DIAGNOSIS OF ADNEXAL MALIGNANCIES BY USING COLOR DOPPLER ENERGY IMAGING AS A SECONDARY TEST IN PERSISTENT MASSES

The purpose of this prospective study was to compare the accuracy of B -mode transvaginal ultrasonography alone and in combination with color Doppler energy (or power Doppler) imaging in differentiating benign f rom malignant adnexal masses. A total of 192 consecutive persistent ad nexal masses (159 benign, 33 malignant) were studied before surgery by B-mode transvaginal ultrasonography with and without color Doppler en ergy. In addition, CA-125 plasma levels were determined and spectral D oppler analysis was performed. By color Doppler energy imaging, a mass was considered malignant when arterial flow was visualized in an echo genic portion of a mass defined as malignant by B-mode. Intratumoral a rterial blood flow could be readily detected by color Doppler energy i maging in all malignant tumors and in 94% of the benign tumors. The co mbined use of transvaginal B-mode ultrasonography and color Doppler en ergy imaging has greater accuracy in the diagnosis of ovarian malignan cies than transvaginal ultrasonography alone (value of kappa: 0.81 and 0.63, respectively), reducing the number of false-positive results. T he use of spectral Doppler analysis was of limited diagnostic value, w ith a Kappa value of 0.17 for the pulsatility index (< 1) and of 0.41 for the resistance index (< 0.4). Also, the association with CA-125 in creased the number of false-negative results. In conclusion, the use o f color Doppler energy imaging seems to be a useful secondary test whe n a mass is suspected to be malignant by B-mode ultrasonography.