The edition · Radiology
An enhancement curve drawn by hand made O-RADS MRI more specific for adnexal cancer
A semi-quantitative intensity curve raised O-RADS MRI specificity from 0.84 to 0.92; a simple cine-derived coupling ratio flagged heart failure risk in thalassaemia; and the bone tumour reporting systems held up in children.
The edition in brief
A two-centre retrospective study of 341 surgically resected adnexal masses found O-RADS MRI with visual assessment of enhancement had sensitivity 0.95 and specificity 0.84 for malignancy; replacing visual assessment with a manually drawn semi-quantitative intensity curve raised specificity to 0.92 and positive predictive value from 0.77 to 0.90, and would have sent fewer benign lesions to gynaecological oncologists. In 1154 patients with transfusion-dependent thalassaemia, a right ventricular-pulmonary arterial coupling ratio calculated from standard cine images was higher than in controls, tracked myocardial and liver iron, and was independently associated with heart failure (OR 3.99, P 0.049). In 80 children with solitary bone lesions, Bone-RADS and OT-RADS showed moderate agreement among five readers (κ 0.47 and 0.43), with Bone-RADS more consistent because of its algorithm. A meta-analysis of quantitative MRI for renal cell carcinoma grading found ADC sensitive but not specific for high grade (0.84 and 0.57), while radiomics models performed better but were heterogeneous and largely unvalidated. Today's pearl covers when a contrast reaction needs adrenaline.
A cine-derived RV coupling ratio tracked iron load and heart failure in thalassaemia
Add RV–pulmonary arterial coupling from standard cine images to thalassaemia cardiac MRI reports; a raised ratio was associated with iron burden, but it is not a treatment threshold.
Bone-RADS and OT-RADS both worked in children, with only moderate reader agreement
Apply Bone-RADS or OT-RADS to paediatric bone lesion MRI, but discuss intermediate categories; readers agreed only moderately.
ADC was sensitive but not specific for high-grade renal cell carcinoma
Low ADC in a renal mass suggests higher grade but has poor specificity; use it to support, not replace, biopsy decisions.
Hives alone need an antihistamine; hives with airway, breathing or circulatory signs need adrenaline
Any contrast reaction involving the airway, breathing or blood pressure is anaphylaxis: give IM adrenaline straight away (0.5 mg in adults; 0.01 mg/kg, maximum 0.5 mg, in children).
Semi-quantitative enhancement curves lifted O-RADS MRI specificity for adnexal masses
Use a semi-quantitative enhancement curve rather than visual assessment when scoring solid adnexal components on O-RADS MRI.
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