P13.15: Usefulness of contrasted power Doppler ultrasonography in the diagnosis of ovarian endometrioma

Endometriosis is a common disease affecting millions of women worldwide. The role of color Doppler ultrasonography in the diagnosis of ovarian endometrioma remains to be unclear. We studied the usefulness of transvaginal power Doppler ultrasonography using microbubble contrast agent in the differentiation between endometriomas and other adnexal masses in non-pregnant women. Ninety-seven women with ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist; 300 mg/ml, 5 ml). Sixty-two had benign ovarian tumors or masses including 15 endometriomas, 5 had borderline ovarian tumors, and 30 women had malignant ovarian tumors. Enhancement of the intratumoral blood flow (tumor vascularity) was seen in all 17 ovarian endometriomas except for one case, by contrasted power Doppler ultrasonography. Ringshaped color flow in the cystic wall of the tumors was significantly seen by contrasted ultrasonography in 13 of 17 (76.5%) endometriomas compared to the other types of ovarian tumors. This feature may differentiate endometriomas from the other ovarian tumors. No colored signal of the blood flow was clearly demonstrated in the internal echogenic parts in any endometrioma by using the contrast agent. This result suggests that these echogenic parts were hemorrhagic contents in the endometriomas. The mean RI of the tumor vessels in endometriomas was significantly lower than those of the other types of benign ovarian tumors. However, no relationships were shown between resistance indices in the tumor vessels and the stages (Re-AFS classification) of endometriosis in these patients. No side effect resulted from intravenous injection of this contrast agent was apparently seen in all 97 patients. In conclusion, contrasted power Doppler ultrasonography may be useful for the diagnosis of ovarian endometriomas.