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Questions and Answers
What is the cut off value for PI above which benign disease is more likely?
What is the characteristic of a mass that is usually benign?
In which phase of the menstrual cycle are the indices highest?
What is the most common cause of ovarian enlargement in young women?
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What is the effect of hormonal therapy on functional ovarian cysts?
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What is a characteristic sonographic appearance of epithelial ovarian tumors?
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Which of the following is a differential consideration for a solid-appearing adnexal mass?
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What is the significance of identifying vascular pedicles between the uterus and mass?
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At what age does the ratio of malignant tumors increase to 1 in 3?
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What is the purpose of pulsed Doppler interrogation of the adnexal branch of the uterine artery?
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What is the significance of an increased diastolic flow in Doppler imaging?
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What is the formula for calculating the Pulsatility Index (PI)?
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What is the significance of evaluating the ovarian volume in sonography?
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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
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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.
