O-RADS MRI without dynamic contrast: high reliability and perfect ADC discrimination for adnexal masses

Non-DCE MRI O-RADS score has excellent inter-rater agreement (κ=0.90) and high PPV for adnexal masses; ADCmean of solid (≤1.3×10⁻³ mm²/s) and cystic (>2.07×10⁻³ mm²/s) components perfectly discriminate malignancy (AUC 1.00, 0.95) in a retrospective study.

• Retrospective analysis of 148 patients (191 adnexal masses) with histopathologic reference standard.
• Solid and cystic ADC cutoffs yielded perfect discrimination (AUC 1.000 and 0.952); simple fluid, low DW signal, and ADC of cystic component >2.07×10⁻³ mm²/s were independent predictors of malignancy in O-RADS scores >3.
• Single-center retrospective design without external validation; small sample size for individual predictor assessment.

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