Ovarian malignancies take the highest toll among all gynecological malignancies in developed countries. In 2018, 4.4% of entire cancer-related mortality among women was attributed to ovarian cancer. The reason probably is that its symptoms do not become evident till the tumor invades the surrounding structures or metastasis or ascites develop. A total of 65% of women with ovarian cancers have stage III or IV diseases at diagnosis, with a 5-year survival rate of only 20–30%. Instead, if the disease is diagnosed at stage IA, when the disease is confined only to the ovary, survival rates of as high as 90% can be achieved. Ultrasound (US) is a modality of choice for the primary diagnosis of the lesion as it clearly demonstrates the morphology. Solid tumors cannot grow larger than 2–3 mm in diameter without inducing their own blood supply. Doppler plays a major role in diagnosis because neoangiogenesis is the major feature of malignant lesions. A resistance index (RI) of <0.4 was found to strongly correlate with the malignant nature of the lesion. But an overlap in RI values between benign and malignant lesions is not uncommon. Three-dimensional (3D) is superior in evaluating papillary projections and characteristics of cystic walls, calcifications, and bone densities, identifying the extent of capsular infiltration of tumors, and calculating the volume.
Disorganized, randomly dispersed vessels with irregular branching and asymmetrical caliber with microaneurysms (MAs) and arteriovenous (AV) fistulae with dichotomous branching are typical features of malignant vasculature and are best studied on 3D power Doppler (3D-PD).
A study by Kurjak et al. showed a qualitative analysis of the tumor vascular architecture added to morphologic parameters and was clinically pertinent, reaching sensitivity, and specificity of 97 and 99%, respectively.
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