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The Power Doppler Velocity Index, Pulsatility Index, and Resistive Index Can Assist in Making a Differential Diagnosis of Primary Ovarian Carcinoma and Krukenberg Tumors

A Preliminary Study

Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (C.-Y.C., Y.-C.W., M.-S.Y., J.-H.H., C.-C.Y., K.-C.C.); Department of Obstetrics and Gynecology, Chutung Veterans Hospital, Jhudong, Taiwan, Republic of China (Y.-C.W.); and National Yang-Ming University, Taipei, Taiwan, Republic of China (C.-Y.C., Y.-C.W., M.-S.Y., J.-H.H., C.-C.Y., K.-C.C.).

Address correspondence to Yi-Cheng Wu, MD, Department of Obstetrics and Gynecology, Chutung Veterans Hospital No. 81, Section 1, Jhongfong Rd, Jhudong Township, Hsinchu County 310, Taiwan, Republic of China. E-mail: zachary.joyce{at}gmail.com

Objective. The aim of this study was to compare the effectiveness of transvaginal power Doppler sonography with spectral Doppler analysis as an aid in preoperatively distinguishing primary ovarian carcinoma and metastatic carcinoma to the ovary (Krukenberg tumors). Methods. Fifty women with ovarian disease were preoperatively examined with transvaginal power Doppler sonography. Six basic parameters were measured, including intratumoral peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, pulsatility index (PI), resistive index (RI), and velocity index (VeI). Blood flow analyses were detectable in all patients. Twelve patients with metastatic carcinoma to the ovary were classified as group 1; 38 patients with primary ovarian carcinoma were classified as group 2. Comparison of intratumoral blood flow analyses between the two groups was performed. Results. The PI, RI, and VeI were significantly lower in patients with metastatic carcinoma to the ovary than those with primary ovarian carcinoma (P < .05). There were no significant differences in the peak systolic velocity (P = .871), end-diastolic velocity (P = .508), and time-averaged maximum velocity (P = .850) between the two groups. Conclusions. Transvaginal power Doppler sonography with spectral Doppler analysis is an effective method in evaluating intratumoral blood flow of Krukenberg tumors. Low impedance (PI, RI, and VeI) might assist us in making differential diagnoses between primary ovarian carcinoma and Krukenberg tumors according to our preliminary results.

Key Words: Krukenberg tumor • metastatic ovarian cancer • power Doppler sonography • pulsatility index • resistive index • velocity index

Abbreviations: EDV, end-diastolic velocity • PI, pulsatility index • PSV, peak systolic velocity • RI, resistive index • TAMXV, time-averaged maximum velocity • 3D, 3-dimensional • VeI, velocity index