©RSNA, 2022

10.1148/radiol.220795

Appendix E1

Supplementary Methods
Search Strategy
PIT (Participants, Index test, Target condition).—
P = Patients with indeterminate adnexal lesions at US.
I = MRI interpreted with the ADNEX or Ovarian-Adnexal Reporting and Data System (O-
RADS) stratification systems.
T = Ovarian and adnexal cancer.
Updated: September 10th, 2022.
Databases: MEDLINE (PubMed), EMBASE (Elsevier), and Web of Science (Clarivate
Analytics),
A controlled vocabulary (Medical Subject Headings in PubMed and EMBASE thesaurus
keywords in EMBASE) was used wherever possible.

Full Search Strings

MEDLINE (PubMed)

2013 to September 10th, 2022

(adnexal[All Fields] OR adnexa[All Fields] OR ovary[All Fields] OR ovarian[All Fields] OR
pelvic[All Fields] OR “ovarian neoplasms”[MeSH Terms] OR “fallopian tube
neoplasms”[MeSH Terms] OR “pelvic neoplasms”[MeSH Terms]) AND (“magnetic resonance
imaging”[MeSH Terms]) AND (O-RADS[All Fields] OR “ovarian-adnexal reporting and data
system”[All Fields] OR “ADNEX MR”[All Fields] OR ADNEX[All Fields] OR “assessment of
different neoplasias in the adnexa”[All Fields]) AND (human[All Fields]).
EMBASE (Elsevier)
2013 to September 10th, 2022
('adnexal mass'/exp OR 'adnexal mass' OR 'adnexa cancer'/exp OR 'adnexa cancer' OR 'adnexal
tumor'/exp OR 'adnexal tumor' OR 'ovarian mass'/exp OR 'ovarian mass' OR 'ovary cancer'/exp
OR 'cancer, ovary' OR 'malignant ovary tumor' OR 'malignant ovary tumor' OR 'ovarial cancer'
OR 'ovarian cancer' OR 'ovarium cancer' OR 'ovary cancer' OR 'ovary tumor'/exp OR 'ovarian
neoplasia' OR 'ovarian neoplasm' OR 'ovarian neoplasms' OR 'ovarian tumor' OR 'ovarian tumor'
OR 'ovarium tumor' OR 'ovarium tumor' OR 'ovary neoplasm' OR 'ovary tumor' OR 'ovary tumor
treatment' OR 'ovary tumor' OR 'ovary tumor treatment') AND ('nuclear magnetic resonance
imaging'/exp OR 'mri' OR 'nmr imaging' OR 'imaging, magnetization transfer' OR 'magnetic
resonance imaging' OR 'magnetic resonance tomography' OR 'magnetization transfer imaging'

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OR 'mr imaging' OR 'nuclear magnetic resonance imaging' OR 'dynamic contrast-enhanced
magnetic resonance imaging'/exp OR 'dce-mri (dynamic contrast-enhanced magnetic resonance
imaging)' OR 'dynamic contrast-enhanced mri' OR 'dynamic contrast-enhanced magnetic
resonance imaging') AND ('gynecologic imaging reporting and data system'/exp OR 'gi-rads' OR
'O-RADS' OR 'gynecologic imaging reporting and data system' OR 'gynecology imaging
reporting and data system' OR 'ovarian adnexal reporting and data system' OR 'ovarian adnexal
reporting data system' OR adnex OR 'adnex mr').

Web of Science (Clarivate Analytics)

#1 (((((TS = (adnexal mass)) OR TS = (adnexal tumor)) OR TS = (adnexal cancer)) OR TS =
(ovarian mass)) OR TS = (ovarian tumor)) OR TS = (ovarian cancer).
Indexes = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI,
CCR-EXPANDED, IC.
Timespan = 2013–05–01 to 2022–09–10.
#2 ((((((TS = (magnetic resonance imaging)) OR TS = (MRI)) OR TS = (MR)) OR TS = (MRI))
OR TS = (dynamic contrast-enhanced magnetic resonance imaging)) OR TS = (DCE-MRI)) OR
TS = (DCE-MR).
Indexes = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI,
CCR-EXPANDED, IC.
Timespan = 2013–05–01 to 2022–09–10.
#3 (((TS = (Ovarian-Adnexal Reporting and Data System)) OR TS = (O-RADS)) OR TS =
(ADNEX)) OR TS = (ADNEX-MR).
Indexes = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI,
CCR-EXPANDED, IC.
Timespan = 2013–05–01 to 2022–09–10.
#1 AND #2 AND #3
Indexes = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI,
CCR-EXPANDED, IC.
Timespan = 2013–05–01 to 2022–09–10.

Article Selection Process

First, after merging the results of these searches and removing duplicates, titles and abstracts of
all obtained records were independently reviewed by S.R. (15 years of experience in gynecologic
imaging and 3 years of experience in conducting systematic reviews), M.D., and L.M.
(respectively with 4 and 20 years of experience in gynecologic imaging), who flagged as eligible
for inclusion all records that declared the diagnostic use of pelvic MRI interpreted with the
ADNEX/O-RADS stratification systems in the title or in the abstract; or that could have
contained these data in the manuscript. Then, the full text of all eligible articles was
independently evaluated for inclusion by the same three reviewers, all references of eligible
articles being also manually searched to identify additional relevant records. Disagreements on
article inclusion and exclusion were solved by arbitration from a fourth reviewer who also

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oversaw the whole study selection process and performed all analyses (A.C., with 4 years of
experience and specific postgraduate training in conducting systematic reviews and meta-
analyses).
The following inclusion criteria were applied: a) performance of pelvic MR on human
subjects for the evaluation of US-indeterminate ovarian or adnexal lesions; b) image
interpretation performed by human readers with the ADNEX-MR or O-RADS MRI stratification
systems; c) clear definition of a reference standard, considering biopsy or surgical pathology
with follow-up or additional imaging confirmation for negative cases; d) sufficient information
to recreate 2 × 2 contingency tables.
Systematic and narrative reviews, guidelines, position papers, white papers, case-control
studies, case reports, and technical notes were excluded. Studies which did not include any
benign lesion and studies in which pelvic MR was interpreted without the ADNEX/O-RADS
stratification systems or with modified versions of these systems were also excluded.

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