title: A critical analysis of Doppler velocimetry in the differential diagnosis of malignant and benign ovarian masses.
abstract: OBJECTIVE
  To evaluate the intratumoral reliability of color Doppler parameters and the contribution of Doppler sonography to the gray-scale differential diagnosis of ovarian masses.
  
  
  METHODS
  An observational study was performed including 67 patients, 15 (22.4%) with malignant ovarian neoplasm and 52 (77.6%) with benign ovarian diseases. We performed the Doppler evaluation in two distinct vessels selected after decreasing the Doppler gain to sample only vessels with higher velocity flow. Doppler measurements were obtained from each identified vessel, and resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured. Intraclass coefficient of correlation (ICC), sensitivity, specificity, and potential improvement in gray-scale ultrasound performance were calculated.
  
  
  RESULTS
  The general ICC were 0.60 (95% CI 0.42-0.73) for RI, 0.65 (95% CI 0.49-0.77) for PI, 0.07 (95% CI -0.17-0.30) for PSV, and 0.19 (95% CI -0.05-0.41) for EDV. The sensitivity and specificity were respectively 84.6% and 86.7% for RI, 69.2% and 93.3% for PI, 80.0% and 65.4% for gray-scale sonography, and 93.3% and 65.4% for gray-scale plus RI (p = 0.013).
  
  
  CONCLUSIONS
  Gynecologists must be careful in interpreting results from Doppler evaluation of ovarian masses because PSV and EDV present poor intratumoral reliability. The lower RI value, evaluated in at least two distinct sites of the tumor, was able to improve the performance of gray-scale ultrasound in differential diagnosis of ovarian masses.
authors.affiliation: Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil.
authors.forename: Ana Carolina da Silva
authors.initials: AC
authors.lastname: Marchesini
authors.forename: Francisco Antônio Akinaga
authors.initials: FA
authors.lastname: Magrio
authors.forename: Aderson Tadeu
authors.initials: AT
authors.lastname: Berezowski
authors.forename: Omero Benedicto Poli
authors.initials: OB
authors.lastname: Neto
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Nogueira
authors.forename: Francisco Jose
authors.initials: FJ
authors.lastname: Candido dos Reis
mesh_terms: D001783:Blood Flow Velocity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D010049:Ovarian Diseases / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging; D010053:Ovary / Q000098:blood supply*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography