O-RADS (Ovarian-Adnexal Reporting and Data System) is the ACR standard for stratifying the malignancy risk of ovarian and adnexal lesions, assigning a category from 0 (incomplete) and 1 (normal) through 5 (high risk, ≥50%). Separate systems exist for ultrasound (US v2022) and MRI (2022).

How do the US and MRI systems differ?

O-RADS US v2022 scores lesions from their sonographic lexicon descriptors (lesion type, size, inner wall, solid component, papillary projections, and color score). O-RADS MRI 2022 centers on the presence of enhancing solid tissue and its dynamic contrast-enhanced time-intensity curve, with a dedicated benign category for homogeneously dark-T2/dark-DWI (fibrous) tissue.

Is this a medical device?

No. It is for educational and research purposes only, is not a regulatory-cleared medical device, and does not replace professional medical judgment.

Aperivue RADS

Ovarian-Adnexal Report Generator

Structured reporting with O-RADS US v2022 & MRI 2022 · Multi-lesion · PACS-ready output

Calculator inputs are in English. Choose the imaging system, then complete the lexicon descriptors to generate a PACS-ready report.

Indication

Menopausal status (affects O-RADS US management)

Comparison

Lesion Assessment

Lesions

Label

Laterality

Size (cm)

O-RADS US v2022 — Lexicon Descriptors

Lesion type

Ascites and/or peritoneal nodules (not otherwise explained)

Select the lesion type and the required descriptors to assign an O-RADS score.

Auto-generated from lesions

PELVIC ULTRASOUND — O-RADS US v2022

TECHNIQUE: Transvaginal ± transabdominal pelvic ultrasound with color Doppler.
COMPARISON: None available.

FINDINGS:

Adnexal lesions:
1. Lesion 1:
   Incomplete input — select the lesion type and required descriptors to categorize.

IMPRESSION:
No categorizable lesion. Complete the lexicon descriptors to assign an O-RADS score.

O-RADS US v2022 — assessment categories

Malignancy risk by ACR O-RADS US v2022 category. The 0–5 scale is shared with O-RADS MRI but the risk basis differs.

Category	Malignancy risk	Typical management
O-RADS US 0	Incomplete	Repeat or complete the ultrasound evaluation.
O-RADS US 1	Normal (≈0%)	Physiologic premenopausal finding; no follow-up.
O-RADS US 2	Almost certainly benign (<1%)	Often none; some lesions warrant follow-up by type and size.
O-RADS US 3	Low (1 to <10%)	Ultrasound specialist, follow-up, or MRI per context.
O-RADS US 4	Intermediate (10 to <50%)	Consider MRI and gynecologic (oncology) specialist referral.
O-RADS US 5	High (≥50%)	Gynecologic oncology referral.

Key decision rules (US v2022)

Lesion type (physiologic, cystic [uni-, bi-, multilocular], or solid) and the presence of any solid component protruding ≥3 mm are the primary branch points.
Color score (1–4) grades vascularity and modifies the category for multilocular cysts and lesions with solid tissue.
A unilocular cyst with a solid component and ≥4 papillary projections is O-RADS 5; fewer projections (or a non-papillary solid component) is O-RADS 4.
A smooth solid lesion with a low color score is typically O-RADS 3–4; an irregular contour or color score 3–4 raises the category.
Ascites and/or peritoneal nodules not otherwise explained are O-RADS 5.

O-RADS MRI 2022 — risk scores

Estimated positive predictive value (PPV) by ACR O-RADS MRI 2022 score — a different risk framework from O-RADS US despite the shared 0–5 scale.

Score	Approx. PPV for malignancy	Typical management
O-RADS MRI 0	Incomplete	Repeat or complete the MRI evaluation.
O-RADS MRI 1	Normal ovaries	No adnexal lesion; no follow-up.
O-RADS MRI 2	Almost certainly benign (PPV ≈0.5%)	Usually none.
O-RADS MRI 3	Low risk (PPV ~5%)	Management individualized by clinical context.
O-RADS MRI 4	Intermediate risk (PPV ~50%)	Gynecologic specialist evaluation.
O-RADS MRI 5	High risk (PPV ~90%)	Gynecologic oncology referral.

Key decision rules (MRI 2022)

The presence and dynamic enhancement of solid tissue drive the score.
Lesions without enhancing solid tissue (simple or benign-type fluid, fat, or fibrous tissue) fall in O-RADS MRI 1–3.
Solid tissue that is homogeneously dark on T2 and on high-b-value DWI (fibrous) is O-RADS MRI 2 (benign).
Enhancing solid tissue is scored by its dynamic contrast-enhanced time-intensity curve: a low-risk curve is O-RADS 4 and a high-risk curve is O-RADS 5; without DCE, enhancement relative to the myometrium at 30–40 s is used.
Peritoneal, mesenteric, or omental nodularity or irregular thickening is O-RADS MRI 5.