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Acr O-Rads

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26 views178 pages

Acr O-Rads

Uploaded by

jacchiu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ACR O-RADS

Goal
Assign probability of malignancy based on
• the composition of the lesion
• the signal intensity characteristics
• the enhancement pattern of any solid tissue
Categories
O-RADS MRI 0 (incomplete examination)
O-RADS MRI 1 (normal ovaries, including follicles and
corpus luteal cysts)
O-RADS MRI 2 (almost certainly benign; PPV <0.5%)
O-RADS MRI 3 (low risk; PPV approximately 5%)
O-RADS MRI 4 (intermediate risk; PPV approximately
50%)
O-RADS MRI 5 (high risk; PPV approximately 90%)
Signal intensity
• Homogeneous or heterogeneous
• T1/T2: hypointense, intermediate, hyperintense
• T2 - in relation to iliopsoas muscle and urine or CSF
• T1 – in relation to iliopsoas muscle and fat
• DWI (high b-value): low or high signal
• In relation to urine or CSF
Lesion types
• Cyst +/- solid component
• Unilocular
• Multilocular
• Solid
• At least 80% enhancing tissue
Lesion with solid component
Size
Fluid descriptors
• Simple or non-simple
• Non-simple fluid
• Endometriotic
• Hemorrhagic
• Proteinaceous
• Lipid containing
Hemorrhagic fluid
Solid component
Solid tissue - enhances with contrast with following patterns:
• Papillary projections
• Mural nodules
• Irregular septations or walls
• Larger solid portion
Non solid tissue – other solid material, benign ie
• Thin/thick smooth septation or wall
• Blood clot
• Non enhancing debris
• Fibrin strands
• Fat
Dermoid (mature teratoma)
• very low risk of malignancy à O-RADS MRI 2
• Some have a small amount of enhancing tissue
(Rokitansky nodule) à still O-RADS 2.
• Rarely, fat-containing lesions contain a large
amount of enhancing soft tissue and can harbor
malignancy, especially when this solid portion
displays irregular margins à O-RADS 4, due to the
risk of an immature teratoma or other malignant
tissue in a dermoid, such as a squamous cell
carcinoma.
DCE
• Compare enhancement of enhancing soft tissue
with myometrium
• Low risk: SI increase slower than myometrium, no
well defined shoulder, no plateau
• Intermediate risk: moderate initial rise of SI, slope
<= myometrium, has shoulder and plateau
• High risk: brisk initial rise slope > myometrium, has
shoulder and plateau
Extra-ovarian findings
Teaching cases

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