Ovarian Masses and O-RADS

A Systematic Approach to Evaluating and Characterizing Adnexal Masses With Ultrasound

Ana Mitchell, MD; Austin Kwong, MD; Simran Sekhon, MD; John P McGahan, MD, FACR


Appl Radiol. 2021;50(3):24-31. 

In This Article


Endometriomas and hemorrhagic cysts may appear similar on sonography. However, hemorrhagic cysts may have characteristics of a retracting clot and/or reticular pattern of internal echoes (Figure 1). According to the recent O-RADS classification, masses with this characteristic pattern of a hemorrhagic ovarian cyst and < 5 cm without internal flow require no follow-up imaging. However, follow-up at 8–12 weeks is recommended for masses > 5 cm. Alternatively, endometriomas usually appear with ground glass, homogeneous, low-level, internal echoes with no solid components on ultrasound (Figure 3). Follow-up at 12 weeks is recommended in these cases.[3]