The Applications Of Contrast-Enhancement Transvaginal Sonography In The Diagnosis Of Ovarian Masses

Purpose(1) To investigate the potential usefulness of contrast-enhanced transvaginal sonography in differential diagnosis of benign versus malignant adnexal masses. To compare the parameters of time-intensity curve between benign and malignant adnexal lesions.(2) To investigate the correlations between enhancement parameters and microvessel density (MVD), and the efficacy of contrast-enhanced transvaginal sonography in determining the tumor vascularity of ovarian masses.MethodsA total of 64 patients with complex adnexal lesions (39 benign,25 malignant) were examined by transvaginal color Doppler sonography and contrast-enhanced transvaginal sonography. The perfusion and enhancement characteristics were observed and analyzed. Time-intensity curves of 49 adnexal lesions (25 benign, 24 malignant) were documented. The following parameters were assessed:arrival time(AT), time to peak intensity (TTP), peak intensity(PI), and area under the enhancement curve (AUC). Immunohistochemistry was performed to evaluate the level of MVD in 41 ovarian tumor slices (20 benign,21 malignant). Then the relationships between enhancement parameters and the level of MVD were analyzed.Results(1) Twenty-six benign masses(66.7%) and 22 malignant tumors(88%) showed vascular distribution with CDFI while 38 benign masses(97.4%) and 24 malignant tumors(96%) showed detectable contrast enhancement. The use of contrast-enhanced sonography showed higher diagnostic efficiency(92.2%) than that of transvaginal color Doppler ultrasonography(81.3%) (P<0.05). (2) Among 25 malignant tumors,24 cases showed detectable contrast enhancement, including 23 cases with a quick, heterogeneous pattern. Among 39 benign lesions,24 were cystic with circle enhancement, including 6 cases with intra-cystic papillae slightly enhanced. The other 15 cases were solid,10 of them had slightly dotted enhancement.(3) The parameters of time-intensity curves:benign group:AT(16.4±4.0)s, TTP(27.6±6.6)s, PI (12.0±6.8) dB, AUC (8.8±6.1);malignant group:AT (13.3±4.8) s, TTP (22.2±6.5) s, PI (18.3±5.7) dB, AUC (17.1±6.5). There is statistic significance of the AT, TTP, PI and AUC among benign and malignant adnexal lesions (P< 0.05).(4) The MVD of malignant group was higher than that of benign group. Malignant lesions contained more microvessels than benign lesions. MVD showed significant difference between the two groups (P< 0.01).(5) It showed significantly positive correlations between PI, AUC of time-intensity curve and MVD (r= 0.595 and 0.533 respectively, P< 0.01).Conclusions(1) Contrast-enhanced transvaginal sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with TIC contrast-enhanced transvaginal sonography might precisely discriminate benign from malignant adnexal masses.(2) The parameters with TIC contrast-enhanced ultrasonography of ovarian lesions are well correlated with MVD, which can be used to estimate the angiogenesis in ovarian masses.