title: Limitations of three-dimensional power Doppler angiography in preoperative evaluation of ovarian tumors.
abstract: BACKGROUND
  This study describes the accuracy of three-dimensional power Doppler (3D-PD) angiography as secondary method for differential diagnosis of ovarian tumors.
  
  
  METHODS
  Seventy-five women scheduled for surgical removal of adnexal masses were assessed by transvaginal ultrasound. Ovarian tumors were classified by IOTA simple rules and two three-dimensional blocks were recorded. In a second step analyses, a 4 cm(3) spherical sample was obtained from the highest vascularized solid area of each stored block. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. The repeatability was assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA), and diagnostic accuracy by area under ROC curve.
  
  
  RESULTS
  IOTA simple rules classified 26 cases as benign, nine as inconclusive and 40 as malignant. There were eight false positive and no false negative. Among the masses classified as inconclusive or malignant by IOTA simple rules, the CCCs were 0.91 for VI, 0.70 for FI, and 0.86 for VFI. The areas under ROC curve were 0.82 for VI, 0.67 for FI and 0.81 for VFI.
  
  
  CONCLUSIONS
  3D-PD angiography presented considerable intraobserver variability and low accuracy for identifying false positive results of IOTA simple rules.
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil. lsilvestre@terra.com.br.
authors.forename: Liliane
authors.initials: L
authors.lastname: Silvestre
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil. wpmartins@gmail.com.
authors.forename: Wellington P
authors.initials: WP
authors.lastname: Martins
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, Ribeirao Preto, 14049-900, Brazil. fjcreis@fmrp.usp.br.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Candido-Dos-Reis
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001783:Blood Flow Velocity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D057234:Preoperative Period; D018615:Ultrasonography, Doppler, Color / Q000379:methods*