Three dimensional ultrasound and power doppler in assessment of uterine and ovarian angiogenesis: a prospective study.
OBJECTIVE
To determine whether three-dimensional power Doppler can improve the recognition of pelvic tumor morphology and angiogenesis.


METHODS
Using this technique we analyzed 180 adnexal masses and 110 uterine lesions. Tumor volume, morphology, and vascularity were evaluated in each patient. Irregular and randomly dispersed vessels with complex branching depicted by comprehensive three dimensional display were suggestive of pelvic malignancy, while linear-like vascular morphology, single vessel arrangement and regular branching were typical for benign structures.


RESULTS
Addition of qualitative analysis of vascular architecture of adnexal tumor to morphological parameters reached 96.15% sensitivity and 98.73% specificity. When endometrial lesions were prospectively analyzed, sensitivity and specificity were 91.67% and 98.49%, respectively. Because the lowest positive predictive value of 16.67% was obtained for myometrial lesions, this method should not be advised for their eva luation.


CONCLUSIONS
Good results achieved by three dimensional ultrasound can be explained by improved recognition of the pelvic lesion 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 the malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Therefore it enhances and facilitates the morphologic and functional evaluation of both benign and malignant pelvic tumors.
Department of Obstetrics and Gynecology, Zagreb University School of Medicine, Holy Ghost Hospital, Sveti Duh 64, 10000 Zagreb, Croatia. asim.kurjak@public.srce.hr
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D000290:Adnexa Uteri / Q000098:blood supply / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging; D018284:Cystadenocarcinoma, Serous / Q000098:blood supply / Q000000981:diagnostic imaging; D018293:Cystadenoma, Serous / Q000098:blood supply / Q000000981:diagnostic imaging; D003884:Dermoid Cyst / Q000098:blood supply / Q000000981:diagnostic imaging; D004715:Endometriosis / Q000000981:diagnostic imaging; D005260:Female; D005833:Genital Neoplasms, Female / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D007889:Leiomyoma / Q000098:blood supply / Q000000981:diagnostic imaging; D008833:Microcirculation / Q000000981:diagnostic imaging; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D014594:Uterine Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging