Role of transvaginal sonography in the detection of endometriomata

Endometriosis is a common cause of pelvic pain and infertility in young women. Transvaginal sonography is major means for diagnosing ovarian masses. In our study, we scanned 60 patients with endometriomata who underwent laparotomy or laparoscopy. We compared preoperative ultrasonographic diagnosis with histological reports. The sonographic criteria for the diagnosis of endometriomata were (1) cystic structure with low, homogeneous echogenicity and (2) thick cystic wall with regular margins. In 50 patients, sonography suggested an endometrioma. In 47 cases, the diagnosis was correct. The false-positive cases were all caused by cystic teratomas with a homogeneous sonographic pattern. Ten false-negative cases were diagnosed by ultrasonography as functional ovarian cysts (5), teratomas (3), and benign ovarian cystoma (1). Only 1 case of a 5-mm endometrioma was demonstrated by laparoscopy but not by TVS. The sensitivity of TVS for diagnosing endometriomata was 82.4% and specificity 97.7%; the positive and negative predictive values were 94% and 92.8%, respectively. The diagnostic accuracy of TVS was 93%. In our experience, TVS is a very specific means for diagnosing endometriomata when the typical pattern is detected; however, the sensitivity of the technique needs to be improved. © 1995 John Wiley & Sons, Inc.     

The likelihood ratio of sonographic findings for the diagnosis of hemorrhagic ovarian cysts.

OBJECTIVE: The purpose of this study was to quantify the likelihood ratio (LR) of specific sonographic features and experienced sonologist assessment in diagnosing a hemorrhagic ovarian cyst and to better understand the diagnostic power of sonography in making this diagnosis. METHODS: Two sonologists, blinded to the patient's clinical history, independently reviewed the sonograms of 252 adnexal masses. For each mass, each sonologist recorded features using a standardized checklist, which included observations regarding the presence of fibrin strands, a retracting clot, septations, and wall irregularity. Each reviewer independently chose 1 specific conclusion from a list of possibilities that included the diagnosis of a hemorrhagic ovarian cyst. Sonographic observations and sonologist predictions were compared with pathologic findings (n = 214) or follow-up sonography (n = 38). RESULTS: Of the 252 masses, there were 30 hemorrhagic cysts. One sonologist correctly identified 25 hemorrhagic cysts, with 1 false-positive, 2 false-negative, and 3 indeterminate calls (LR 185). The other sonologist correctly identified 24 hemorrhagic cysts, with 1 false-positive, 0 false-negative, and 6 indeterminate calls (LR 178). The 2 cases incorrectly diagnosed as hemorrhagic cysts were endometriomas at pathologic diagnosis. Specific sonographic observations and combinations of observations performed as follows: retracting clot (LR >67); fibrin strands (LR 40); fibrin strands and no septations (LR 100); and fibrin strands, no septations, and smooth wall (LR 200). CONCLUSIONS: Fibrin strands and a retracting clot are paramount observations in allowing high confidence in the diagnosis of hemorrhagic ovarian cysts. Approximately 90% of hemorrhagic ovarian cysts will exhibit at least 1 of these 2 features.     

盆腔单纯囊性肿物超声定性诊断与穿刺治疗病例选择

目的探讨女性盆腔囊性肿物的超声定性诊断及其对超声引导穿刺抽吸治疗病例选择的指导意义.方法分析526个有病理结果的女性盆腔囊性肿物的声像图表现及144个病变超声引导介入治疗效果.结果 526个肿物中超声定性诊断与病理诊断总符合率为95.6%(503/526).部分卵巢囊性畸胎瘤、黏液性囊腺瘤、输卵管积脓、卵巢出血性囊肿或交界性浆液性囊腺瘤可有与子宫内膜异位囊肿或卵巢冠囊肿相似的声像图表现.超声介入治疗后复发者多为子宫内膜异位囊肿中囊壁厚、囊内或囊壁有中等回声块状物或酒精凝固时间短者.包裹性积液和绝经后卵巢囊肿抗炎治疗或随访观察中可完全消失.结论超声对盆腔囊性肿物的定性诊断率较高,但部分不典型病例仍有误诊可能.超声引导穿刺抽吸治疗前应观察2～3个月经周期.     

