Innovative optimization of greater omentum imaging report and data system for enhanced risk stratification of omental lesions.

Background: In 2020, we introduced the Greater Omentum Imaging-Reporting and Data System (GOI-RADS), a novel classification system related to peritoneal lesions. However, its clinical application remained unvalidated.

Objective: This study aimed to validate GOI-RADS, optimize its parameters for a new grading system, and explore its clinical usefulness.

Methods: A retrospective-prospective study was conducted to validate and refine the GOI-RADS system. The study consisted of two phases: a retrospective validation phase and a prospective application phase. The first phase included patients with peritoneal lesions from 2019 to 2021, classified by GOI-RADS and verified against pathology. Contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) data were collected for developing a new grading system. Odds ratios optimized parameters. The second phase (2021-2024) assessed diagnostic consistency among sonographers and performance of grading systems.

Results: Among 215 patients with peritoneal lesions, the actual malignancy rates for GOI-RADS 2 (40.00%) and GOI-RADS 3 (61.22%) were much higher than predicted (5.56% and 37.25%). Combining CEUS and RTE parameters showed varying sensitivity and specificity: RTE + GOI-RADS (95.35%, 55.56%) and CEUS + GOI-RADS (96.51%, 44.44%). However, the grading system based on multiple ultrasound parameters, specifically when incorporating RTE, CEUS parameters, and GOI-RADS (Multi-GOIRADS), exhibited the highest diagnostic sensitivity and specificity of 88.37% and 83.33%, respectively. Its simplified version, sMulti-GOIRADS, had sensitivity of 73.26% and specificity of 94.44%. In the prospective study involving three sonographers of different qualifications, the use of sMulti-GOIRADS was found to be the most time-efficient and showed excellent diagnostic consistency among them. In contrast, Multi-GOIRADS required more time for scoring but offered superior diagnostic performance, particularly among senior sonographers (88.35% and 91.43%).

Conclusions: This study proposes a multiparametric ultrasound-based imaging-reporting and data system for risk stratification of omental malignancy, Multi-GOIRADS, and presents an optimized and simplified version, sMulti-GOIRADS, which demonstrates excellent diagnostic consistency and performance in clinical applications.