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Contrast-Enhanced, Three-Dimensional Power Doppler Sonography for Differentiation of Adnexal Masses

From the Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia.

Address reprint requests to: Asim Kurjak, MD, PhD Department of Obstetrics and Gynecology Medical School University of Zagreb Sveti Duh Hospital, Sveti Duh 64 Zagreb 10000 Croatia E-mail: asim.kurjak{at}public.srce.hr

Objective: To investigate the potential usefulness of contrast-enhanced, three-dimensional power Doppler sonography in the differentiation of benign and malignant adnexal lesions.

Methods: A total of 45 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy. All the results were compared with histopathology.

Results: There were 12 cases of ovarian malignancy and 33 benign adnexal lesions. Of the 12 ovarian cancers, seven (58.3%) showed vascular distribution suggestive of malignancy at nonenhanced three-dimensional power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy. One cystadenofibroma demonstrated penetrating vessels at initial scan, whereas two benign lesions (fibroma and cystadenofibroma) were misdiagnosed as malignant at contrast-enhanced, three-dimensional power Doppler sonography. The use of a contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency (95.6%) that was superior to that of nonenhanced three-dimensional power Doppler sonography (86.7%).

Conclusion: Contrast-enhanced, three-dimensional power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with three-dimensional morphologic ultrasound assessment, enhanced three-dimensional power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.

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