Hair as a sonographic marker of ovarian teratomas: improved identification using transvaginal sonography and simulation model.

An in vitro sonographic model was developed to simulate the transvaginal sonographic appearance of hair-containing cystic teratomas of the ovary. Two groups of patients with ovarian teratomas were compared: group A--consisting of 32 patients scanned before the simulation model was used, and group B--consisting of 25 patients in whom the diagnosis of hair-containing ovarian teratomas was made after the simulation model experience. The positive predictive value of transvaginal sonography in correctly diagnosing this type of tumor was 27/32 (84%) in group A and 25/25 (100%) in group B. By using this simple in vitro simulation model, the preoperative diagnosis of ovarian cystic teratomas by transvaginal sonography was made very accurate, enabling prospective planning of the type of operation and its timing.     

Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography.

OBJECTIVE: To assess the prevalence and natural history of ovarian pathology in pregnancy. METHODS: Three thousand consecutive pregnant women presenting before 14 weeks' gestation at the early pregnancy unit at St George's Hospital, London, underwent ultrasound examination during which both ovaries were visualized. Women found to have a simple ovarian cyst with a minimum diameter > or =25 mm or a complex ovarian cyst of any size were included in the study. They were followed up with ultrasound scans every 4-6 weeks until either resolution of the ovarian cyst occurred, intervention was required or the pregnancy was concluded. If the cyst persisted at 20 weeks' gestation, these women were rescanned 6 weeks after conclusion of the pregnancy. Women were managed expectantly throughout their pregnancy. RESULTS: One hundred and sixty one women with a total of 166 cysts were included for analysis. At presentation, 43.7% of the women were asymptomatic and 56.3% had pain and/or vaginal bleeding. The mean gestational age at presentation was 53 (range, 28-98) days, the mean maternal age was 30 (range, 17-42) years, and the mean ovarian cyst diameter was 48 (range, 12-115) mm. The first-trimester pregnancy diagnoses were 106 intrauterine pregnancies, 40 miscarriages, five ectopic pregnancies, three pregnancies of unknown location and seven terminations of pregnancy. The sonographic features of the ovarian cysts included: 117 simple and anechoic, 21 hemorrhagic, 16 with mixed echogenicity, seven with a ground-glass appearance, three solid/cystic with papillary projections and two with low-level echoes. One hundred and nineteen (71.7%) of the cysts resolved spontaneously and were presumed to be physiological, 40 (24.1%) persisted and seven (4.2%) required intervention, four of these as an emergency because of pain. There was one case of borderline malignancy and no cases of malignancy. Five (3.0%) of the cysts underwent torsion. Only 0.13% (4/3000) of all women who initially presented to our unit required acute intervention during their pregnancy. CONCLUSIONS: The majority of cysts detected in early pregnancy are physiological and resolve. Very few persist and intervention during the pregnancy is rarely indicated. The expectant management of ovarian cysts detected in the first trimester is safe and should be encouraged. Examining the ovaries in the first trimester is of limited value.     

Pitfalls in the sonographic evaluation of adnexal masses

ABSTRACT: Sonographic evaluation of adnexal masses is subject to a variety of potential pitfalls that can lead to diagnostic overcalls and undercalls. Familiarity with the pitfalls associated with sonographic findings related to normal ovarian physiology, hemorrhagic ovarian cysts, endometriomas, cystic teratomas, extraovarian cystic masses, and exophytic uterine masses helps the imager avoid subjecting patients to unnecessary anxiety and testing, unnecessary or needlessly aggressive surgical evaluation, and incorrect diagnoses.     

The spectrum of sonographic findings in endometriomas

The sonographic features of 40 pathologically proven endometriomas in 32 patients were reviewed to evaluate their sonographic spectrum. Acoustic enhancement was present in 88% and indeterminate in 10% due to technical factors. With respect to internal echo texture, the majority of endometriomas were predominantly anechoic (80%): 7 were totally anechoic; 4 contained septations; 12 contained scattered internal echoes, with or without septations; and 9 contained dependent echoes, with or without septations. Seven endometriomas contained diffuse, low-level internal echoes and were considered hypoechoic, but still fluid-containing masses. Only 1 was echogenic. The overall appearance frequently simulated that of hemorrhagic ovarian cyst, but in some cases endometriomas resembled tubo-ovarian abscess, cystadenoma/cystadenocarcinoma, or ectopic pregnancy.     

