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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1273-1280 • 0278-4297

Diagnostic Parameters to Differentiate Benign From Malignant Ovarian Masses With Contrast-Enhanced Transvaginal Sonography

Arthur C. Fleischer, MD, Andrej Lyshchik, MD, PhD, Howard W. Jones, III, MD, Marta A. Crispens, MD, Rochelle F. Andreotti, MD, Phillip K. Williams, RDMS and David A. Fishman, MD

Departments of Radiology (A.C.F., A.L., R.F.A., P.K.W.) and Obstetrics and Gynecology (A.C.F., H.W.J., M.A.C., R.F.A.), Vanderbilt University Medical Center, Nashville, Tennessee USA; and Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, New York USA (D.A.F.).

Address correspondence to Arthur C. Fleischer, MD, Department of Radiology, 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 study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast-enhanced transvaginal sonography (TVS). Methods. Thirty-three consecutive patients with 36 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 TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash-out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Twenty-six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds–1 was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash-out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful. Conclusions. Our data suggest that the AUC, peak enhancement, and half wash-out time had the greatest diagnostic accuracy for contrast-enhanced TVS in differentiation between benign and malignant ovarian masses.

Key Words: ovarian cancer • contrast-enhanced transvaginal sonography • pulse inversion harmonic imaging

Abbreviations: AUC, area under the enhancement curve • CI, confidence interval • CT, computed tomography • PET, positron emission tomography • PIH, pulse inversion harmonic • ROI, region of interest • TVS, transvaginal sonography




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S. Dutta, F.-q. Wang, A. C. Fleischer, and D. A. Fishman
New Frontiers for Ovarian Cancer Risk Evaluation: Proteomics and Contrast-Enhanced Ultrasound
Am. J. Roentgenol., February 1, 2010; 194(2): 349 - 354.
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