Applications of Doppler ultrasonography in the diagnosis of ovarian tumors complications.

Introduction. Ovarian tumors include masses with a fluid or parenchymal cystic character, characterized by typical or abnormal epithelial proliferation. They present an extreme diversity, the classification being realized according to several criteria. Ovarian tumors may be benign or malignant, cystic or solid, uni- or bilateral, secretory or non-secretory, primary or secondary. Ultrasound examination remains the gold standard imaging procedure used in ovarian mass evaluation. Doppler examination evaluates arterial and venous blood flow. The most commonly used Doppler spectral wave parameters are the resistivity index and the pulsatility index. The most commonly encountered complications of ovarian tumors are torsion of the ovary or adnexa, intracystic hemorrhage, as well as their malignant transformation. Although the diagnosis of adnexal torsion is most commonly based on the clinical examination of the patient, color Doppler evaluation may be useful by demonstrating the absence of arterial and venous flow. In case of intracystic hemorrhage, the resorption of the blood within the ovarian cyst determines the distinct ultrasound features, ranging from hyperecogenic aspects identified at the onset of hemorrhage, to hypo-/anecogenic images later. The model of the internal echoes will undergo changes with the passage of time and resorption of the clot. Doppler examination in the presence of intracystic hemorrhage will not reveal internal vascularization. Suggestive criteria for malignant ovarian masses are thick, multiple septations, papillary projections, solid stuctures within the tumor mass and ascites. Doppler ultrasound in malignant tumors identifies vessels of neoformation, which have low pulsatility and resistivity index. Conclusions. Color Doppler ultrasound can provide additional information to 2D ultrasound examination regarding the nature of the lesions, their malignant potential, and the presence of the torsion of the adnexa or ovary. The specificity and the positive predictive value of the 2D ultrasound examination in the diagnosis of the ovarian tumor complications increase when an extra examination using color and spectral Doppler is performed. [ABSTRACT FROM AUTHOR]