{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T11:21:19Z","timestamp":1782732079795,"version":"3.54.5"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To validate prospectively the ADNEX magnetic resonance (MR) scoring system to assess adnexal masses and to evaluate a new, modified ADNEX MR scoring system that incorporates diffusion\u2010weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2015 and September 2018, 323 consecutive women with adnexal masses diagnosed on transvaginal ultrasound (TVS) underwent standardized MR imaging (MRI) including diffusion and dynamic contrast\u2010enhanced sequences. Of these, 131 underwent subsequent surgery. For interpretation of the MRI examinations, we applied the five\u2010category ADNEX MR scoring system, along with a modified scoring system including DWI with ADC mapping. For both scoring systems, a score was given for all adnexal masses. Histological diagnosis was considered as the gold standard and lesions were classified as benign or malignant. The difference between the predictive values for diagnosing malignancy of the classical and modified scoring systems was assessed on the basis of the areas under the receiver\u2010operating\u2010characteristics (AUC) curves. The sensitivity and specificity for diagnosing malignancy of each score were also calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 131 women with adnexal mass(es) diagnosed on TVS who underwent MRI and subsequent surgery, the surgery revealed 161 adnexal masses in 126 women; five women had no mass. Histological examination confirmed 161 adnexal masses, of which all had been detected on MRI: 32 malignant tumors, 15 borderline tumors, which were classified as part of the malignant group (<jats:italic>n<\/jats:italic> = 47), and 114 benign lesions. The AUC for prediction of a malignant lesion was 0.938 (95% CI, 0.902\u20130.975) using the classical ADNEX MR scoring system and 0.974 (95% CI, 0.953\u20130.996) using the modified scoring system. Pairwise comparison of these AUCs revealed a significant difference (<jats:italic>P<\/jats:italic> = 0.0032). The sensitivity and specificity for diagnosing malignancy with an ADNEX MR score of 4 or more were 95.5% and 86.6%, respectively, using the classic scoring system, and 95.7% and 93.3%, respectively, using the modified scoring system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DWI with ADC mapping could be integrated into the ADNEX MR scoring system to improve specificity, thereby potentially optimizing clinical management by avoiding unnecessary surgery. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22090","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T23:35:43Z","timestamp":1590104143000},"page":"478-487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Magnetic resonance scoring system for assessment of adnexal masses: added value of diffusion\u2010weighted imaging including apparent diffusion coefficient map"],"prefix":"10.1002","volume":"57","author":[{"given":"N. A.","family":"Hottat","sequence":"first","affiliation":[{"name":"Department of Radiology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"},{"name":"Department of Radiology, UZ Brussel, Vrije Universiteit Brussel  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Van Pachterbeke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Vanden Houte","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Denolin","sequence":"additional","affiliation":[{"name":"Siemens Healthineers, Beersel  Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-342X","authenticated-orcid":false,"given":"J. C.","family":"Jani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Cannie","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"},{"name":"Department of Radiology, UZ Brussel, Vrije Universiteit Brussel  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4293\/108680812X13291597716069"},{"key":"e_1_2_7_3_1","first-page":"473","volume-title":"Obstetrics and gynecology","author":"Callahan T","year":"2018"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.01.041"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.7632"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5365"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70005-6"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.177.1.1770123"},{"issue":"3","key":"e_1_2_7_9_1","first-page":"9","article-title":"Complex adnexal masses: detection and characterization with MR imaging\u2013multivariate analysis","volume":"214","author":"Hricak H","year":"2000","journal-title":"Radiology"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.180.5.1801297"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.13121161"},{"key":"e_1_2_7_12_1","volume-title":"Breast imaging reporting and data system: ACR BI\u2010RADS\u00a0\u2013\u00a0breast imaging atlas","author":"Ikeda D","year":"2003"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.326125520"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3747\/co.19.980"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4600-3"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-017-1272-7"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.23639"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.23057"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.06.1403"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.293085130"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/14980811"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12110446"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-009-1299-4"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2011.22.4.275"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7819-10-237"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10100751"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00287.x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.20369"},{"key":"e_1_2_7_29_1","volume-title":"World Health Organization","author":"WHO Classification of Tumours of Female Reproductive Organs","year":"2014"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.07.493"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.12.9713"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10100213"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2018.07.004"}],"container-title":["Ultrasound in Obstetrics &amp; 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