title: Contrast-enhanced sonography helps in discrimination of benign from malignant adnexal masses.
abstract: OBJECTIVE
  To investigate the potential efficacy of real-time contrast-enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study.
  
  
  METHODS
  Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real-time postinjection sequences were computerized with time-intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables.
  
  
  RESULTS
  Ninety-nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels.
  
  
  CONCLUSIONS
  Contrast-enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.
authors.affiliation: Department of Gynecology and Obstetrics, Fetal Medicine, and Human Reproduction, Bretonneau University Hospital, Tours, France. marret@med.univ-tours.fr
authors.forename: Henri
authors.initials: H
authors.lastname: Marret
authors.forename: Stéphane
authors.initials: S
authors.lastname: Sauget
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.forename: Molly
authors.initials: M
authors.lastname: Brewer
authors.forename: James
authors.initials: J
authors.lastname: Ranger-Moore
authors.forename: Gilles
authors.initials: G
authors.lastname: Body
authors.forename: François
authors.initials: F
authors.lastname: Tranquart
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D018394:CA-125 Antigen / Q000097:blood; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D011134:Polysaccharides; D012372:ROC Curve; D018608:Ultrasonography, Doppler
chemical_list: D018394:CA-125 Antigen; D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508