Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 3 , ISSUE 1 ( January-March, 2009 ) > List of Articles


B-mode and Power Doppler Ultrasound in Adnexal Masses

Silvia Ajossa, Anna Maria Paoletti, Nicoletta Garau, Valerio Mais, Bruno Piras, Enrico Silvetti, Gian Benedetto Melis, Stefano Angioni, Marco Angiolucci, Monica Pilloni

Keywords : B-mode ultrasonography,power Doppler,adnexal masses,ovary,ovarian cancer,transvaginal ultrasonography

Citation Information : Ajossa S, Paoletti AM, Garau N, Mais V, Piras B, Silvetti E, Melis GB, Angioni S, Angiolucci M, Pilloni M. B-mode and Power Doppler Ultrasound in Adnexal Masses. Donald School J Ultrasound Obstet Gynecol 2009; 3 (1):31-40.

DOI: 10.5005/jp-journals-10009-1006

License: CC BY-NC 4.0

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2009; The Author(s).


Adnexal masses can be classified in ovarian, paraovarian or tubal. In the present review we analyzed the diagnostic performance of transvaginal ultrasonography in identifying simple ultrasonographic findings of benign adnexal pathology but also the role of color Doppler in the differential diagnoses between benign and malignant masses and in the preoperative triage. Because of many kinds of adnexal masses have usually a typical ultrasound appearance, the results of the studies present in literature showed a good and sufficient diagnostic accuracy. Unfortunately some cases with uncertain findings are present and in these cases the addition of color Doppler can be useful as demonstrated by several authors. Using the location of flow evaluated using color Doppler as main parameter a mass should be graded as malignant if flow is shown centrally within the excrescences or solid areas. The same approach should be used to triage the patients with adnexal masses to the most appropriate surgical approach with an increase of less invasive surgery.

