Evaluation of two different methods for vascular sampling by three-dimensional power Doppler angiography in solid and cystic-solid adnexal masses

Objective To analyze two different methods for performing three-dimensional power Doppler angiography (3D-PDA) vascular sampling in solid and cystic-solid adnexal masses. Methods Twenty-one 3D-PDA volumes from 18 consecutive and unselected solid or cystic-solid adnexal masses (13 malignant and five benign) were analyzed. A single examiner (J. L. A.) acquired all the volumes according to a predetermined scanning protocol. Two different observers (one inexperienced and the other experienced) calculated 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from solid tumor areas. First, manual sampling (Plane A, 15◦ rotation-step) was performed, and 1 week later 5-cm3 sphere sampling from the most vascularized area was carried out. The observers made a record of any difficulty that they encountered in delineating the solid areas of tumors or in distinguishing true tumor vessels from preexisting vessels, the time spent performing each analysis was recorded and inter- and intraobserver reproducibility was evaluated for each method using intraclass correlation coefficients (ICC). Results In four (19.0%) of the 21 volumes sphere sampling could not be performed because it was not possible to obtain a sphere smaller than 5.5 cm3. This happened in cases in which image zooming was used when acquiring the 3D volume. The inexperienced observer encountered more difficulty, but not significantly more, than the experienced observer when analyzing 3D-PDA volumes both by manual sampling (29% vs. 14% of cases) and 5-cm3 sphere sampling (35% vs. 18% of cases). The mean time spent by the inexperienced observer was significantly greater (P < 0.001) than that spent by the experienced observer both for manual sampling (6.11 min vs. 1.85 min) and 5-cm3 sphere sampling (2.93 min vs. 2.15 min). Contrary to the findings for the experienced observer, the inexperienced observer required less time to perform sphere sampling than they did manual sampling. Interobserver agreement was high for both methods: ICC for manual volume, 0.993; manual VI, 0.908; manual FI, 0.913; manual VFI, 0.914; sphere volume, 0.949; sphere VI, 0.954; sphere FI 0.850; and sphere VFI, 0.953. Intraobserver reproducibility was also high, with all ICCs above 0.99. Conclusions Manual and 5-cm3 sphere sampling are reproducible methods for 3D-PDA vascular sampling. Caution is required when image zoom is used at the time of acquiring the volume because this may prevent sphere sampling. Difficulties found in performing both manual and sphere sampling do not seem to significantly affect the reproducibility of Doppler index calculations

Tumor angiogenesis assessed by three-dimensional power Doppler ultrasound in early, advanced and metastatic ovarian cancer: a preliminary study

Objective To evaluate tumor vascularity by threedimensional power Doppler ultrasound (3D-PDU) in early and advanced stage primary ovarian cancers and in metastatic tumors to the ovary. Patients and methods This was a retrospective analysis of clinical and sonographic data from 49 women with primary ovarian cancers or metastatic tumors to the ovary. All women underwent 3D-PDU prior to surgery. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) from solid portions or papillary projections in the tumors were calculated using the Virtual Organ Computer-aided AnaLysis (VOCALTM) program. Definitive histological diagnosis was obtained in each case. Results Among the 49 women, 10 had stage I primary cancers (five low-malignant potential tumors and five invasive tumors), 26 had advanced stage primary ovarian cancers and 13 had metastatic tumors to the ovary. Mean VI and VFI were significantly higher in advanced stage tumors and metastatic tumors as compared with early stage tumors. No differences in 3D-PDU indices were found between advanced stage and metastatic cancers. Conclusions Vascular indices derived from 3D-PDU tend to be higher in advanced stage and metastatic ovarian cancers as compared with early stage ovarian tumors

Clarifying the role of three-dimensional transvaginal sonography in reproductive medicine: an evidenced-based appraisal

This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity