Limitations of three-dimensional power Doppler angiography in preoperative evaluation of ovarian tumors

Abstract

BackgroundThis study describes the accuracy of three-dimensional power Doppler (3D-PD) angiography as secondary method for differential diagnosis of ovarian tumors.MethodSeventy-five women scheduled for surgical removal of adnexal masses were assessed by transvaginal ultrasound. Ovarian tumors were classified by IOTA simple rules and two three-dimensional blocks were recorded. In a second step analyses, a 4 cm3 spherical sample was obtained from the highest vascularized solid area of each stored block. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. The repeatability was assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA), and diagnostic accuracy by area under ROC curve.ResultsIOTA simple rules classified 26 cases as benign, nine as inconclusive and 40 as malignant. There were eight false positive and no false negative. Among the masses classified as inconclusive or malignant by IOTA simple rules, the CCCs were 0.91 for VI, 0.70 for FI, and 0.86 for VFI. The areas under ROC curve were 0.82 for VI, 0.67 for FI and 0.81 for VFI.Conclusions3D-PD angiography presented considerable intraobserver variability and low accuracy for identifying false positive results of IOTA simple rules.

Association Between Endometrial/Subendometrial Vasculature and Embryo Transfer Outcome: A Meta‐analysis and Subgroup Analysis

“…Despite the above results, the efficiency of using 3D power Doppler quantification of the VI, FI, and VFI to assess vascularization has been questioned in several reports . Some researchers think that the use of this technique for assessing vascularization is limited because of the high dependence on the gain, pulse repetition frequency, and other machine settings, which affect attenuation and reproducibility .…”

A prospective study to evaluate the role of serum vascular endothelial growth factor levels and color Doppler indices in prediction of malignancy in adnexal masses

“…37 There is limited evidence with use of three dimensional and power Doppler indices for detection of malignancy. 21,38,39 Studies have demonstrated three dimensional power doppler indices to have a positive correlation with serum VEGF levels in ovarian masses. 21,38 Preoperative serum levels of vascular endothelial growth factor (VEGF) were correlated with three dimensional power Doppler indices in ovarian masses and the vascularization index (VI), flow index (FI) and vascularization flow index (VFI), correlated positively with serum VEGF levels, which were higher in malignant ovarian masses than in benign masses.…”

“…38 However, another study which evaluated the 3-D power Doppler indices concluded that VI, FI and VFI had a high intra-observer variability and low accuracy for identifying false positive results of IOTA simple rules. 39 Also, the inaccessibility to 3-D power doppler and expertise can be a limitation in low resource settings.…”

Three-/Four-dimensional Ultrasound for the Assessment of Ovarian Tumors

“…39 Silvestre et al also reported that three-dimensional power Doppler indices have low accuracy for discriminating between benign and malignant tumors classified as inconclusive when using International Ovarian Tumor Analysis group (IOTA) simple rules. 40 Some studies have used contrast-enhanced 3D-PDU. Huchon et al reported that using contrast agent improved the visualization of vascular network and 3D-PDA derived indices were higher in malignant compared with benign tumors.…”