shu-508 and Adnexal-Diseases

The echo-enhancing effect of an ultrasound contrast medium (Levovist) in color Doppler sonography of small vessels in ovarian tumors was studied in a group of 30 women. The vascularity of adnexal masses with a suspicion of primary carcinoma in 3 and benign lesions in 27 cases was investigated before and after injection of 300 mg/ml of Levovist. In 17 cases color flow mapping showed increased vascularity either in the cystic wall or in solid structures within the tumor. In all patients we observed enhancement of Doppler signal intensity. Our results show that Levovist facilitates waveform analysis in very small vessels with poor velocity patterns.

Topics: Adnexal Diseases; Adult; Aged; Female; Humans; Injections, Intravenous; Middle Aged; Ovarian Cysts; Polysaccharides; Regional Blood Flow; Ultrasonography, Doppler, Color

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.. 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.. 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.. 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.

Topics: Adnexal Diseases; Adult; Aged; Area Under Curve; CA-125 Antigen; Contrast Media; Female; Humans; Image Enhancement; Image Processing, Computer-Assisted; Middle Aged; Ovarian Neoplasms; Polysaccharides; ROC Curve; Ultrasonography, Doppler

To evaluate the effects of a microbubble contrast agent on the power Doppler ultrasonographic (US) examination of adnexal tumors, with a special focus on the timing of the transit of the microbubble bolus.. Seventy patients who were suspected of having ovarian tumors were examined preoperatively with contrast material-enhanced US. Images obtained during a 5-minute examination were stored digitally, and the behavior of the contrast agent was evaluated objectively with measurement of the time-dependent image intensity at the region of interest with a computer program. A time-intensity curve in each case was derived and analyzed. The Mann-Whitney U test was used to compare intensity changes and tumor parameters in benign and malignant adnexal tumors.. Both the baseline and maximum power Doppler intensities, as well as the absolute and relative (percent) rise in intensity, were significantly higher (P <.001) in malignant as compared with benign tumors. The arrival time was shorter (17.5 vs 22.5 seconds; P =.005) and the duration of contrast agent effect was longer (190.4 vs 103.6 seconds; P <.001) in malignant tumors than they were in benign tumors. The area under the time-intensity curve was significantly greater in malignant tumors compared with that in benign tumors (P <.001).. After microbubble contrast agent injection, malignant and benign adnexal lesions behave differently in degree, onset, and duration of Doppler US enhancement.

Topics: Adnexal Diseases; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Female; Humans; Microspheres; Middle Aged; Ovarian Neoplasms; Polysaccharides; Predictive Value of Tests; Sensitivity and Specificity; Statistics, Nonparametric; Ultrasonography, Doppler

Our objective was to characterize the properties of an intravascular ultrasonographic contrast agent in examination of adnexal masses and to compare contrast agent properties between benign and malignant adnexal tumors. Fifty-eight consecutively examined women with suspected ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist). Fourteen women had ovarian cancer, 3 had borderline ovarian tumors, 18 had benign ovarian neoplasms, and 23 had functional adnexal cystic masses or endometriomas. The effect of the contrast agent was evaluated visually and by using computerized power Doppler signal intensity measurements. In visual evaluation, the brightness of the power Doppler signal and the amount of recognizable vascular areas increased in each tumor after contrast agent administration. The number of vessels in power Doppler ultrasonograms, both before and after contrast agent enhancement, was significantly higher in malignant than in benign adnexal masses, as also was the increase in the number of recognizable vessels after contrast agent administration. Contrast agent uptake time was significantly shorter in malignant than in benign tumors. No significant differences were found in the power Doppler signal intensities or their changes between benign and malignant tumors. In conclusion, use of sonographic contrast agent facilitates imaging of tumor vessels. For differentiation of benign and malignant tumors, the kinetic properties of the contrast agent, such as uptake and washout times, may have more potential than the use of the contrast agent in anatomic imaging of the tumor vessels.

Topics: Abscess; Adenofibroma; Adnexal Diseases; Adult; Aged; Aged, 80 and over; Contrast Media; Cystadenoma; Dermoid Cyst; Endometriosis; Fallopian Tube Diseases; Female; Humans; Image Enhancement; Middle Aged; Ovarian Cysts; Ovarian Diseases; Ovarian Neoplasms; Polysaccharides; Ultrasonography, Doppler