Gi-Rads: Reporting System For Ultrasound Evaluation Of Adnexal Masses In Clinical Practice


MD, Associate Professor. Shahid Beheshti university -Tehran


The principals of GI-RADS reporting system is based on the pattern recognition analysis of the tumors and estimation of risk of malignancy in different tumor features.
Ultrasound is the first step for evaluation of adnexal lesions but until now a common language for describing the imaging observations is not papular, in order to make a similar understanding of findings and their importance. This is highly important for inter sub-specialty communications in offices and at the bedside.
The reporting structure is built based on GIRADS categorization, which means, according to previous studies there are some patterns description predict probability of risk of malignancy for a lesion in question similar to BIRADS in breast imaging.
G1: normal ovaries
G2:lesions which seems to be functional
G3: lesion considered probably benign
G4/G5: probably or very probably malignant
They benefit from more imaging(CT/MRI) and surgery but under oncho-gynechologist service.
RMI: Risk of Malignancy Index; scoring system is the method of choice for predicting whether or not an ovarian mass is likely to be malignant.
    RMI score = ultrasound score x menopausal score x CA125    level in U/ml
Ultrasound score:
2-Solid areas
5-Intraabdominal metastases
 RMI values greater than 200 were shown to be associated with a higher risk of malignancy and demonstrated a sensitivity of 85.4% and a specificity of 96.9% .
 ROMA: Risk of Ovarian Malignancy Algorithm ,can be used as a supplement to the standard presurgical evaluation to further assess the likelihood of malignancy before surgery when the presurgical evaluation does not indicate malignancy.
It combines the results of human epididymis protein 4 (HE4) enzyme, CA 125 , and menopausal status to generate a single numerical score that correlates with the likelihood of malignancy being seen at surgery.