Endometriomas: diagnostic performance of US.
OBJECTIVE
To determine the diagnostic performance of specific ultrasonographic (US) features in discriminating endometriomas from other adnexal masses.


METHODS
Two sonologists independently reviewed the sonograms of 252 adnexal masses in 226 women and recorded US features by using a standardized checklist. The diagnostic performance of specific US features and overall reviewer impression in discriminating endometriomas from other adnexal masses were evaluated.


RESULTS
There were 40 endometriomas. Diffuse low-level internal echoes were present in 38 (95%) endometriomas and 40 (19%) nonendometriomas (positive likelihood ratio, 5). The positive likelihood ratio for the diagnosis of endometrioma increased to 8 if masses with neoplastic features at gray-scale US were excluded, allowing identification of 30 endometriomas (75%). The presence of multilocularity or hyperechoic wall foci further increased the positive likelihood ratio to 48, allowing the identification of 18 endometriomas (45%).


CONCLUSIONS
An adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present. A patient with a mass with diffuse low-level internal echoes and other US features may benefit from additional imaging.
Patel
M D
MD
Department of Radiology, University of California, San Francisco, USA.
Feldstein
V A
VA
Chen
D C
DC
Lipson
S D
SD
Filly
R A
RA
D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D015331:Cohort Studies; D003560:Cysts / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging; D006801:Humans; D016013:Likelihood Functions; D010048:Ovarian Cysts / Q000000981:diagnostic imaging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013724:Teratoma / Q000000981:diagnostic imaging; D014463:Ultrasonography