The role of CnTI-SonoVue in the diagnosis of ovarian masses with papillary projections: a preliminary study.
OBJECTIVE
To describe sonographically the distribution patterns of a second-generation contrast agent in the microcirculation of unilocular and multilocular ovarian masses with papillary projections, and to investigate whether qualitative evaluation of the passage of the contrast agent can improve the performance of sonography in distinguishing between benign and malignant masses with papillary projections.


METHODS
Thirty-three patients with unilocular or multilocular ovarian masses with papillary projections were enrolled into the study in three clinical centers. The contrast-enhanced transvaginal examination was performed using 'Contrast Tuned Imaging' (CnTI) technology and SonoVue ultrasound contrast agent.


RESULTS
Twenty-four (73%) lesions were benign, eight (24%) were borderline ovarian tumors, and one patient presented with an endometrioid ovarian adenocarcinoma. On color and power Doppler examinations the presence of vessels was demonstrated in 17 papillary projections, while on CnTI-SonoVue examination, the presence of vessels was shown in these 17 and in six additional cases. In all cases with absent papillary perfusion after SonoVue intravenous injection, the cyst wall appeared unequivocally regular. The sensitivity and specificity of conventional color Doppler examination with regard to malignancy were 100% and 67% and the positive and negative likelihood ratios were 3.03 and 0.16, respectively. For the contrast-enhanced examination the corresponding values were 100%, 42%, 1.7 and 0.26. The difference in specificity was statistically significant (P<0.05) because 14 cases, in which papillary perfusion was detected after SonoVue injection, proved to be benign on pathological examination.


CONCLUSIONS
Qualitative evaluation of blood circulation in papillary projections using CnTI-SonoVue examination does not improve the discrimination of benign from borderline/malignant ovarian masses with papillary projections.
Testa
A C
AC
Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy, and Department of Obstetrics and Gynecology, University Hospital Katholieke Universiteit Leuven, Belgium. atesta@rm.unicatt.it
Timmerman
D
D
Exacoustos
C
C
Fruscella
E
E
Van Holsbeke
C
C
Bokor
D
D
Arduini
D
D
Scambia
G
G
Ferrandina
G
G
D000290:Adnexa Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D045423:Microbubbles; D008833:Microcirculation / Q000000981:diagnostic imaging; D008875:Middle Aged; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D010051:Ovarian Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color / Q000379:methods
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride