Ultrasound assessment of ovarian lesions: O-RADS approach

Lesions of ovarian or adnexal origin are common in all age groups, but there is significant variability in the interpretation of the words, definitions, and morphologic descriptions by the radiologists and the clinicians. There has also been a paradigm shift in the diagnosis and management of ovarian lesions during the last 20 years. Ovarian-Adnexal Reporting and Data System (O-RADS) by the American College of Radiology (ACR) was introduced in 2018. ORADS US (ultrasonography) serves as a tool to simplify the characterization of adnexal lesions, minimize the use of misleading terminology, and aid in the management of such lesions. It maintains the six risk assessment categories (O-RADS US 0–5) with an increasing predicted risk of malignancy from O-RADS US 1 to 5. In this pictorial essay, we briefly summarize the O-RADS and its descriptors, followed by representative ultrasound images to help clinicians understand what the O-RADS descriptors in the ultrasound report would mean.