(Ultrasound Review) The objective of research from the University of Navarra was to analyze the usefulness of transvaginal color Doppler in the assessment of venous flow in adnexal masses. To date, Doppler ultrasound research of adnexal masses has concentrated on peak systolic velocities and resistive indices in assessing the nature of tumors.
Published recently in the May issue of Ultrasound in Obstetrics and Gynecology, this study used a venous velocity cutoff of 10 cm/s to differentiate benign from malignant adnexal masses. One hundred and eighty patients were examined with transvaginal ultrasound using a 6.5 MHz transducer, Doppler velocity filter of 100 Hz, and output power minimized to less than 80 mW/cm2.
Gray-scale assessment employed Sassone’s scoring system that evaluates "wall thickness (1–3), presence of septa and their thickness (1–3), inner wall structure (1–4), and echogenicity (1–5). A combined score of nine or greater was considered as being suggestive of malignancy," the study stated.
Ultrasound was performed within the week prior to surgical removal of the adnexal mass. This enabled comparison of histopathology with ultrasound findings. The vessels were differentiated using the usual waveform characteristics, arteries were biphasic, and veins showed continuous monophasic flow.
Color Doppler was used to locate vessels within the adnexal mass and the highest venous flow velocity (VFV) was measured. According to the authors, determination of the vessel angle was not possible, so no angle correction was used. Measurement of the resistive index and peak systolic velocity was also performed for the intratumoral arteries.
There were 25 (27.5%) malignant masses and 66 (72.5%) benign masses. "Venous flow velocity was significantly higher in malignant tumors. The numbers of arterial and venous vessels were significantly higher in malignant tumors," the authors stated.
They found that Doppler was significantly more specific than morphologic evaluation with comparable sensitivity, when there was flow demonstrated and the lowest arterial RI was 0.45 or less, or when venous flow velocity was 10 cm/s or greater.
The authors concluded, "These results indicate that the addition of venous flow assessment to conventional arterial evaluation may increase the diagnostic performance of Doppler ultrasound in the differentiation of malignant from benign adnexal masses."
"Transvaginal color Doppler assessment of venous flow in adnexal masses"J L Alcázar and G López-García
Dept of Obstetrics and Gynecology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
Ultrasound Obstet Gynecol 2001(May); 17:434–438
By Ultrasound Review
July 4, 2001
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