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

Goziyeva M.A, Goziyev M.SH, Toshpulatov B.B.
2026 · doi:10.5281/zenodo.18523978 · W7128311272
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This dissertation-derived clinical series studied transvaginal quantitative Doppler ultrasound in 115 women evaluated for pelvic tumors to differentiate uterine leiomyoma phenotypes and suspected sarcoma, using a structured vascularity scoring scheme (color signal count and central vs peripheral distribution) plus sampled Doppler resistance/velocity indices (e.g., RI/IR, Vmax, Vmin, TAMX, S/D) from uterine, arcuate, and intra-tumoral vessels when feasible. The authors found that Doppler profiles differed across simple myoma, myoma with ischemic/degenerative changes, leiomyoma associated with adenomyosis, and proliferative myoma, showing a trend toward richer central vascularity and lower resistance indices in proliferative lesions. In the comparison of proliferative myoma (n=60) versus uterine sarcoma (n=5), sarcomas showed heterogeneous low-resistance intra-tumoral flow and intense mixed vascularity, but with overlap between groups; the work also reports diagnostic effectiveness up to 97.7% within the dissertation framework, without separate external validation. Relevance to endometriosis and/or adenomyosis: the paper includes and differentiates “leiomyoma associated with adenomyosis” as one of the analyzed uterine phenotypes, though its main focus is Doppler-based discrimination of leiomyoma phenotypes and suspected sarcoma rather than endometriosis/adenomyosis mechanisms.

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Abstract

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.
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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. Files 2715-2719.pdf Files (214.0 kB) | Name | Size | Download all | |---|---|---| | md5:e9d8c19f3ba6dab73a1d4f2110cfa3d0 | 214.0 kB | Preview Download | Additional details

References

- Dissertation source: "Improving Diagnostic Methods for Uterine Mass Lesions" (Andijan State Medical Institute, 2025). - Timmerman D, et al. Standardized ultrasound terminology and reporting in gynecology. (Consensus publications). - ESGO/EURACAN/GCIG guidelines for uterine sarcomas. (Recent guideline updates). - ACOG guidance on management of symptomatic uterine leiomyomas.

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