THE ROLE OF TRANSVAGINAL ULTRASONOGRAPHY COMBINED WITH COLOR VELOCITYIMAGING AND PULSED DOPPLER IN THE DIAGNOSIS OF ENDOMETRIOMA

Objective: To assess the diagnostic accuracy of transvaginal ultrasono graphy alone and combined with color velocity imaging and pulsed Doppl er in differentiating ovarian endometriomas from other nonendometrioti c masses. Design: Prospective study with pathological confirmation of sonographic diagnosis. Setting: Department of Obstetrics and Gynecolog y at a university hospital. Patient(s): A series of 78 consecutive pat ients diagnosed as having an adnexal mass and scheduled for surgery, b etween January 1995 and March 1996. Intervention(s): Transvaginal ultr asonography and color velocity imaging and pulsed Doppler was performe d before surgery in all patients. A total of 82 masses were diagnosed (four patients had bilateral masses). CA-125 plasma levels were measur ed in all patients. Ultrasound diagnosis was compared with definitive histopathological diagnosis. Main Outcome Measure(s): The presence of a round-shaped homogeneous cyst with low-level echoes was considered a s sonographic diagnosis of ovarian endometrioma. The typical vascular pattern from endometrioma was considered as ''pericystic flow at the l evel of the ovarian hilius.'' The sensitivity, specificity, and positi ve and negative predictive values were calculated for transvaginal ult rasonography alone and combined with color velocity imaging and pulsed Doppler. Result(s): Twenty seven (32.9%) of the 82 masses were proven to be ovarian endometriomas. Morphological assessment diagnosed corre ctly 24 (88.9%) of 27 endometriomas (false-positive rate: 9%). Typical flow pattern was present in 90.5% of endometriomas (false-positive ra te: 80%). CA-125 levels in patients with endometrioma (45.6 +/- 6.3 U/ mL; mean +/- SEM) were significantly higher than in patients with none ndometriotic masses (26.5 +/- 5.5 U/mL). The sensitivity, specificity, and positive and negative predictive values of transvaginal ultrasono graphy alone and combined with color velocity imaging and pulsed Doppl er were 88.9%, 91%, 84.2%, and 94.5%, and 76.2%, 88.9%, 82.4%, and 82. 4%, respectively. For CA-125 levels, using a cutoff greater than or eq ual to 35 U/mL, these figures were 79.3%, 84.6%, 79.3%, and 84.6%, res pectively. Conclusion(s): The use of color velocity imaging and pulsed Doppler does not improve the diagnostic accuracy of transvaginal ultr asonography alone in the diagnosis of ovarian endometrioma.