Contrast-enhanced sonography helps in discrimination of benign from malignant adnexal masses.

OBJECTIVE: To investigate the potential efficacy of real-time contrast-enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study. METHODS: Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real-time postinjection sequences were computerized with time-intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables. RESULTS: Ninety-nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels. CONCLUSIONS: Contrast-enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.     

Intravascular contrast agent in the ultrasonography of ectopic pregnancy.

OBJECTIVES: The aim of this study was to characterize the effect of an intravascular ultrasound contrast agent in the adnexal circulation and to evaluate the applicability of the contrast agent in imaging ectopic trophoblastic blood flow. DESIGN: Thirty-three color Doppler and 13 power Doppler examinations were performed among 30 patients with ectopic pregnancy, first without and then with galactose-based contrast agent enhancement. The effect of the contrast agent was evaluated both visually (color Doppler) and with computerized power Doppler signal intensity measurements. RESULTS: The Doppler signal intensity from the adnexal blood circulation increased within 30 s after antebrachial injection, yielding an effect that was recognizable up to 2-4 min later. There was a clear enhancement of trophoblastic flow after addition of the contrast agent in all except one of the ectopic pregnancies. In 12% of the cases, trophoblastic flow could be imaged only by using the contrast agent. The contrast agent increased the amount of recognizable vascular areas around the trophoblastic mass in 91% of the examinations, resulting in a more complete peritrophoblastic ring. The increase in the mean intensity of the power Doppler signal was 7.8% (p < 0.01). CONCLUSIONS: The intravascular ultrasound contrast agent has a recognizable effect on Doppler ultrasonographic examination of the adnexal circulation. It appears to be of help when examining ectopic pregnancies where the finding in color flow imaging is ambiguous. The use of a contrast agent may also facilitate localization of trophoblastic tissue in a hemorrhagic adnexal mass.     

实时三维超声结合三维能量多普勒显像对卵巢小肿块的诊断价值

目的 探讨实时三维超声结合三维能量多普勒显像(three-dimensional power Doppler ultrasound,3DPD)对卵巢小肿块的诊断价值.方法 107例卵巢小肿块患者进行实时三维超声及3DPD检查.分析声像图表现及其与良恶性的关系.结果 实时三维超声结合3DPD显示肿块包膜、内壁及内部有无血流等3项指标良恶性间比较差异有统计学意义(P＜0.05).二者结合诊断的敏感性和特异性分别为92.9%和97.3%.结论 实时三维超声结合3DPD对卵巢小肿块的良恶性诊断有一定价值,显示卵巢小肿块包膜不完整、内壁有颗粒状或乳头状突起及内部有血流时提示为恶性.     

经阴道超声造影诊断附件肿块的价值

目的 探讨经阴道超声造影技术在附件肿块诊断中的应用价值.方法 对30例附件包块(良性21例,恶性9例)患者行二维超声及超声造影匹配成像检查,并与术后病理对照,总结其声像图表现.结果 超声造影增强可区分实质部分与囊性部分;良性肿瘤内微血管不丰富,仅囊壁可见血管;而恶性肿瘤微血管极丰富,且血管形态异常,可见粗大不规则的肿瘤血管.造影剂在部分恶性肿瘤具有特征性的动态增强与消退过程.结论 经阴道超声造影有助于提高对附件包块的良、恶性病变鉴别诊断能力.     

Early ovarian cancer: 3-D power Doppler

Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with “positive” findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.     

经静脉声学造影剂增强乳腺肿块彩色血流信号的初步研究

本文探讨经静脉声学造影剂对乳腺肿块彩色血流信号的增强作用及鉴别良恶性病变的应用价值。１０例患者中７例为乳腺癌，３例为良性肿块，经静脉注射声学造影剂后，病灶区彩色血流信号显著增强：６例乳腺癌和１例良性肿块病灶内见有片状彩色血流区，血管数增多２～６条；１例直径＜１．０ｃｍ的乳腺癌见有１条彩色血流束；２例良性肿块中１例无彩色信号而另１例仅有１条血管。结果提示：经静脉声学造影剂能显著增强乳腺肿块彩色多普勒血流信号，更准确地反映肿块血供状况；有助于准确鉴别乳腺良、恶性病变。     

经阴道彩色多普勒能量显像在卵巢小肿块诊断的应用

目的 探讨经阴道彩色多普勒能量显像(TV-CDE)在卵巢小肿块(直径≤3cm)诊断的应用。方法 105例由TV-CDE诊断的卵巢小肿块患者，其中包括67例非赘生性肿块(长期随访证实)，38例赘生性肿块(经手术病理证实，良性肿瘤31例，恶性肿瘤7例)。结果 卵巢非赘生性小肿块及良性小肿瘤以周边血流或隔上血流为主，呈条状或星点状；卵巢恶性小肿瘤以实质或乳头上血流为主，呈网状或树枝状。结论 TV-CDE能完整、清晰地显示卵巢恶性小肿瘤的内部血管树(网)，为卵巢小肿块良恶性鉴别诊断提供了新的途径。     

The role of CnTI-SonoVue in the diagnosis of ovarian masses with papillary projections: a preliminary study.

