Background: The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. Purpose: To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. Study Type: A prospective multicenter study. Population: In all, 531 women (mean age, 44
11.2 years; range, 21–79 years) with 572 sonographically indeterminate AM. Field Strength/Sequence: 1.5T/precontrast T1-weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T2-WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm2; and dynamic contrast-enhanced perfusion T1-WI liver acquisition with volume acceleration (LAVA). Assessment: All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. Statistical Tests: Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. Results: In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861). View this article online at wileyonlinelibrary.com. DOI: 10.1002/jmri.27285 Received Apr 30, 2020, Accepted for publication Jun 26, 2020. *Address reprint requests to: M.A.A.B., Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt, Alfourqan Radiology Center-Albalashoun-Belbiees-Alsharkia-Egypt, 44631, Egypt. E-mail: drmohammad_basha@yahoo.com or mohammad_basha76@yahoo.com Contract grant sponsor: The authors state that this work has not received any funding. From the 1Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 2Department of Radio-Diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt; 3Department of Radio-Diagnosis, Faculty of Human Medicine, Al Azhar University, Cairo, Egypt; 4Department of Radio-Diagnosis, Faculty of Human Medicine, Suez Canal University, Ismailia, Egypt; 5Department of Radio-Diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt; 6Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 7Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 8Department of Clinical Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; and 9Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt 292 © 2020 International Society for Magnetic Resonance in Medicine Data Conclusion: The current study supports the high validity and reproducibility of the ADNEX MR Scoring system for the diagnosis of sonographically indeterminate AM. Level of Evidence: 1 Technical Efficacy Stage: