Abstract
Introduction Accurate characterization of ovarian lesions is essential for guiding clinical management, influencing decisions on conservative follow-up, medical treatment, or surgical intervention. The Ovarian-Adnexal Reporting and Data System (O-RADS) has emerged as a standardized tool for risk stratification, aiming to improve diagnostic accuracy and management of ovarian adnexal pathologies. This study aimed to compare the diagnostic performance of ultrasonography (USG) and magnetic resonance imaging (MRI) in evaluating ovarian lesions using the O-RADS classification system. Materials and methods This prospective observational study was conducted at the Department of Radiodiagnosis, Shri BM Patil Medical College Hospital & Research Centre, Vijayapura, from April 2023 to March 2025. Forty-four patients with clinically suspected ovarian lesions who underwent both USG and MRI, followed by histopathological confirmation, were included. Lesions were classified according to the O-RADS system on both imaging modalities, and findings were correlated with histopathological results. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for both imaging techniques. Results The mean age of patients was 35.7 years, with the majority (29, 65.9%) in the 21-40 years age group. Abdominal pain was the most common clinical presentation (40, 90.9%). Both USG and MRI showed identical lesion morphologies, with multilocular cystic lesions without solid components being the most frequent (13, 29.5%). The distribution of O-RADS scores was similar between the modalities, with most lesions categorized as O-RADS 3 (27(61.4%) on USG and 28 (63.6%) on MRI). Histopathology revealed 35 (79.5%) benign and 9 (20.5%) malignant lesions. A significant correlation was found between O-RADS scores and malignancy (p<0.001), with all O-RADS 3 lesions being benign and all O-RADS 5 lesions being malignant. Both USG and MRI demonstrated identical diagnostic performance, with 100% sensitivity, 95% specificity, 98% positive predictive value, and 97% negative predictive value. Conclusion Both ultrasonography and magnetic resonance imaging, when used with the O-RADS classification system, provide excellent and comparable diagnostic accuracy in evaluating ovarian lesions. The significant correlation between O-RADS scores and histopathological findings highlights the system's clinical utility in risk stratification and management decisions. A tiered imaging approach, with ultrasonography as the first-line modality and MRI reserved for specific indications, offers an effective and cost-efficient strategy for managing ovarian pathologies.