Value of three-dimensional contrast-enhanced ultrasound in the diagnosis of small adnexal masses.

The main purpose of this study was to determine whether three-dimensional contrast-enhanced ultrasound (3D-CEUS) can provide useful information to distinguish malignant from benign adnexal masses (≤4 cm). Forty-seven patients with 51 adnexal masses were examined with 3D-CEUS. The sonographic features of masses were analyzed. All diagnoses were confirmed by surgical pathology and long-term follow-up results. The 51 masses included 43 benign and 8 malignant lesions. On 3D-CEUS images, benign lesions appeared as round structures formed by sparse and straight capillary vessels. Malignant lesions showed irregular stereo structures with dense and tortuous vascular distribution. A 3D-CEUS scoring system was established. There were no statistically significant differences in scores at each time point between the 20th and 70th seconds, and the area under the receiver operating characteristic curve for this time period was the largest (0.995). A cut-off score of 8 was established, with scores ≥8 being suggestive of malignancy. The 3D-CEUS scoring system had a high sensitivity (100%) and specificity (98%). 3D-CEUS is likely to be the new tool to distinguish malignant from benign small adnexal masses and diagnose early ovarian cancer.