QUANTITATIVE DOPPLER ULTRASOUND MARKERS AND VASCULARITY SCORING FOR DIFFERENTIATING UTERINE LEIOMYOMA PHENOTYPES AND SUSPECTED SARCOMA

Background: Doppler ultrasound complements grayscale imaging by providing hemodynamic information that may improve the characterization of uterine masses. However, variability in acquisition and subjective interpretation limit reproducibility.Aim: To propose a structured, quantitative Doppler‑based framework (vascularity scoring + resistance indices) for differentiating common leiomyoma phenotypes and guiding escalation for suspected malignancy, based on a dissertation‑derived clinical series.Methods: A cohort of 115 women evaluated for pelvic tumors underwent transvaginal ultrasound (TVUS) with color Doppler mapping (CDM)/energy Doppler and pulsed Doppler. Intra‑tumoral vascularity was graded by the number of color signals (≤5, 5–10, >10) and by distribution (central vs peripheral). Doppler indices (RI/IR, Vmax, Vmin, TAMX, and S/D) were sampled in uterine arteries, arcuate arteries, and intra‑tumoral vessels when feasible. Indeterminate or high‑risk presentations were escalated to CT and/or MRI.Results: Doppler profiles differed across simple myoma, myoma with ischemic/degenerative changes, leiomyoma associated with adenomyosis, and proliferative myoma, with a gradient toward richer central vascularity and lower resistance indices in proliferative lesions. In the comparative analysis (proliferative myoma n=60 vs uterine sarcoma n=5), sarcomas demonstrated heterogeneous, low‑resistance intra‑tumoral flow and intense mixed vascularity, but overlap existed. The integrated imaging strategy (TVUS+CDM with selective CT/MRI) achieved an overall diagnostic effectiveness reported as high in the dissertation (up to 97.7%).Conclusions: Quantitative vascularity grading and standardized Doppler index reporting can reduce subjectivity and improve triage of uterine masses. Because Doppler features overlap between proliferative leiomyoma and sarcoma, suspicious patterns should prompt MRI and multidisciplinary evaluation rather than “rule‑out” decisions based on ultrasound alone.