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Contrast-Enhanced Transvaginal Sonography of Benign Versus Malignant Ovarian Masses

Preliminary Findings

Departments of Radiology and Radiological Sciences (A.C.F., A.L., R.F.A., P.K.W.) and Obstetrics and Gynecology (A.C.F., H.W.J., M.C., R.F.A.) and Institute of Imaging Science (M.L.), Vanderbilt University Medical Center, Nashville, Tennessee USA; and Department of Gynecologic Oncology, New York University, New York, New York USA (D.A.F.).

Address correspondence to Arthur C. Fleischer, MD, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, RR-1213 MCN, 1161 21st Ave N, Nashville, TN 37232-2675 USA. E-mail: arthur.fleischer{at}vanderbilt.edu

Objective. The aim of this prospective study was to evaluate differences in contrast enhancement and contrast enhancement kinetics in benign versus malignant ovarian masses with pulse inversion harmonic transvaginal sonography. Methods. Seventeen consecutive patients with 23 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic transvaginal sonography. The following parameters were assessed in all tumors: detectable contrast enhancement, time to peak enhancement (wash-in), peak contrast enhancement, half wash-out time, and area under the enhancement curve. Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Fourteen benign masses and 9 malignancies were studied. There was a statistically significant difference in the peak enhancement (mean ± SD, 23.3 ± 2.8 versus 12.3 ± 3.9 dB; P < .01), half wash-out time (139.9 ± 43.6 versus 46.3 ± 19.7 seconds; P < .01), and area under the enhancement curve (2012.9 ± 532.9 versus 523.9 ± 318 seconds^–1; P < .01) in malignant masses compared with benign disease. There was no statistically significant difference in the time to peak enhancement (26.1 ± 6.3 versus 24.9 ± 7.6 seconds; P = .07). Conclusions. Overall, our data showed a significant difference in the contrast enhancement kinetic parameters between benign and malignant ovarian masses.

Key Words: benign versus malignant • contrast enhancement kinetics • contrast-enhanced transvaginal sonography • ovarian masses

Abbreviations: AUC, area under the enhancement curve • MVI, microvascular imaging • PIH, pulse inversion harmonic • ROI, region of interest • TVS, transvaginal sonography

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