Efficacy of Intra-Cystic Methotrexate Injection in Management of Benign Persistent Ovarian Cysts
OBJECTIVE The aim of this study was to determine whether three-dimensional power Doppler can improve the ability to differentiate benign from malignant ovarian masses. METHODS Transvaginal color Doppler and three-dimensional power Doppler were performed on 120 patients with ovarian lesions. All patients underwent both ultrasound examinations during the day prior to laparotomy or laparoscopy. Scoring systems combining morphological and Doppler parameters were adopted for two- and three-dimensional ultrasound examinations. RESULTS In each of 11 ovarian malignancies, preoperative diagnosis by three-dimensional power Doppler was confirmed by histopathology. Transvaginal color Doppler missed 1 case of serous cystadenocarcinoma, while 3 benign lesions were considered false positive. In 1 case of cystadenofibroma both transvaginal color Doppler and three-dimensional power Doppler were falsely positive. Qualitative analysis of the tumor vascularity architecture added to morphological parameters had a sensitivity and specificity of 100 and 99.08%, respectively. CONCLUSIONS Better results achieved by three-dimensional ultrasound can be explained by improved recognition of the ovarian mass anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three-dimensional power Doppler imaging can detect structural abnormalities of malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Three-dimensional power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian masses.