Alcázar Juan Luis, Mercé Luis T, García Manero Manuel
Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
J Ultrasound Med. 2005 May;24(5):689-96. doi: 10.7863/jum.2005.24.5.689.
The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses.
Forty-five women (mean age, 52.3 years; range, 17-82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case.
Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162).
Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.
本研究旨在探讨一种新概念（“血管采样”）作为第三步在鉴别B超和彩色多普勒超声提示的附件包块良恶性病变中的作用。
对45例经B超诊断为复杂附件包块的女性（平均年龄52.3岁；范围17 - 82岁）进行三维能量多普勒超声评估。4例女性有双侧包块。在进行形态学重新评估后，使用彩色脉冲多普勒超声获取血流速度波形，并计算血流速度指标（阻力指数、搏动指数和收缩期峰值速度）。此后，使用三维能量多普勒超声评估高度可疑区域（粗大乳头样突起、实性区域和厚分隔）的血管化情况，即对肿瘤可疑区域进行重点评估（“采样”）。通过虚拟器官计算机辅助分析程序自动计算血管指标（血管化指数、血流指数和血管血流指数）。每例均获得明确的组织学诊断。
40个包块（82%）为恶性，9个（18%）为良性。形态学评估显示10个（20%）单房实性包块，20个（41%）多房实性包块，19个（39%）以实性为主的包块。所有病例均发现血流。恶性肿瘤的血管化指数中位数（15.5%对8.2%；P = 0.002）、血流指数（33.6对20.8；P = 0.007）和血管血流指数（5.2对2.3；P = 0.001）显著更高。阻力指数（0.43对0.45；P = 0.770）、搏动指数（0.62对0.65；P = 0.694）和收缩期峰值速度（15.6对12 cm/s；P = 0.162）未发现差异。
三维能量多普勒血管采样似乎是预测血管化复杂附件包块中卵巢癌的一种有前景的工具。它可能优于传统的彩色脉冲多普勒成像。
