Comparison study of magnetic resonance imaging and ultrasonography in evaluation of ovarian lesions with emphasis on ovarian adnexal reporting and data system

Abstract

Introduction: Accurate characterization of ovarian lesions is crucial for appropriate clinical management, as it directly influences the decision between conservative follow-up, medical management, or surgical intervention. The Ovarian-Adnexal Reporting and Data System (O- RADS) has emerged as a standardized risk stratification system aimed at improving diagnostic accuracy and clinical management of ovarian- adnexal pathologies. This study was undertaken to compare the diagnostic performance of ultrasonography (USG) and magnetic resonance imaging (MRI) in the evaluation of ovarian lesions using the O-RADS classification system. Materials and Methods: This prospective observational study was conducted in the Department of Radiodiagnosis at Shri B M Patil Medical College Hospital & Research Centre, Vijayapura from April 2023 to April 2025. A total of 44 patients with clinically suspected ovarian lesions who underwent both USG and MRI followed by histopathological confirmation were included. Lesions were characterized according to the O-RADS classification on both modalities, and the findings were correlated with histopathological results. “Statistical analysis was performed to determine sensitivity, specificity, positive predictive value, and negative predictive value of both imaging modalities.” Results: The mean age of patients was 35.7 years, with the majority (65.9%) in the 21-40 years age group. Abdominal pain was the predominant clinical presentation (90.9%). Both USG and MRI showed identical morphological characterization of lesions, with multilocular cystic lesions without solid components being the most common (29.5%). The distribution of O-RADS scores was similar between both modalities, with most lesions classified as O-RADS 3 (61.4% on USG and 63.6% on MRI). Histopathologically, 79.5% of lesions were benign and 20.5% were malignant. A significant association was found between O-RADS scores and malignancy (p<0.001), with all O-RADS 3 lesions being benign and most O-RADS 5 lesions (80%) being malignant. Both USG and MRI demonstrated identical diagnostic performance with “100% sensitivity, 95% specificity, 98% positive predictive value, and 97% negative predictive value.” Conclusion: Both ultrasonography and magnetic resonance imaging, when utilized within the framework of the O-RADS classification system, provide excellent and comparable diagnostic accuracy in the evaluation of ovarian lesions. The significant association between O-RADS scores and histopathological outcomes validates the clinical utility of this classification system for risk stratification and management planning. A tiered imaging approach, with ultrasonography as the first-line modality and MRI reserved for specific indications, appears to be the most rational and cost-effective strategy for evaluating ovarian lesions.