Three-dimensional ultrasound and power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian lesions. Introduction of the 3D quantitative technique for measurements of blood flow and vascularization may increase clinical relevance of these studies.

Objective. To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. Methods. Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two-and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. Results. Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 ± 0.02 cm 3 ) from that in those who had hyperplasia (7.81 ± 0.03 cm ). With combined morphologic and threedimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. Conclusions. Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors. Key words: gynecologic malignancy; morphology; vascularity; three-dimensional sonography; preoperative evaluation. espite numerous efforts and innovative approaches, an effective method for early detection of ovarian cancer, as well as accurate and reliable preoperative evaluation of adnexal and endometrial lesions, has yet not been found. At this time, the best strategy includes a combination of several noninvasive diagnostic tests that are performed in the setting of a clinical trial. Among these, sonography has no known hazards. Malignant adnexal tumors could be detected by changes in ovarian volume or morphology, or both.1 Although, no universally accepted criteria exist for the sonographic diagnosis of ovarian cancer, scoring systems featuring explicit and reproducible criteria have been developed. [2][3][4][5]

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