EP23.62: Ovarian teratomas and endometriomas: is there any difference in ultrasonographic morphology and vascularisation?

Anđela Jurišić, Jelena Brakus, A. Rakic, Zrinka Jurišić, E. Djakovic, P. Cabunac
In: Ultrasound in Obstetrics & Gynecology · 2024 · vol. 64(S1) , pp. 343 · doi:10.1002/uog.28997 · PMID:39248983 · W4402361186
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-08-09 ⓘ

This study found that combined morphological and hemodynamic transvaginal ultrasound characteristics can differentiate ovarian endometriomas from teratomas, with distinct common presentations and resistance index values.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-24 · read from full text ⓘ

This retrospective study evaluated whether combined transvaginal ultrasound morphology and Doppler hemodynamics could differentiate ovarian endometriomas from ovarian dermoid teratomas in 93 reproductive-age patients, using histopathologic confirmation to form two groups (46 endometriomas, 46 teratomas). Researchers recorded morphological features, classified masses into one of nine morphological types, and measured vessel localization, number of vessels within the mass, peak and end-diastolic flow velocities (Vmax, Vmin), and resistance indexes (RI) in uterine/ovarian arteries and intramass vessels. Endometriomas most often appeared as cystic isoechoic lesions, whereas teratomas most often appeared as cystic multicomponent masses, and RI values differed significantly between groups (0.571 ± 0.116 vs 0.540 ± 0.132; p = 0.02). The paper’s key limitation is its single-center, retrospective design. This paper is centrally about endometriosis — specifically distinguishing endometriomas from ovarian teratomas using ultrasound morphological and vascular parameters.

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Abstract

Endometriomas and ovarian dermoid cysts (teratomas) are common findings in women of their reproductive age. Since their appearance as adnexal masses is usually non-specific, this study aimed to determine if a combined morphological and hemodynamic ultrasonographic exam could help differentiate these gynecological tumours. 93 patients treated in Obstetrics and Gynecology Clinic Narodni front from January 1st, 2023. until January 1st, 2024. were included in this retrospective study. The adnexal masses were diagnosed via transvaginal ultrasound. Morphological characteristics of the masses, along with the hemodynamics (localization of the blood vessels, number of vessels inside the mass, peak flow velocity (Vmax), and end-diastolic flow velocity (Vmin) in the uterine, ovarian artery, and vessels inside the mass, along with the resistance indexes (RI) in the mentioned blood vessels) were obtained during the transvaginal ultrasound scan. The masses were also classified into one of the 9 morphological types: cystic transonic, cystic isoechoic, cystic hyperechoic, multicomponent cyst, multilocular mass, cyst with papillary projections, solid cystic, solid non-homogeneous, and exophytic tumour. Two groups, endometriomas, and teratomas, were formed after histopathologic confirmation. Endometriomas were found in 46 patients and ovarian teratomas in 46 patients, while one patient had both tumours. The most frequent morphological presentation of teratomas (54.34%) was cystic multicomponent mass, followed by cystic hyperechoic mass (22%). The most frequent morphological presentation of endometriomas (54.34%) was cystic isoechoic formation, followed by cystic transonic and cystic multilocular tumour (17%, respectively) (p < 0.01). RI in endometriomas (0.571 ± 0.116) was significantly different than RI in teratomas (0.540 ± 0.132) (p = 0.02). A transvaginal ultrasound scan with a combined morphological and hemodynamic examination could be a powerful tool in differentiating endometriomas and ovarian teratomas.
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Objectives

Endometriomas and ovarian dermoid cysts (teratomas) are common findings in women of their reproductive age. Since their appearance as adnexal masses is usually non-specific, this study aimed to determine if a combined morphological and hemodynamic ultrasonographic exam could help differentiate these gynecological tumours.

Methods

93 patients treated in Obstetrics and Gynecology Clinic Narodni front from January 1st, 2023. until January 1st, 2024. were included in this retrospective study. The adnexal masses were diagnosed via transvaginal ultrasound. Morphological characteristics of the masses, along with the hemodynamics (localization of the blood vessels, number of vessels inside the mass, peak flow velocity (Vmax), and end-diastolic flow velocity (Vmin) in the uterine, ovarian artery, and vessels inside the mass, along with the resistance indexes (RI) in the mentioned blood vessels) were obtained during the transvaginal ultrasound scan. The masses were also classified into one of the 9 morphological types: cystic transonic, cystic isoechoic, cystic hyperechoic, multicomponent cyst, multilocular mass, cyst with papillary projections, solid cystic, solid non-homogeneous, and exophytic tumour. Two groups, endometriomas, and teratomas, were formed after histopathologic confirmation.

Results

Endometriomas were found in 46 patients and ovarian teratomas in 46 patients, while one patient had both tumours. The most frequent morphological presentation of teratomas (54.34%) was cystic multicomponent mass, followed by cystic hyperechoic mass (22%). The most frequent morphological presentation of endometriomas (54.34%) was cystic isoechoic formation, followed by cystic transonic and cystic multilocular tumour (17%, respectively) (p < 0.01). RI in endometriomas (0.571 ± 0.116) was significantly different than RI in teratomas (0.540 ± 0.132) (p = 0.02).

Conclusions

A transvaginal ultrasound scan with a combined morphological and hemodynamic examination could be a powerful tool in differentiating endometriomas and ovarian teratomas.

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