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t assignment of mass origin. • Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139). • Prospective assignment of O-RADS-MRI score resulted in misclassification of 9.25% of sonographically indeterminate pelvic masses. • Most errors were interpretive (74.8%) due to misinterpretation of solid tissue as defined by the lexicon or incorrect assignment of mass origin. • Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139).An interplay of multiple genetic and environmental fact