Adnexal lesion — Ultrasound (O-RADS)

USACR O-RADS US v2022

Risk stratification of an adnexal lesion on ultrasound.

Applies to

Adnexal or ovarian lesion on transvaginal / transabdominal ultrasound

Does not apply to

Pelvic inflammatory disease or ectopic pregnancy
Non-visualized or absent ovary

What to report

Tap an item to check it off while dictating.

1.Laterality and size
Side and maximum diameter (largest of three planes; report all three for follow-up).
2.Lesion type
Unilocular, multilocular, cystic with solid component, or solid — the primary O-RADS branch point.
3.Inner walls and septa
Smooth versus irregular inner wall (irregularity <3 mm in height); number of locules.
4.Solid components and papillary projections
Solid tissue protruding ≥3 mm; count papillary projections (<4 versus ≥4).
5.Color score
IOTA color score 1–4 (no / minimal / moderate / very strong flow).
6.Acoustic shadowing and contour
Broad shadowing suggests a benign fibromatous lesion; assess the outer contour of solid lesions (smooth vs irregular).
7.Ascites and peritoneal nodules
Unexplained ascites or peritoneal nodules with an O-RADS 3–5 lesion upgrade the score to 5.
Pitfall: In premenopausal patients, physiologic follicles and corpora lutea should not be over-called.

Sources

O-RADS US v2022 update — Strachowski LM et al. Radiology (2023)

Content review: Content pending clinical review · 2026-07-09

Educational reference for trained clinicians. Verify every result against the cited original guideline before use. Not a substitute for clinical judgment or medical advice.

Adnexal lesion — Ultrasound (O-RADS)

What to report

Scores & calculators

O-RADS US risk category

Ellipsoid volume

Sources