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Objective: To assess the performance of a power doppler vascularity index in the preoperative diagnosis of ovarian malignancy., Patients and Methods: Two successive series of adnexal masses (N=101 and N=82) were examined prospectively with power Doppler before surgical treatment. A vascularity index, called Power Doppler Index (PDI), based on the number of colored pixels, was estimated on selected frames (defined region of interest covering the entire tumor) of the tumors using an in house color-quantifying program. The first study was monocentric to test the inter- and intraobserver reproducibilities and the availability of the parameter. The second was multicentric to validate the first results. The sensitivity and specificity of PDI, resistance index (RI) and subjective visual scoring were compared using receiver operating characteristic (ROC) curves., Results: Histology identified 23 malignant and 78 benign lesions in the first study and 34 malignant and 48 benign tumors in the second. PDI was considerably higher in malignant than in benign lesions (0.34+/-0.04 vs 0.12+/-0.06 (P<0.001)). Intra-observer and interobserver variability of PDI was low (intraclass correlation coefficients estimated at 0.99 and 0.98, respectively). The PDI cut-off value for differential diagnosis was set at 0.265 (26.5% of the tumor is colored) in the first study and 0.107 in the second. Sensitivity and specificity were 100% (95% CI [87.8; 100.0]) and 97.4% (95% CI [91.0; 99.7]), respectively, for PDI in the first study compared to 75% (95% CI [72.9; 90.7]) and 60% (95% CI [56.3; 92.5]) in the second study. Using logistic regression, visual Doppler scoring performed best., Discussion and Conclusion: The Power Doppler Index obtained using our color quantifying software has discriminating power for adnexal masses but visual Doppler scoring performs best.

Objective: To investigate the potential efficacy of real-time contrast-enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study., Methods: Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real-time postinjection sequences were computerized with time-intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables., Results: Ninety-nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels., Conclusions: Contrast-enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.

Pelvic sonography is the gold standard for diagnosis of ovarian masses. Only 2% of adnexal masses or malignant or bordeline tumors. Does Doppler US improve the diagnostic accuracy of sonography? The purpose of this article is to review current data and identify what areas still require further evaluation with regards to Doppler characterization of adnexal masses. It has been shown that Doppler evaluation of the ovary and cyst or tumor improves the diagnostic accuracy of US to differentiate between benign and malignant lesions. Hemodynamic data collected from pulsed Doppler imaging and Doppler energy vascular mapping have been shown to improve the characterization of malignant lesions. These data improve the accuracy of B-mode US combined with clinical evaluation and CA125 measurement. Nonetheless, the sensitivity and specificity values are between 85-90%, with few missed malignancies, but several false positive results. Useful Doppler data include the resistive index and the central intratumoral location of vascular flow. The use of 3D US with computer post-processing as well as sonographic contrast agents could provide additional information, but these techniques have not yet been validated. All suspicious adnexal lesions should be evaluated by an experienced sonographer and include discriminatory parameters to distinguish between benign and malignant lesions.