Drawing the curve, not just looking at it, sharpens O-RADS MRI

The edition in brief

O-RADS MRI triages adnexal masses by whether a solid component enhances more or less avidly than the outer myometrium, and that judgement is usually made by eye. In a two-centre retrospective study of 341 masses in 321 women, all surgically resected, 35.2% were malignant. Visual assessment gave sensitivity 0.95 (95% CI 0.89 to 0.98), specificity 0.84 (0.79 to 0.89) and positive predictive value 0.77 (0.69 to 0.83). Adding a manually drawn semi-quantitative intensity curve raised specificity to 0.92 (0.88 to 0.95, p = 0.007) and positive predictive value to 0.90 (0.83 to 0.95, p = 0.002), with inter- and intra-reader agreement of kappa 0.63 to 0.85, and would have cut the proportion of benign lesions sent to a gynaecological oncologist from 16% to 9%. A post hoc sex-stratified analysis of the randomised TARGET trial, 1,216 patients with 30% to 90% stenosis on CT angiography, found CT-derived fractional flow reserve reduced unnecessary invasive angiography in men, while two-year major adverse cardiovascular events were lower in women in the CT-FFR arm (adjusted HR 0.48, 0.27 to 0.87) and not in men (0.89, 0.59 to 1.33). There was no significant sex-by-treatment interaction, so the difference between those two numbers is not itself established. An AJR expert panel sets out how to put breast cancer risk models into practice, where societies disagree, and when a calculated risk should change a screening plan. And a review of the Prostate Imaging Quality system argues for moving PI-QUAL out of research and into routine reporting through audits, protocol work, structured reports and quality dashboards.