OBJECTIVES: To describe sonographically the distribution patterns of a second-generation contrast agent in the microcirculation of unilocular and multilocular ovarian masses with papillary projections, and to investigate whether qualitative evaluation of the passage of the contrast agent can improve the performance of sonography in distinguishing between benign and malignant masses with papillary projections. METHODS: Thirty-three patients with unilocular or multilocular ovarian masses with papillary projections were enrolled into the study in three clinical centers. The contrast-enhanced transvaginal examination was performed using 'Contrast Tuned Imaging' (CnTI) technology and SonoVue ultrasound contrast agent. RESULTS: Twenty-four (73%) lesions were benign, eight (24%) were borderline ovarian tumors, and one patient presented with an endometrioid ovarian adenocarcinoma. On color and power Doppler examinations the presence of vessels was demonstrated in 17 papillary projections, while on CnTI-SonoVue examination, the presence of vessels was shown in these 17 and in six additional cases. In all cases with absent papillary perfusion after SonoVue intravenous injection, the cyst wall appeared unequivocally regular. The sensitivity and specificity of conventional color Doppler examination with regard to malignancy were 100% and 67% and the positive and negative likelihood ratios were 3.03 and 0.16, respectively. For the contrast-enhanced examination the corresponding values were 100%, 42%, 1.7 and 0.26. The difference in specificity was statistically significant (P<0.05) because 14 cases, in which papillary perfusion was detected after SonoVue injection, proved to be benign on pathological examination. CONCLUSION: Qualitative evaluation of blood circulation in papillary projections using CnTI-SonoVue examination does not improve the discrimination of benign from borderline/malignant ovarian masses with papillary projections.     

Three-dimensional power Doppler vascular sampling: a new method for predicting ovarian cancer in vascularized complex adnexal masses.

OBJECTIVE: The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses. METHODS: Forty-five women (mean age, 52.3 years; range, 17-82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS: Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162). CONCLUSIONS: Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.     

三维能量多普勒超声定量研究卵巢肿物血管的价值

目的应用阴式三维能量多普勒超声定量测量卵巢肿物内血管参数并评价其对鉴别卵巢肿物良恶性的价值。 方法使用三维能量多普勒超声对44例术前诊断卵巢肿物的患者及20例正常卵巢的育龄妇女进行检查并测量相应的血管参数：血管形成指数（VI）、血流指数（FI）、血管形成一血流指数（VFI）。比较卵巢良性肿物组（23例）、恶性肿物组（21例）和正常卵巢对照组（20例）血管参数值的差异及其与肿物血管分型的关系。 结果卵巢恶性肿物组的VI、FIVFI值均明显高于良性肿物组和正常卵巢对照组。良性肿物组的VI值亦高于正常卵巢对照组。 结论三维能量多普勒超声定量测量卵巢肿物血管参数可为鉴别卵巢肿物良恶性及卵巢恶性肿物的早期诊断提供有价值的信息。     

Contribution of morphological assessment of the vessel tree by three-dimensional ultrasound to a correct diagnosis of malignancy in ovarian masses.

OBJECTIVE: To determine whether subjective evaluation of the morphology of the vessel tree of ovarian tumors, as depicted by three-dimensional (3D) power Doppler ultrasound, can discriminate between benign and malignant ovarian tumors, and whether it improves characterization compared with using gray-scale ultrasound imaging alone. METHODS: A consecutive series of 104 women scheduled for surgical removal of an ovarian mass were examined with transvaginal two-dimensional (2D) gray-scale and 3D power Doppler ultrasound. Predetermined vessel characteristics, e.g. density of vessels, branching, caliber changes and tortuosity, were evaluated in 360 degrees rotating 3D images of the vessel tree of the tumor. Ultrasound results were compared with those of the histology of the surgical specimens. Univariate and multivariate logistic regression were used. RESULTS: There were 77 benign tumors, six borderline tumors and 21 invasive malignancies. All vascular features differed significantly between benign and malignant tumors. The areas under their receiver-operating characteristics (ROC) curves (AUCs) were in the range 0.61-0.83. The AUC of a logistic regression model containing three gray-scale ultrasound variables was 0.98. This model correctly classified all malignancies, with a false-positive rate of 10% (8/77). Adding branching of vessels in the whole tumor to the gray-scale model yielded an AUC of 0.99 and resulted in all malignancies and an additional four benign tumors being correctly classified. CONCLUSIONS: Subjective evaluation of the morphology of the vessel tree, as depicted by 3D power Doppler ultrasound, can be used to discriminate between benign and malignant ovarian tumors, but adds little to gray-scale ultrasound imaging in an ordinary population of tumors.     

