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Contrast-Enhanced Sonography Helps in Discrimination of Benign From Malignant Adnexal Masses

Department of Gynecology, Obstetrics, Fetal Medicine, and Human Reproduction (H.M., S.S., G.B.) and Department of Medical Imaging and Ultrasound (F.T.), Bretonneau University Hospital, Tours, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Clinique 202, Faculty of Medicine, Tours, France (B.G.); Departments of Obstetrics and Gynecology and Biomedical Engineering, Division of Gynecologic Oncology, University of Arizona, Tucson, Arizona USA (M.B.); and School of Public Health, Arizona Cancer Center, Tucson, Arizona USA (J.R.-M.).

Address correspondence and reprint requests to Henri Marret, MD, Department of Gynecology and Obstetrics, Bretonneau University Hospital, 2 Boulevard Tonnellé, 37044 Tours Cedex, France. E-mail: marret{at}med.univ-tours.fr.

Objective. To investigate the potential efficacy of real-time contrast-enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study. Methods. Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real-time postinjection sequences were computerized with time-intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables. Results. Ninety-nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels. Conclusions. Contrast-enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.

Key Words: adnexal mass • contrast agents • contrast enhancement • ovarian cancer • power Doppler sonography

Abbreviations: AUC, area under the curve • CA 125, cancer antigen 125 • CI, confidence interval • OR, odds ratio • RI, resistive index • ROI, region of interest

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