Transabdominal color Doppler ultrasonography of the painful adolescent ovary.

The objective of this study was to determine if color flow Doppler ultrasonography based on patterns of perfusion can aid in providing a specific diagnosis of ovarian masses associated with pelvic pain. Color flow Doppler images of 42 ovarian lesions in 42 adolescent girls (age range, 10 to 17 years) were analyzed prospectively. The color flow patterns were classified into three main categories: lesions with no vascularity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, seven simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ovarian torsions. A peripheral pattern of flow was observed in 29 of 34 (85%) cystic lesions, including 18 hemorrhagic and six simple cysts, three cystadenomas and two abscesses. Peripheral flow was also identified in four enlarged ovaries, two with inflammatory disease and two with torsion. Internal flow was noted in five patients with enlarged ovaries due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovarian flow was identified in 90% of normal ovaries. Resistive indices, obtained in 33 abnormal ovaries, were higher in cystic lesions than in inflammatory lesions, although the values overlapped. Our findings showed that internal ovarian flow can be found in inflammatory processes and normal ovaries, but the absence of flow also is nonspecific and can be found in a variety of ovarian cystic lesions as well as in torsion. This overlap limits the usefulness of color Doppler ultrasonography for differentiating cystic ovarian lesions associated with pain in adolescent girls.     

超声在妊娠合并卵巢肿瘤患者的诊断价值

目的探讨超声检查在妊娠合并卵巢肿瘤患者的诊断价值。方法回顾性分析2016年1月~2018年12月就诊的48例妊娠患者临床及超声检查资料,年龄20~41岁（30.5±4.7岁）,所有患者均在妊娠期超声检查发现并经手术病理证实卵巢肿瘤,总结超声检查在妊娠期卵巢肿瘤诊治的价值。结果48例妊娠合并卵巢肿瘤患者,经超声发现病灶共51例,其中成熟性畸胎瘤28例,粘液性、浆液性囊腺瘤分别为8例、10例,黄体囊肿并出血2例,浆-粘液性肿瘤并内膜样囊肿、单纯性囊肿、甲状腺肿各1例,超声检查可显示各类型病灶特征。肿瘤直径2.2~12.1 cm（5.5±2.1 cm）,超声上提示恶性病变3例,提示妊娠合并卵巢肿瘤并发肿瘤蒂扭转或黄体囊肿出血7例。因患者意愿终止妊娠并肿瘤切除3例,因妊娠急腹症、可疑恶变、肿瘤体积较大等采用腹腔镜手术切除卵巢肿瘤共12例,采用期待疗法33例,在剖宫产分娩时进行卵巢肿瘤切除,大部分患者取得良好的妊娠结局。结论超声检查可测量妊娠合并卵巢肿瘤的病灶大小、判断良恶性、鉴别组织学来源、有无合并症、并对妊娠过程中卵巢肿瘤进行动态监测,为临床决策提供关键证据。      

Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings

PURPOSE: The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. METHODS: The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. RESULTS: The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). CONCLUSIONS: When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected.     

Gray scale B scan characteristics of intra-abdominal cystic masses.

A comparison of the gray scale characteristics of 119 intra-abdominal cystic masses was performed. Each cystic mass was evaluated with regard to: 1) The presence or absence of internal echoes, septa, and fluid-fluid levels; 2) The appearance of the wall; 3) Conformity to adjacent organs and, 4) Changes in the surrounding soft tissues. Abscesses, hematomas, lymphoceles, urinomas, and necrotic tumors were evaluated. Necrotic tumors and some abscesses and hematomas have specific sonographic characteristics. In most cases, a definite diagnosis cannot be made from the sonographic appearance; however, in conjunction with the clinical history, the differential diagnosis can be narrowed to a couple of cystic lesions among the many that may be found in the abdomen. The diagnosis can be confirmed by aspiration under ultrasound. A comparison between these cystic masses and pancreatic pseudocysts, renal cysts, and ovarian cysts was made.     

