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Three-Dimensional Power Doppler Vascular Sampling

A New Method for Predicting Ovarian Cancer in Vascularized Complex Adnexal Masses

Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain (J.L.A., M.G.M.); and Department of Obstetrics and Gynecology, Hospital Ruber Internacional, Madrid, Spain. (L.T.M.).

Address correspondence to Juan Luis Alcázar, MD, Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. E-mail: jlalcazar{at}unav.es

Objective. The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses. Methods. Forty-five women (mean age, 52.3 years; range, 17–82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case. Results. Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162). Conclusions. Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.

Key Words: ovarian cancer • power Doppler sonography • 3-dimensional sonography

Abbreviations: AUC, area under the curve • FI, flow index • PI, pulsatility index • PSV, peak systolic velocity • RI, resistive index • 3D, 3-dimensional • 2D, 2-dimensional • VFI, vascular flow index • VI, vascularization index • VOCAL, Virtual Organ Computer-Aided Analysis

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