Ovarian cancer represents 7% of all cancers in pregnant women. Characterising an ovarian mass during pregnancy is essential to avoid unnecessary treatment and, if treatment is required, to plan it accordingly. Although ultrasonography (US) is the first-line modality to characterise adnexal masses, MRI is indicated when adnexal masses are indeterminate at the US examination. An MRI risk stratification system has been proposed to assign a malignancy probability based on the adnexal lesion’s MRI, but features of the scoring system require the administration of intravenous gadolinium-based contrast agents, a method that might have a limited use in pregnant women. The non-contrast MRI score (NCMS) has been used and evaluated in non-pregnant women to characterise adnexal masses indeterminate at the US examination. Therefore, we evaluated the diagnostic accuracy of the NCMS in pregnant women, analysing 20 cases referred to our specialised institution. We also evaluated the diagnostic agreement between two radiologists with different expertise. The two readers classified ovarian masses as benign or malignant using both subjective assessment (SA), based on the interpretive evaluation of imaging findings derived from personal experience, and the NCMS, which includes five categories where 4 and 5 indicate a high probability of a malignant mass. The expert radiologist correctly classified 90% of the diagnoses, using both SA and the NCMS, relying on a sensitivity of 85.7% and a specificity of 92.3%, with a false positive rate of 7.7% and a false negative rate of 14.3%. The non-expert radiologist correctly identified patients at a lower rate, especially using the SA. The analysis of the inter-observer agreement showed a K = 0.47 (95% CI: 0.48–0.94) for the SA (agreement in 71.4% of cases) and a K = 0.8 (95% CI: 0.77–1.00) for the NCMS (agreement in 90% of cases). Although in pregnant patients, non-contrast MRI is used, our results support the use of a quantitative score, i.e., the NCMS, as an accurate tool. This procedure may help less experienced radiologists to reduce the rate of false negatives or positives, especially in centres not specialised in gynaecological imaging, making the MRI interpretation easier and more accurate for radiologists who are not experts in the field, either.
卵巢癌占妊娠期女性所有癌症的7%。妊娠期卵巢肿块的定性对于避免不必要的治疗至关重要，若需治疗则需据此制定相应方案。虽然超声是附件肿块定性的一线检查手段，但当超声检查无法明确附件肿块性质时，需进行磁共振成像检查。已有研究提出基于附件病变磁共振特征的恶性风险分层系统，但该评分系统需使用静脉钆对比剂，而该方法在孕妇中的应用可能受限。非增强磁共振评分系统已在非妊娠女性中应用于超声检查无法明确的附件肿块定性。为此，我们通过分析转诊至本专科机构的20例病例，评估了非增强磁共振评分系统在孕妇中的诊断准确性，并比较了两位不同经验水平放射科医师的诊断一致性。两位阅片者分别采用基于个人经验对影像表现进行判读的主观评估法，以及包含五个等级的非增强磁共振评分系统（其中4-5级提示恶性概率较高）对卵巢肿块进行良恶性分类。资深放射科医师使用两种方法均实现90%的正确诊断率，敏感性达85.7%，特异性达92.3%，假阳性率7.7%，假阴性率14.3%。非资深医师的诊断准确率较低，尤以主观评估法为甚。观察者间一致性分析显示：主观评估法的Kappa值为0.47（95%CI：0.48-0.94），诊断一致率为71.4%；非增强磁共振评分系统的Kappa值为0.8（95%CI：0.77-1.00），诊断一致率达90%。尽管孕妇群体中常规使用非增强磁共振，但本研究结果支持将定量评分系统（即非增强磁共振评分）作为精准诊断工具。该方案有助于经验不足的放射科医师降低假阴性或假阳性率，特别是在非妇科影像专科中心，亦能使非该领域专家的放射科医师更便捷、更准确地进行磁共振影像判读。
肿瘤(癌症)患者之家