Journal of Ultrasound in Medicine, Vol 16, Issue 5 349-354, Copyright © 1997 by American Institute of Ultrasound in Medicine
Evaluation of adnexal masses using three-dimensional ultrasonographic technology: preliminary report
L. Chan, W. M. Lin, B. Uerpairojkit, D. Hartman, E. A. Reece and W. Helm
Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA 19140, USA.
The purpose of the current study was to demonstrate the ability of
three-dimensional ultrasonographic technology to enhance the morphologic
scoring system and further improve the ability to differentiate benign from
malignant ovarian masses. We performed conventional two-dimensional and
three-dimensional transabdominal and transvaginal ultrasonography on eight
women with adnexal masses. All patients underwent exploratory laparotomy or
diagnostic laparoscopy. The three-dimensional ultrasonographic findings
were compared with the two-dimensional ultrasonograms, the intraoperative
observations, and gross and histopathologic findings. The morphologic
scoring system as described by Sassone and coworkers was adopted, with
scores of less than 9 suggestive of benign lesions, and this system was
applied in both the two-dimensional and three-dimensional ultrasonographic
examinations. The morphologic scores were subsequently compared. The images
were dissected in the XYZ planes, and the areas suggestive of malignancy,
as suggested by two-dimensional ultrasonography, were determined to be
either negative or positive and confirmatory. In each of the eight adnexal
masses, three-dimensional ultrasonography confirmed the preoperative
diagnoses. The morphologic scores did not differ between two-dimensional
and three-dimensional ultrasonograms for the benign cysts. In one case of
benign solid fibroma, both the two-dimensional and three-dimensional gray
scale morphologic scores were falsely positive at greater than 9. In one
case of malignant serous papillary cystadenocarcinoma the two-dimensional
morphologic score was a 9, where- as the three-dimensional score was 13.
This difference in scores can be attributed to the additional views
available with three-dimensional volume scanning, which allowed better
characterization of the pathologic conditions. In addition,
three-dimensional sonographic technology had the added advantage of
high-speed image acquisition and recording to decrease the time of scanning
to improve patient comfort. Furthermore, three-dimensional ultrasonography
allowed the real-time analysis of the acquired image data to be conducted
at a later time when the patient is off the examination table. Our
preliminary results suggest that three-dimensional transvaginal
ultrasonographic technology can enhance and facilitate the morphologic
evaluation of both benign and malignant adnexal masses.