Classification of ovarian lesions by high-frequency transvaginal sonography

Two hundred patients suspected of having ovarian pathology were scanned with a 6.5-MHz transvaginal probe. Normal anatomical structures and abnormal findings were recorded and classified according to their shape, size, location, and sonographic characteristics. The sonographic images were correlated with the surgical findings, whenever available. A sonographic classification of ovarian lesions was compiled according to the presence or absence of the following sonographic components: septae, papillae, loculations, daughter cysts, solid mass, or fluid, and their relationship to malignancy.     

High‐Resolution Sonographic Findings of Ovarian Granulosa Cell Tumors

Objective. This study was performed to determine the high‐resolution sonographic findings of ovarian granulosa cell tumors (GCTs) and to correlate the sonographic findings with the pathologic findings. Methods. A retrospective review of sonographic findings was conducted on 16 patients with surgically proven ovarian GCTs. Patients' ages ranged from 10 to 64 years (mean, 37.7 years). We evaluated the sizes and morphologic appearances of the ovarian tumors. The blood flow patterns of the tumors were assessed with Doppler sonography (n = 6). Sonographic findings were compared with pathologic findings. Results. The maximal diameters of the masses were 2.0 to 15.4 cm (mean, 8.2 cm). The morphologic appearances of the masses were classified into 3 patterns; solid and cystic (n = 10), solid with a sponge form appearance (n = 4), and entirely solid (n = 2). The measured resistive index and pulsatility index of the solid portions were 0.23 to 0.5 and 0.26 to 0.62, respectively. Pathologic diagnoses of 13 adult ovarian GCTs and 3 juvenile GCTs were obtained. The solid and cystic masses had GCTs with macrofollicular and microfollicular patterns pathologically. The solid masses with a sponge form appearance had prominent hemorrhagic necrosis and diffuse proliferation of granulosa cells with trabecular and microfollicular patterns. The entirely solid masses had diffuse cellular proliferation with a trabecular pattern without cystic changes or hemorrhagic foci. Conclusions. Sonographic findings of ovarian GCTs included solid and cystic masses, solid masses with a sponge form appearance, and entirely solid masses, and the sonographic findings correlated well with the histopathologic findings.     

新生儿及婴儿期卵巢囊肿蒂扭转的超声表现

目的总结新生儿及婴儿卵巢囊肿蒂扭转的超声声像图特征。 方法对2006年1月至2016年12月在首都医科大学附属北京儿童医院就诊,经手术及病理检查诊断为卵巢囊肿83例（84个囊肿）患儿的超声图像表现进行总结。 结果术前超声声像图示84个卵巢囊性肿物中51个囊肿内含液体-碎片分层及和（或）回缩块,诊断为复杂型囊肿（46个手术及病理诊断为卵巢囊肿蒂扭转,其余5个为未扭转的卵巢囊肿）;33个术前超声无囊内出血改变,诊断为单纯性囊肿（7个手术及病理诊断为卵巢囊肿蒂扭转,其余26个为未扭转的卵巢囊肿）。 结论囊内液体-碎片分层及回缩块可作为诊断卵巢囊肿蒂扭转的重要间接征象。囊内液体-碎片分层及回缩块对诊断卵巢囊肿蒂扭转有临床价值。     

Role of color Doppler ultrasonography in the diagnosis of endometriotic cyst.

We studied the role of color Doppler ultrasonography in the distinction between endometriomas and other adnexal masses. Three hundred and fifty-two ovarian lesions were studied, comparing sonographic diagnosis with pathologic findings. On color Doppler sonography, an endometriotic cyst usually appeared as a cystic lesion with diffuse internal echoes and low vascularization. The sensitivity and specificity of color Doppler transvaginal sonography in detecting endometriotic cysts were 91.8% and 95.3%, respectively. The positive and negative predictive values were 95.5% and 91.5%, respectively. In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.     

Sonographic features of ovarian remnants.

