Quantitative flow measurements for classification of ovarian tumors by transvaginal color Doppler sonography in postmenopausal patients

Abstract

Color Doppler and Duplex measurements were obtained in 83 (42 benign, 41 malignant) ovarian tumors in postmenopausal patients. An ATL UM9/HDI was used. The following flow criteria were analyzed: lowest resistance index (RI) and pulsatility index (PI), total number of arteries and number of central arteries and the maximum, mean and sum of systolic, end-diastolic and time-averaged maximum velocities of all intratumoral vessels. In 98% of malignant and in 85% of benign lesions, vessels were detected. All flow criteria showed highly significant differences between benign and malignant tumors (p < 0.0001). However, there was a considerable overlap between benign and malignant tumors (e.g. the median of the lowest RI was 0.62 (range 0.26-1.0) for benign and 0.40 (0.22-0.66) for malignant tumors; the median of the maximum systolic velocity was 17.5 cm/s (range 5.2-61.5 cm/s) for benign and 47.05 cm/s (14.6-105.0 cm/s) for malignant tumors). Differentiation of malignant tumors by the lowest RI and PI, number of arteries and maximum of systolic flow velocities gave a sensitivity of 77-85%, specificity of 77-83% and accuracy of 80-84%. Differentiation was superior by calculation of the maximum end-diastolic velocities and by the summation of the systolic, end-diastolic and time-averaged maximum flow velocities: sensitivity 90-9.5% specificity 83-86% and accuracy 87-91%. This study confirms that a single measurement is not sufficient for an accurate differentiation of ovarian lesions and, besides the measurement of minimum RI and PI, the measurements of flow velocities as Doppler criteria play an important role.

Spherical Tissue Sampling in 3-Dimensional Power Doppler Angiography

“…Therefore, analysis in most studies is limited to the first (follicular) phase of the cycle. 1,22,23 Then we compared invasive ovarian cancer cases and controls during the secretory phase of the cycle. Subsequently, we compared a group of borderline tumors with a control group in the prolifera-tive phase of the cycle.…”

“…[1][2][3][4][5][6] However, the traditional 2-dimensional (2D) approach with blood flow detection within only 1 artery supplying a pathologic area had been criticized. 1,[5][6][7][8][9] A more advanced approach with examination of the power Doppler vascularity index has been proposed, 10 although the method still uses plain 2D images only. New more general approaches have been developed and introduced thanks to the application of 3-dimensional (3D) ultrasound technologies 11 such as 3D power Doppler angiography (PDA) and virtual organ computeraided analysis (VOCAL).…”

Prospective evaluation of three different models for the pre‐operative diagnosis of ovarian cancer

“…With the advent of transvaginal colour Doppler imaging vascular changes within the ovary can be studied, in addition to the morphology. The results with this technique are wide ranging 6,7 , with most authors showing little improvement compared with grey‐scale morphology 8–11 .…”

Ultrasound for evaluation of adnexal malignancy: From 2D to 3D ultrasound

“…A renewed interest in the use of transvaginal color Doppler for assessment of adnexal tumors arose, and some authors directed attention to the peak systolic velocity (PSV) and/or time averaged maximum velocity (TAMXV) measured from intratumoral structures (Table 3). 5,24,25 Although statistical analysis was not employed, Prompeler et al 24 achieved more favorable results on velocity compared to impedance measurement. Hata et al 5 reported that PSV diagnosis exhibited a significantly higher specificity than RI, showing almost the same sensitivity.…”