TRANSABDOMINAL COLOR DOPPLER ULTRASONOGRAPHY OF THE PAINFUL ADOLESCENT OVARY

The objective of this study was to determine if color flow Doppler ult rasonography based on patterns of perfusion can aid in providing a spe cific diagnosis of ovarian masses associated with pelvic pain. Color f low Doppler images of 42 ovarian lesions in 42 adolescent girls (age r ange, 10 to 17 years) were analyzed prospectively. The color flow patt erns were classified into three main categories: lesions with no vascu larity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, sev en simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ova rian torsions. A peripheral pattern of flow was observed in 29 of 34 ( 85%) cystic lesions, including 18 hemorrhagic and six simple cysts, th ree cystadenomas and two abscesses. Peripheral flow was also identifie d in four enlarged ovaries, two with inflammatory disease and two with torsion. Internal flow was noted in five patients with enlarged ovari es due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovari an flow was identified in 90% of normal ovaries. Resistive indices, ob tained in 33 abnormal ovaries, were higher in cystic lesions than in i nflammatory lesions, although the values overlapped. Our findings show ed that internal ovarian flow can be found in inflammatory processes a nd 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 ado lescent girls.