O-RADS Calculator (US + MRI)
Risk stratification
| O-RADS | Risk category | Malignancy | Management (typical) |
|---|
O-RADS categories at a glance
O-RADS US v2022
| Category | Risk of malignancy | ACR management (summary) |
|---|---|---|
| 0 Technically inadequate | — | Repeat US if the limitation may resolve; otherwise consider MRI |
| 1 Normal ovary | 0% | None |
| 2 Almost certainly benign | <1% | None, or follow-up US by cyst type and size (simple cyst >5 cm premenopausal or >3 cm postmenopausal: US in 12 months) |
| 3 Low risk | 1 to <10% | Gynecology; US within 6 months if not excised; MRI (O-RADS MRI) or a US specialist for solid lesions |
| 4 Intermediate risk | 10 to <50% | Gynecologic oncology involved; MRI or US specialist to characterize |
| 5 High risk | ≥50% | Refer to gynecologic oncology; imaging per their protocol |
O-RADS MRI
| Category | Approximate PPV for malignancy |
|---|---|
| 0 Incomplete evaluation | — |
| 1 Normal ovaries (no lesion) | — |
| 2 Almost certainly benign | <0.5% |
| 3 Low risk | ~5% |
| 4 Intermediate risk | ~50% |
| 5 High risk | ~90% |
US: Strachowski et al., Radiology 2023 (v2022, Table 2). MRI: ACR O-RADS MRI Risk Stratification System, September 2020; PPV per category from Thomassin-Naggara et al., JAMA Netw Open 2020. Score each lesion; management follows the highest score. The calculator above gives the category, management and report text for one lesion.
Categorias O-RADS em resumo
O-RADS US v2022
| Categoria | Risco de malignidade | Conduta do ACR (resumo) |
|---|---|---|
| 0 Tecnicamente inadequado | — | Repetir o US se a limitação puder ser superada; caso contrário, considerar RM |
| 1 Ovário normal | 0% | Nenhuma |
| 2 Quase certamente benigno | <1% | Nenhuma, ou US de controle conforme o tipo e o tamanho do cisto (cisto simples >5 cm na pré-menopausa ou >3 cm na pós-menopausa: US em 12 meses) |
| 3 Baixo risco | 1 a <10% | Ginecologia; US em até 6 meses se não ressecado; RM (O-RADS RM) ou especialista em US para lesões sólidas |
| 4 Risco intermediário | 10 a <50% | Com participação da ginecologia oncológica; RM ou especialista em US para caracterização |
| 5 Alto risco | ≥50% | Encaminhar à ginecologia oncológica; exames conforme o protocolo da equipe |
O-RADS RM
| Categoria | VPP aproximado para malignidade |
|---|---|
| 0 Avaliação incompleta | — |
| 1 Ovários normais (sem lesão) | — |
| 2 Quase certamente benigno | <0,5% |
| 3 Baixo risco | ~5% |
| 4 Risco intermediário | ~50% |
| 5 Alto risco | ~90% |
US: Strachowski et al., Radiology 2023 (v2022, Tabela 2). RM: ACR O-RADS MRI Risk Stratification System, setembro de 2020; VPP por categoria de Thomassin-Naggara et al., JAMA Netw Open 2020. O ACR ainda não publicou recomendações de conduta para o O-RADS RM. Classifique cada lesão; a conduta segue a maior pontuação.
Sources & notes
O-RADS US
- Strachowski LM, et al. O-RADS US v2022: an update from the ACR O-RADS US Committee. Radiology 2023;308(3):e230685. doi:10.1148/radiol.230685
- Andreotti RF, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR O-RADS Committee. Radiology 2020;294:168–185. Risk bands: 1 0%, 2 <1%, 3 1–<10%, 4 10–<50%, 5 ≥50%.
- Jha P, et al. Diagnostic performance of the O-RADS ultrasound risk score in women in the United States. JAMA Netw Open 2022;5:e2216370.
- ACR O-RADS Ultrasound (v2022 assessment categories, classic benign lesions, lexicon).
O-RADS MRI
- ACR O-RADS MRI Risk Stratification System, September 2020, and O-RADS MR Lexicon, July 2021. ACR O-RADS MRI
- ACR O-RADS MRI Assessment Categories (February 2024), MRI Lexicon (revised October 2023), MRI Report Template and Sample Reports (2023), and O-RADS US v2022 Report Template (2023). Report wording on this page follows these templates.
- Sadowski EA, et al. O-RADS MRI risk stratification system: guide for assessing adnexal lesions from the ACR O-RADS Committee. Radiology 2022;303:35–47. doi:10.1148/radiol.204371
- Thomassin-Naggara I, et al. O-RADS MRI score for risk stratification of sonographically indeterminate adnexal masses. JAMA Netw Open 2020;3(1):e1919896. PPV: 2 <0.5%, 3 ~5%, 4 ~50%, 5 ~90%.
- Suarez-Weiss KE, et al. Practical tips for reporting adnexal lesions using O-RADS MRI. RadioGraphics 2023;43(7):e220142. doi:10.1148/rg.220142
Ultrasound to MRI, and staging
- Sadowski EA, et al. O-RADS MRI after initial ultrasound for adnexal lesions: AJR Expert Panel Narrative Review. AJR 2023;220:6–15. doi:10.2214/AJR.22.28084
- Avesani G, et al. ESR Essentials: characterisation and staging of adnexal masses with MRI and CT, practice recommendations by ESUR. Eur Radiol 2024;34:7673–7689. doi:10.1007/s00330-024-10817-1
Management wording follows DHMC practice: after the diagnostic exam we refer to gynecology or gynecologic oncology, and that team orders further imaging.
O texto de conduta segue o modelo de laudo O-RADS US v2022 do ACR. O ACR ainda não publicou recomendações de conduta para o O-RADS RM (Sadowski et al., Radiology 2022); ela fica a critério da equipe assistente.
Assumes an average-risk patient without acute symptoms; clinical judgment supersedes. Each lesion is scored separately; management follows the highest-scoring lesion. Risk percentages apply to the category overall, not individual features.
