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The Use of Contrasted Transvaginal Sonography in the Diagnosis of Gynecologic Diseases

A Preliminary Study

Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy (A.C.T., G.F., Er.F.); Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (C.V.H., D.T.); Department of Obstetrics and Gynecology, Biomedical Science Institute L. Sacco, University of Milan, Milan, Italy (En.F., F.P.G.L.); Department of Obstetrics and Gynecology, University of "Tor Vergata," Rome, Italy (D.A., C.E.); Bracco Imaging SpA Imaging Guided and Integrated Technology Medical Affaire, Milan, Italy (D.B.); and Department of Oncology, Catholic University of Sacred Heart, Campobasso, Italy (G.S.).

Address correspondence to Antonia C. Testa, MD, Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy. E-mail: atesta{at}rm.unicatt.it.

Objective. The purpose of this study was to evaluate the efficacy of a new contrast-dedicated ultrasound technology, contrast-tuned imaging (CnTI), implemented on an endovaginal probe and using the second-generation contrast agent SonoVue (Bracco International BV, Amsterdam, the Netherlands), compared with the standard ultrasound examination in different gynecologic diseases. Methods. Eighty-nine patients were enrolled in the study in 4 different clinical centers. The study included 40 patients with uncertain pelvic adnexal masses, 10 patients with pelvic masses indicative of recurrences of gynecologic tumors, 26 patients with uterine pathologic features, and 13 patients with cervical lesions. Results. Application of CnTI technology after the SonoVue injection gave a picture of the intralesional microvascularization dramatically different from that obtained during color Doppler examination. Of the 40 pelvic masses, 15 (37.5%) were considered benign and 25 (62.5%) were considered malignant at B-mode and color Doppler examinations. Contrast-enhanced sonography showed no intralesional contrast perfusion in 11 (73%) of 15 cases, and all these were benign at final diagnosis. Of the 4 (27%) cases that had perfusion, 2 were malignant. Conversely, of the 25 cases with positive findings at color Doppler examination and therefore expected to show the appearance of contrast tissue-filling morphologic characteristics, 13 (52%) were malignant at final diagnosis. For evaluation of uterine pathologic features, the CnTI-SonoVue technology did not appear to be superior to the B-mode and color Doppler examinations; however, for the evaluation of cervical cancer, CnTI-SonoVue technology revealed a better definition of the margins of the neoplastic lesions in 4 (40%) of 10 cases. Conclusions. In the evaluation of uncertain pelvic masses, the CnTI technology led to an improvement in the ability of the practitioner to differentiate benign from malignant adnexal lesions.

Key Words: contrast media • endovaginal probe • gynecology • sonography

Abbreviations: CnTI, contrast-tuned imaging • CTF, contrast tissue-filling • FIGO, International Federation of Gynecology and Obstetrics

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