Sonographic Features of Ovarian Tumors

Study Notes

Solid Tumors

Mixed solid to cystic ovarian masses are typical of all epithelial ovarian tumors
Identifying connection with uterus helps differentiate ovarian lesion from pedunculated fibroid
Color Doppler is useful in identifying vascular pedicles between uterus and mass

Differential Considerations

Pedunculated fibroid
Dermoid
Fibroma
Thecoma
Granulosa cell tumor
Brenner tumor
Metastasis

Statistics

During peak fertile years, only 1 in 15 malignant; ratio becomes 1 in 3 after age 40
¼ bilateral; most occur in women >40
Large and often filled pelvic cavity
Ovary with volume twice that of the opposite side is generally considered abnormal
More sonographically complex the tumor, more likely to be malignant, especially if associated with ascites

Common Solid Masses

Solid teratoma
Adenocarcinoma
Fibroma
Dysgerminoma
Torsion

Doppler of the Ovary

Color Doppler is helpful in differentiating potential cyst from adjacent vascular structures
Pulsed Doppler interrogation of adnexal branch of uterine artery, ovarian artery, and intratumoral flow determine resistive index or pulsatility index
Abnormal waveforms seen in inflammatory masses, metabolically active masses, and corpus luteum cysts

Resistive Index (RI) and Pulsatility Index (PI)

RI is not a sensitive indicator of malignancy
PI is calculated as peak-systolic velocity minus end-diastolic velocity divided by mean velocity
RI is peak-systolic velocity minus end-diastolic velocity divided by peak-systolic velocity
Increased diastolic flow suggests neovascularity and likelihood of malignancy
Cut-off value for PI is 1.0 and value of RI is 0.4
Malignancy considered more likely below these values
Benign disease is more likely above these values

Benign and Malignant Masses

Mass showing complete absence or minimal diastolic flow usually benign
Diastolic notch in early diastole may also be a sign of benign disease
PI and RI values may vary considerably in fertile patients during menstrual cycle

Benign Adnexal Cysts

Functional ovarian cysts
Corpus luteum cysts
Hemorrhagic cysts
Theca-lutein cysts

Functional Cysts

Result from normal function of ovary
Most common cause of ovarian enlargement in young women
Hormonal therapy sometimes administered to suppress cysts
Most cysts measure

Description

This quiz covers the sonographic appearance of ovarian tumors, including their differential diagnosis from other adnexal masses. It highlights the importance of identifying connections with the uterus and using color Doppler to identify vascular pedicles.