Ovarian remnants occur after a portion of ovarian tissue is left behind unintentionally after oophorectomy. The ovarian remnant may be functional and cystic, producing pelvic pain and, in some patients, extrinsic compression of the distal ureter. Ovarian remnants frequently are associated with adhesions from previous pelvic surgery for endometriosis or pelvic inflammatory disease. Ovarian remnants also may be included within pelvic peritoneal inclusion cysts. In this retrospective study, the sonographic features of ovarian remnants in 10 patients with surgical proof or clinical follow-up data are described. Most ovarian remnants were simple cysts (seven of 10), three had multiple septations, and six had a rim of presumably ovarian tissue with arterial and venous flow. Three patients with ovarian remnant masses that were aspirated had symptomatic relief without recurrence. In one patient, guided aspiration was unsuccessful, probably owing to the presence of organized hemorrhage within the mass. Extrinsic compression of the distal ureter was observed in one patient, who was treated with gonadotropin releasing hormone agonist (Lupron). The sonographic findings of a completely cystic or multiseptated pelvic mass with a rim of vascularized solid tissue in a postoophorectomy patient, although such cases are rare, suggest the diagnosis of an ovarian remnant. If the diagnosis can be established with a high degree of certainty, sonographically guided aspiration may be attempted in an effort to provide symptomatic relief. Otherwise, sonography is useful in serial assessment of these masses in patients receiving medical treatment.     

超声对卵巢子宫内膜异位囊肿的鉴别诊断

目的:探讨卵巢子宫内膜异位囊肿与卵巢其它囊性肿物的超声鉴别诊断.方法:对比分析279个术前超声或术后病理诊断为卵巢子宫内膜异位囊肿的卵巢囊性肿物的声像图表现与病理结果.结果:卵巢子宫内膜异位囊肿超声诊断与病理诊断的符合率为94.3%.结论:超声对卵巢子宫内膜异位囊肿诊断率高,但仍需与其它囊性肿物相鉴别,部分病例有与卵巢黄体囊肿出血、卵巢脓肿、囊性畸胎瘤、粘液性囊腺瘤、卵巢子宫内膜异位囊肿合并感染相似的声像图表现.     

Utility of targeted sonography in the evaluation of focal breast pain.

OBJECTIVE: To determine the utility of targeted sonography in the evaluation of patients with focal breast pain. METHODS: From January 1995 through December 1999, 110 targeted sonographic examinations were performed in 99 patients for evaluation of focal breast pain in the absence of an associated palpable mass. The sonographic, mammographic, and clinical findings were reviewed. The hospital pathology database was searched to identify any interval cancers and false-negative interpretations. RESULTS: No cancer was identified in any of the 110 examinations. Eighty-five (77.3%) of the examinations had negative findings. Cysts were identified in 15 cases (13.6%), and 3 solid masses (2.7%) were identified. Two of these 3 solid masses had biopsies and were shown to be benign, whereas the third mass was followed for 29 months without change. Most patients were premenopausal, had no family or personal history of breast cancer, and were not taking exogenous hormones. Eighty-five patients (77%) were referred by primary care physicians. CONCLUSIONS: In patients with focal breast pain without an associated palpable mass, sonography may be more useful for patient reassurance than for cancer detection.     

卵巢血肿的超声诊断与临床价值

目的 探讨卵巢血肿的声像图特点与临床价值。方法 对32例超声诊断并经动态观察及手术病理证实为卵巢血肿的病例进行回顾性分析。结果 卵巢血肿声像图有其特征性，内部回声表现多样，短期内动态观察出现变化直至消失。本文总结分析32例声像图，根据内部回声特点将其归纳为五种不同类型：细点状回声型25％、粗网状回声型9．4％、囊实分界回声型15．6％、混合回声型37．5％、单纯囊肿型12．5％。结论 认识卵巢血肿独特的声像图特点，注重短期内超声复查，并与卵巢其它肿物相鉴别，可提高其诊断率，减少误诊的发生。     

Ovarian torsion: sonographic evaluation

The sonographic and clinical findings of 13 patients with surgically proven ovarian torsion are reported. Sonography demonstrated an abnormal pelvic mass in all patients. The appearance was nonspecific, ranging from solid to cystic, but frequently reflected the commonly associated ovarian pathology present in 69% of patients. The mass was large (mean diameter: 8 cm) and frequently midline (8/13). The clinical findings were variable and nonspecific, leading to a correct preoperative differential diagnosis in only 35% of patients. Preoperative sonography reduced the likelihood of unnecessary appendectomy in patients with ovarian torsion.