超声造影定量分析鉴别诊断卵巢良恶性肿瘤

目的 探讨CEUS在鉴别诊断卵巢良恶性肿瘤中的应用价值。 方法 纳入因卵巢肿瘤接受手术的患者48例,共51个肿块,于术前1周内行经腹CEUS检查,动态观察肿瘤的造影增强模式,绘制肿瘤ROI时间-强度曲线并获得峰值强度(I_max)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)及曲线下面积(AUC);比较良恶性肿瘤间各参数差异。 结果 51个肿块中,良性肿瘤24个,恶性肿瘤27个;CEUS中良性肿瘤呈均匀增强,恶性肿瘤呈不均匀增强;恶性肿瘤造影剂I_max、AUC和mTT均大于良性肿瘤(P均<0.05), 而RT和TTP二者间差异无统计学意义(P均>0.05)。 结论 CEUS可准确评价肿瘤内血流灌注特点,在鉴别诊断卵巢良恶性肿瘤中有重要应用价值。     

Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis.

OBJECTIVE: To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS: Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS: Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS: A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.     

Contrast-enhanced transvaginal sonography of benign versus malignant ovarian masses: preliminary findings.

OBJECTIVE: The aim of this prospective study was to evaluate differences in contrast enhancement and contrast enhancement kinetics in benign versus malignant ovarian masses with pulse inversion harmonic transvaginal sonography. METHODS: Seventeen consecutive patients with 23 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic transvaginal sonography. The following parameters were assessed in all tumors: detectable contrast enhancement, time to peak enhancement (wash-in), peak contrast enhancement, half wash-out time, and area under the enhancement curve. Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. RESULTS: Fourteen benign masses and 9 malignancies were studied. There was a statistically significant difference in the peak enhancement (mean +/- SD, 23.3 +/- 2.8 versus 12.3 +/- 3.9 dB; P < .01), half wash-out time (139.9 +/- 43.6 versus 46.3 +/- 19.7 seconds; P < .01), and area under the enhancement curve (2012.9 +/- 532.9 versus 523.9 +/- 318 seconds(-1); P < .01) in malignant masses compared with benign disease. There was no statistically significant difference in the time to peak enhancement (26.1 +/- 6.3 versus 24.9 +/- 7.6 seconds; P = .07). CONCLUSIONS: Overall, our data showed a significant difference in the contrast enhancement kinetic parameters between benign and malignant ovarian masses.     

The use of contrasted transvaginal sonography in the diagnosis of gynecologic diseases: a preliminary study.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a new contrast-dedicated ultrasound technology, contrast-tuned imaging (CnTI), implemented on an endovaginal probe and using the second-generation contrast agent SonoVue (Bracco International BV, Amsterdam, the Netherlands), compared with the standard ultrasound examination in different gynecologic diseases. METHODS: Eighty-nine patients were enrolled in the study in 4 different clinical centers. The study included 40 patients with uncertain pelvic adnexal masses, 10 patients with pelvic masses indicative of recurrences of gynecologic tumors, 26 patients with uterine pathologic features, and 13 patients with cervical lesions. RESULTS: Application of CnTI technology after the SonoVue injection gave a picture of the intralesional microvascularization dramatically different from that obtained during color Doppler examination. Of the 40 pelvic masses, 15 (37.5%) were considered benign and 25 (62.5%) were considered malignant at B-mode and color Doppler examinations. Contrast-enhanced sonography showed no intralesional contrast perfusion in 11 (73%) of 15 cases, and all these were benign at final diagnosis. Of the 4 (27%) cases that had perfusion, 2 were malignant. Conversely, of the 25 cases with positive findings at color Doppler examination and therefore expected to show the appearance of contrast tissue-filling morphologic characteristics, 13 (52%) were malignant at final diagnosis. For evaluation of uterine pathologic features, the CnTI-SonoVue technology did not appear to be superior to the B-mode and color Doppler examinations; however, for the evaluation of cervical cancer, CnTI-SonoVue technology revealed a better definition of the margins of the neoplastic lesions in 4 (40%) of 10 cases. CONCLUSIONS: In the evaluation of uncertain pelvic masses, the CnTI technology led to an improvement in the ability of the practitioner to differentiate benign from malignant adnexal lesions.     

