The Applications Of Transvaginal Three-dimensional Ultrasonography In The Diagnosis Of Adnexal Masses

Objective：(1) To evaluate the feasibility of application of transvaginal three-dimensionalcontrast-enhanced ultrasound (3D-CEUS) in the examination of adnexal masses. Toinvestigate the value of3D-CEUS images for differentiation of adnexal masses.(2) To evaluate the performation of the manual and sphere contour samplingmethods of VOCAL in three-dimensional power Doppler angiography (3D-PDA) ofadnexal masses.(3) To compare the accuracy of3D-CEUS and3D-PDA in differentiation ofadnexal masses.Methods:(1)A total of38women with complex adnexal masses were successivelyexamined by two-dimensional contrast-enhanced ultrasound (2D-CEUS) and3D-CEUS. The characteristics of adnexal masses in contrast-enhanced transvaginalsonography were observed. The vessels of adnexal masses showed by3D-CEUS weredivided into five types. Type Ⅴ was diagnosed as malignancy. The diagnosis wasconfirmed by pathology or follow-up. The influence of3D-CEUS to clinical outcomecompared to2D-CEUS was followed up.(2) Forty patients with forty-one adnexal masses were examined by3D-PDA. Thevascular indices of3D-PDA were measured by manual and sphere contour samplingmethods in VOCAL software. Receiver–operating characteristics curve （ROC）forpredicting malignancy was drawn according to the histological diagnosis after surgery.The influence of two sampling methods to diagnosis was analyzed.(3) A total of38women with adnexal masses were successively examined by3D-PDA,2D-CEUS and3D-CEUS. The vascular characteristics of the masses wereobserved and analyzed after images of3D-CEUS and3D-PDA were reconstructed. The vascular images of the masses showed by3D-CEUS and3D-PDA were dividedinto five types. Type Ⅴ was diagnosed as malignancy. The difference of the accuracybetween3D-CEUS and3D-PDA for predicting malignancy were compared.Results:(1) The vascular feature of92.9%(13/14) malignant masses, which showed in3D-CEUS image, was the tortuous vessels densely distributed in the tumor parenchymawith caliber changes. As to24benign masses: one mature teratoma could be observedenhancement along capsule of cyst but no enhancement in cyst. Six cystic masses withpapillae could be observed enhancement along capsule of cyst and three of whichshowed enhancement in papillae;17solid masses could be observed a few vessels in therim,52.9%(9/17) masses showed regular thin or short vessels in them,29.4%(5/17)masses showed regular branch vessels in them,17.6%(3/17) masses showed no vesselin them.3D-CEUS could add some information for94.7%(36/38) cases but made nochange in diagnosis compared to2D-CEUS.(2) The vascular indices of3D-PDA measured by manual and sphere contoursampling methods in VOCAL had no statistical difference for predicting malignancy inadnexal masses.(P>0.05)(3) The accuracy of3D-CEUS and3D-PDA for predicting malignancy in adnexalmasses had no statistical difference(P>0.05).Conclusions:(1)3D-CEUS could clearly show the vascular three-dimensional feature of adnexalmasses. It could increase diagnostic confidence and be used in differentiation of adnexalmasses as a supplementary method of2D-CEUS.(2) The sampling methods of VOCAL had no influence to the outcome of3D-PDAin differentiation of adnexal masses.(3) The performance of3D-CEUS wasn’t better than3D-PDA for predictingmalignancy in adnexal masses, but it can display microvascular more clearly.