Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography

Objective. To study a spectrum of systems (two-dimensional transvaginal, tr ansvaginal color Doppler, three-dimensional, three-dimensional power Dopple r, and contrast-enhanced three-dimensional power Doppler sonography) for pr eoperative evaluation of pelvic tumors. Methods. Two hundred ninety-two pat ients were evaluated by the 5 complementary methods in preoperative sonogra phic assessments. We examined adnexal and endometrial morphology, thickness , and volume by two- and three-dimensional sonography and analyzed blood fl ow by transvaginal color, pulsed Doppler, and three-dimensional power Doppl er sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. Results. Morphologic assessment by three -dimensional sonography yielded additional information in 58% of cases comp ared with two-dimensional sonography. Furthermore, this modality was superi or to two-dimensional sonography in accurate depiction and diagnosis of 2 c ases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in p atients with malignant disease was significantly different (28.2 +/- 0.02 c m(3)) from that in those who had hyperplasia (7.81 +/- 0.03 cm(3)), polyps (3.5 +/- 0.02 cm(3)), or normal endometria (0.8 +/- 0.02 cm(3)). With combi ned morphologic and three-dimensional power Doppler examination of endometr ial lesions, sensitivity and specificity reached 89% and 97%, respectively. Conclusions. Combined morphologic and vascular imaging improves preoperati ve assessment of gynecologic tumors.