乳腺肿块的能量多普勒血流定量与病理微血管定量相关性研究

目的　研究超声造影及能量多普勒技术测定乳腺肿瘤的彩色象素密度与病理微血管密度的相关性。方法　应用超声造影和能量多普勒技术观察 5 1例乳腺肿块血流信号 (2 8例良性 ,2 3例恶性 ) ,计算机辅助测量肿瘤血流的彩色象素密度 ,对手术标本进行抗CD3 4因子免疫组化染色测量肿瘤微血管密度。结果　彩色象素密度及微血管密度值均表现为同样梯度 ,即恶性组 >良性组 >对照组 (10例远离肿块的周围乳腺组织 )。恶性组中腋下淋巴结转移组的彩色象素密度及微血管面密度均高于无腋下淋巴结转移组 (P <0 .0 5 )。能量多普勒测定的彩色象素密度与病理微血管面密度有较好的相关性 (r =0 .84,P<0 .0 0 1)。结论　能量多普勒血流定量测值与肿瘤微血管密度测值相关性较好 ,能量多普勒超声造影对乳腺肿瘤的鉴别诊断及乳癌预后的评估有帮助     

Complex adnexal mass in pregnancy: predictive value of color Doppler sonography.

We sought to establish color Doppler sonographic criteria specific to benign and malignant neoplasms in pregnant patients for parameters already reported for complex adnexal masses in nongravid patients. Thirty-four patients with complex adnexal masses were evaluated during the second trimester with transabdominal sonography and transvaginal color Doppler sonography. The lowest pulsatility index obtained was chosen to be indicative of histologic type. A pulsatility index of less than 1.0 in a morphologically suspect area was taken to be suggestive of malignancy. Prospective diagnoses made by color Doppler sonography were compared with actual histologic diagnosis. Three malignant ovarian lesions and five tumors of low malignant potential were identified correctly, with a sensitivity of 0.89 and a mean pulsatility index of 0.71 (range, 0.44 to 1.3). The mean pulsatility index for benign masses was 1.21 (range, 0.4 to 2.8) (P = 0.03). The negative predictive value of a pulsatility index greater than 1.0 was 0.93. The positive predictive value and false-positive rate for a pulsatility index less than 1.0, however, were 0.42 and 0.48, respectively. Low impedance was associated with malignant ovarian masses detected during pregnancy. A considerable overlap in blood flow patterns, however, may cause incorrect assignment of malignant potential to some benign lesions.     

Use of Doppler ultrasound in the evaluation of breast carcinoma.

Ultrasound is an imaging modality commonly used to evaluate breast lesions in hopes to distinguish benign from malignant solid masses. Angiogenesis, defined as the emergence of new vessels to further the growth of tumor, has stimulated interest in the potential uses of Doppler ultrasound in patients with breast cancer. This article describes different forms of Doppler ultrasound, including color Doppler (CD), power Doppler (PD), and spectral Doppler (SD), as well as 3-dimensional (3D) ultrasound and ultrasound contrast media. We review the role of Doppler ultrasound in distinguishing benign from malignant solid breast masses. We also discuss the role of ultrasound in predicting tumor grade, histology, node status, and lymphatic vascular invasion, and in monitoring breast cancer treatment.     

卵巢Brenner瘤15例超声表现分析

目的：探讨超声在卵巢Brenner瘤中的诊断价值 方法：回顾性分析2014年1月至2018年11月期间武汉大学人民医院妇产科诊断为卵巢Brenner瘤的15例病例,分析其超声表现及彩色多普勒血流特点。 结果：15例卵巢Brenner瘤患者中,良性12例,恶性1例,交界性2例。12例良性者,表现为实性者5例,其中4例肿瘤内可见强回声钙化,后伴声影,1例肿瘤内未见钙化,表现为囊性者2例,内均未见钙化,1例良性者合并粘液性囊腺瘤,肿瘤呈囊性,未见钙化,余4例超声检查未见病灶,仅在显微镜下发现Brenner瘤病灶。2例交界性者,1例表现为囊性,未见钙化,1例表现为囊实性,可见钙化。1例恶性者表现为囊实性,内可钙化。彩色多普勒显示良性、交界性、恶性卵巢Brenner瘤内均表现为无血流或少许血流信号,三者间无明显差异。 结论：卵巢Brenner瘤可表现为实性、囊性或囊实性包块,良性者多表现为实性,恶性者多表现为囊实性,交界性者可表现为囊性或囊实性,混合其他肿瘤者声像图表现更加复杂。无论良性、交界性、恶性,肿瘤内均可出现钙化,彩色多普勒对三者之间的鉴别意义有限。