背景：卵巢附件报告和数据系统（O-RADS）对恶性肿瘤的特异性有限。增强超声可以帮助区分恶性和良性病变，但其对O-RADS的附加价值尚未评估。目的：建立一个将O-RADS和增强超声结合的诊断模型，并验证O-RADS加增强超声是否具有比单独使用O-RADS更好的诊断性能。材料和方法：这项前瞻性研究纳入了2018年5月至2021年3月间进行手术前接受增强超声检查，并被美国超声学协会O-RADS 3、4或5级分类的病变，以组织病理学作为参考标准的参与者。从2021年4月至2022年7月，招募了病理学确认的卵巢附件病变的患者作为验证组。在初步研究中，评估了初始增强时间、与子宫肌层相比的增强强度、造影剂分布方式以及病变增强动态变化。利用这些增强超声特征计算了良性（得分≤2）和恶性（得分≥4）病变的增强超声评分。然后，根据O-RADS分类加增强超声评分对病变进行重新评估。使用DeLong方法构建接收者操作特征曲线，并进行比较。该组合系统在一个独立的组进行了验证。结果：初步研究中共纳入了76名女性（平均年龄44岁±13 [标准差]），验证组共纳入了46名女性（平均年龄42岁±14）。初步研究中观察到良性和恶性病变的初始增强时间（P < .001）、增强强度（P < .001）和增强动态变化（P < .001）之间的差异。利用这些特征计算了增强超声评分。对于增强超声评分为4或更高的病变，O-RADS风险分层被升级一个级别；对于增强超声评分为2或更低的病变，O-RADS风险分层被降级一个级别。在验证组中，O-RADS加增强超声评分的诊断性能更高（受试者工作特征曲线下面积[AUC]=0.93），低于O-RADS（AUC=0.71，P < .001）。结论：增强超声改善了O-RADS分类3-5的恶性肿瘤的诊断性能。©RSNA，2023本文的补充材料可供参考。本期编辑人Grant也发表了评论文章。

Background The Ovarian-Adnexal Reporting and Data System (O-RADS) has limited specificity for malignancy. Contrast-enhanced US can help distinguish malignant from benign lesions, but its added value to O-RADS has not yet been assessed. Purpose To establish a diagnostic model combining O-RADS and contrast-enhanced US and to validate whether O-RADS plus contrast-enhanced US has a better diagnostic performance than O-RADS alone. Materials and Methods This prospective study included participants from May 2018 to March 2021 who underwent contrast-enhanced US before surgery and had lesions categorized as O-RADS 3, 4, or 5 by US, with a histopathologic reference standard. From April 2021 to July 2022, participants with pathologically confirmed ovarian-adnexal lesions were recruited for the validation group. In the pilot group, the initial enhancement time and enhancement intensity in comparison with the uterine myometrium, contrast agent distribution pattern, and dynamic changes in enhancement of lesions were assessed. Contrast-enhanced US features were used to calculate contrast-enhanced US scores for benign (score ≤2) and malignant (score ≥4) lesions. Lesions were then re-rated according to O-RADS category plus contrast-enhanced US scores. Receiver operating characteristic curves were constructed and compared using the DeLong method. The combined system was validated in an independent group. Results The pilot group included 76 women (mean age, 44 years ± 13 [SD]), and the validation group included 46 women (mean age, 42 years ± 14). Differences in initial enhancement time (P < .001), enhancement intensity (P < .001), and dynamic changes in enhancement (P < .001) between benign and malignant lesions were observed in the pilot group. Contrast-enhanced US scores were calculated using these features. The O-RADS risk stratification was upgraded one level for contrast-enhanced US scores of 4 or more and downgraded one level for contrast-enhanced US scores of 2 or less. In the validation group, the diagnostic performance of O-RADS plus contrast-enhanced US score was higher (area under the receiver operating characteristic curve [AUC] = 0.93) than O-RADS (AUC = 0.71, P < .001). Conclusion Contrast-enhanced US improved the diagnostic performance for malignancy of the O-RADS categories 3-5. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Grant in this issue.