR imaging. Diagn Interv Imaging. 2019;100(10):635–46. DOI: 10.1016/j.diii.2018.06.003.

33. Ikeda D.M., Hylton N.M., Kuhl C.K. Breast imaging reporting and data system, BI-RADS: magnetic resonance imaging. Reston, Va: American College of Radiology, 2003.

34. Ruiz M., Labauge P., Louboutin A. et al. External validation of the MR imaging scoring system for the management of adnexal masses. Eur J Obstet Gynecol Reprod Biol. 2016;205:115–9. DOI: 10.1016/j.ejogrb.2016.07.493.

35. Sadowski E.A., Robbins J.B., Rockall A.G., Thomassin-Naggara I. A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system. Abdom Radiol. 2018;43(3):679–95. DOI: 10.1007/s00261-017-1272-7.

36. Pereira P.N., Sarian L.O., Yoshida A. et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses. Diagn Interv Radiol. 2018;24(2):63–71. DOI: 10.5152/dir.2018.17378.


For citations:

Solopova A.E., Dudina A.N. О-RADS and ADNEX MR scoring system: standardization of assessment and modern approaches to stratification of ovarian malignancy risks. Obstetrics, Gynecology and Reproduction. 2019;13(4):345-353. (In Russ.)

Views: 14848

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)