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  1. Simple ovarian cysts in premenopausal patients. Int. J Gynecol. Obstet 1997;57: 49-55.
  2. Transvaginal ultrasound and computed tomography combined with clinical parameters and CA 125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women. Ultrasound Obstet. Gynecol 1997;9:339-43.
  3. The diagnosis of functional ovarian cysts using transvaginal ultrasound combined with clinical parameters, CA125 determinations and color Doppler. Eur. J. Obstet. Gynecol. Reprod. Biol 2003;110:83-88.
  4. The management of persistent clear pelvic cysts diagnosed by ultrasonography. Obstet. Gynecol 1988;72:320-22.
  5. A practical approach to the ultrasound characterization of adnexal masses. Ultrasound Q. 2007;23:87-105.
  6. Gynecol Endocrinol 1991;5:123-29.
  7. Transvaginal ultrasonography combined with CA 125 plasma levels in the diagnosis of endometrioma. Fertil Steril. 1996;65:293-98.
  8. Transvaginal sonographic appearance of endometriomata: spectrum of findings. J Ultrasound Med 1992;11:129-33.
  9. Endometriomas: diagnostic performance of US. Radiology 1999;210:739-45.
  10. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound Obstet. Gynecol 2002;20:630-34.
  11. Acoustic streaming in ovarian cysts. J Ultrasound Med 2005;24:617-21.
  12. Transvaginal ultrasonography in the diagnosis of cystic teratoma. Obstet. Gynecol 1995;85:48-52.
  13. Imaging of ovarian masses: magnetic resonance imaging. Clin. Obstet. Gynecol 1991;34:443-51.
  14. Sonographic features of ovarian cystadenofibromas: spectrum of findings. J Ultrasound Med. 2001;20:915-19.
  15. Ovarian fibroma: a review on the clinical characteristics, diagnostic difficulties, and management options of 23 cases. Gynecol. Obstet. Invest 2006;62:1-6.
  16. Use of morphology to characterize and manage common adnexal masses. Best Pract. Res. Clin. Obstet. Gynaecol 2004;18:71-89.
  17. Epithelial tumours of the ovary: CT findings and correlation with US. Radiology 1991;178:811-18.
  18. Variable echogenicity as a sonographic sign in the preoperative diagnosis of ovarian mucinous tumors. J. Ultrasound Med 2006;25:1583-85.
  19. et al. Paraovarian and paratubal cyst: preoperative diagnosis using transabdominal and transvaginal sonography. J. Clin. Ultrasound 1996;24:117-22.
  20. Sonographic diagnosis of paraovarian cysts: value of detecting a separate ipsilateral ovary. AJR Am Roentgenol 1995;164:1441-44.
  21. Paraovarian/paratubal cysts: comparison of transvaginal sonographic and pathological findings to establish diagnostic criteria. Ultrasound Obstet. Gynecol 2006;28:330-34.
  22. Diagnosis of paraovarian cysts using transvaginal sonography combined with CA 125 determination. Ultrasound Obstet. Gynecol 2006;28:853-58.
  23. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet. Gynecol 1998;12:56-66.
  24. Transvaginal ultrasonography associated with color Doppler energy in the diagnosis of hydrosalpinx. Hum. Reprod 2000;15:1568-72.
  25. Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses. AJR Am J Roentgenol 2006;186:1033-38.
  26. Endovaginal sonography with laparoscopic correlation. J Ultrasound Med 1990;9:681-89.
  27. Ultrasound of pelvic inflammatory disease Ultrasound Q 2004;20:171-79.
  28. Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations. Clin. Exp. Obstet. Gynecol 2003;30:117-21.
  29. Benign pelvic masses: sonographic spectrum. Radiographics 1996;16:321-34.
  30. Benign cystic mesothelioma: case reports. Br J Obstet. Gynaecol 1984;91:932-38.
  31. Benign cystic mesothelioma: case reports. Br J Obstet Gynaecol 1984;91:932-38.
  32. Entrapped ovarian cyst: an unusual case of persistent abdominal pain. Acta Radiol 1990;31:285-86.
  33. Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas). Cancer. 1989;64:1336-46.
  34. Peritoneal inclusion cysts: ovarian fluid in peritoneal adhesions. Radiology 1988;169:189-91.
  35. Imaging of peritoneal inclusion cysts. AJR. Am J Roentgenol 2000;174:1559-63.
  36. Transvaginal sonographic appearance of peritoneal pseudocysts. Ultrasound Obstet Gynecol 2004;23:284-88.
  37. Role of transvaginal sonography in the diagnosis of peritoneal inclusion cysts. J Ultrasound Med 2004;23:1193-200.
  38. Cyst distortion: a new sonographic sign of peritoneal pseudocyst with regular morphology. Ultrasound Obstet. Gynecol 2007;29:240-41.
  39. Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses. Ultrasound Obstet Gynecol 1998;11:277-82.
  40. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology 1998;208:103-10.
  41. Color Doppler energy prediction of malignancy in adnexal masses using logistic regression models. Ultrasound Obstet. Gynecol 2002;20:597-604.
  42. Complex pelvic mass as a target of evaluation of vessel distribution by color Doppler sonography for the diagnosis of adnexal malignancies: results of a multicenter European study. J Ultrasound Med. 2002;21:1105-11.
  43. Preoperative sonographic features of borderline ovarian tumors. Ultrasound Obstet Gynecol 2005;25: 50-59.
  44. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol 1991;78:70-76.
  45. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet. Gynaecol 1990;97:922-29.
  46. Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis. Ultrasound Obstet. Gynecol 1997;10:41-47.
  47. A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: the development of a new logistic regression model. Am J Obstet. Gynecol 1999;181:57-65.
  48. Best Pract Res Clin. Obstet. Gynaecol 2006;20:881-906.
  49. Intraobserver and interobserver agreement of grayscale typical ultrasonographic patterns for the diagnosis of ovarian cancer. Ultrasound Med Biol 2008;34:1711-16.
  50. Transvaginal sonographic appearance of functional ovarian cysts. Hum. Reprod 1997;12:1246-49.
  51. Blood flow in functional cysts and benign ovarian neoplasms in premenopausal women. J Ultrasound Med 1997;16:819-24.
  52. The role of color Doppler in the diagnosis of endometriomas. Ultrasound Obstet. Gynecol 1995;5:51-54.
  53. The diagnosis of endometriomas using color Doppler energy imaging. Hum. Reprod 1998;13:1691-95.
  54. Clinical applications of colour Doppler energy imaging in the female reproductive tract and pregnancy. Hum Reprod Update 1999;5:515-29.
  55. Transvaginal color Doppler sonography in adnexal masses: which parameter performs best? Ultrasound Obstet Gynecol 1996;8:114-19.
  56. Limited contribution of Doppler velocimetry to the differential diagnosis of extrauterine pelvic tumors. Obstet Gynecol 1994;83:425-33.
  57. AJR Am J Roentgenol. 1996;166:385-93.
  58. Controversies in assessment of ovarian tumors with transvaginal color Doppler ultrasound. Acta Obstet Gynecol Scand 1996;75:316-29.
  59. Combined transvaginal B-mode and color Doppler sonography for differential diagnosis of ovarian tumors: results of a multivariate logistic regression analysis. Gynecol. Oncol 2000;77:78-86.
  60. Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach. Am. J. Obstet. Gynecol 2005;192:401-06.
  61. Impact of a multiparameter, ultrasound-based triage on surgical management of adnexal masses. Ultrasound Obstet. Gynecol 2002;20:181-85.
  62. Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system. Ultrasound Obstet Gynecol 2008;32:220-25.
  63. Effect of quality of gynaecological ultrasonography on management of patients with suspected ovarian cancer: a randomised controlled trial. Lancet Oncol 2008;9:124-31.
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