title: Value of three-dimensional contrast-enhanced power Doppler ultrasound for characterizing adnexal masses.
abstract: OBJECTIVE
  The aim of this study was to assess the diagnostic performance of 3-D contrast-enhanced power Doppler ultrasonography (3-D CEPDUS) for differentiating benign and malignant adnexal masses.
  
  
  METHODS
  Consecutive patients with adnexal masses were included prospectively and underwent 2-D ultrasonography and 3-D CEPDUS in a tertiary centre in Paris, France. The main outcome measure was the diagnostic accuracy of 3-D CEPDUS to diagnose malignant and borderline adnexal masses. The reference standard was the final histological examination. Two-dimensional ultrasonography and 3-D CEPDUS were compared using semiquantitative scores. Three-dimensional CEPDUS assessed vessel density, vessel pattern, and three vascular indexes in a 5-mL region of interest (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]). The 2-D and 3-D examinations were done by different sonographers who were blinded to the other test. The pathologist was blinded to ultrasonography findings.
  
  
  RESULTS
  Of 99 patients, 88 had benign tumors and were compared to the 11 patients with borderline (n = 5) or malignant (n = 6) tumors. The sensitivity of the subjective 2-D score was 55% (95% confidence interval [CI], 25-84) and specificity 94% (95%CI, 89-99). The sensitivity of the subjective 3-D score was 82% (95%CI, 58-100) and specificity 90% (95%CI, 83-96). Improvement of detection of malignant or borderline tumors by subjective 3-D score was 150%. Vessel density and patterns were not more efficient than the subjective 3-D score. The mean vascular index values were significantly different between benign and borderline/malignant groups: VI, 7.2 versus 35.5 (P < 0.0001); FI, 37.0 versus 48.2 (P = 0.003); and VFI, 2.9 versus 17.6 (P < 0.0001), respectively.
  
  
  CONCLUSIONS
  3-D CEPDUS improves detection of malignant and borderline adnexal masses.
authors.affiliation: Department of Gynecological and Oncological Surgery, European Hospital Georges Pompidou, AP-HP, Paris, France. cyrille.huchon@egp.aphp.fr
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.forename: Ulrike
authors.initials: U
authors.lastname: Metzger
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bats
authors.forename: Cherazade
authors.initials: C
authors.lastname: Bensaid
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Lefrère-Belda
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dujardin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bernard
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lécuru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*