Advanced

Intravenous contrast ultrasound examination using contrast-tuned imaging (CnTI (TM)) and the contrast medium SonoVue (R) for discrimination between benign and malignant adnexal masses with solid components

Testa, A. C.; Timmerman, D.; Van Belle, V.; Fruscella, E.; Van Holsbeke, C.; Savelli, L.; Ferrazzi, E.; Leone, F. P. G.; Marret, H. and Tranquart, F., et al. (2009) In Ultrasound in Obstetrics & Gynecology 34(6). p.699-710
Abstract
Objective To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology. Methods In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue (R). Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The... (More)
Objective To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology. Methods In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue (R). Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The sensitivity and specificity with regard to malignancy were calculated and receiver-operating characteristics (ROC) curves were drawn for gray-scale, power Doppler and contrast variables and for pattern recognition (subjective assignment of a certainly benign, probably benign, uncertain or malignant diagnosis, using gray-scale and power Doppler ultrasound findings). The gold standard was the histological diagnosis of the surgically removed tumors. Results After exclusions (surgical removal of the mass > 3 months after the ultrasound examination, technical problems), 72 adnexal masses with solid components were used in our statistical analyses. The values for peak contrast signal intensity and area under the contrast signal intensity curve in malignant tumors were significantly higher than those in borderline tumors and benign tumors, while those for the benign and borderline tumors were similar. The area under the ROC curve of the best contrast variable with regard to diagnosing borderline or invasive malignancy (0.84) was larger than that of the best gray-scale (0.75) and power Doppler ultrasound variable (0.79) but smaller than that of pattern recognition (0.93). Conclusion Findings on ultrasound contrast examination differed between benign and malignant tumors but there was a substantial overlap in contrast findings between benign and borderline tumors. It appears that ultrasound contrast examination is not superior to conventional ultrasound techniques, which also have difficulty in distinguishing between benign and borderline tumors, but can easily differentiate invasive malignancies from other tumors. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ultrasonography, transvaginal ultrasound, contrast media, ovarian neoplasms
in
Ultrasound in Obstetrics & Gynecology
volume
34
issue
6
pages
699 - 710
publisher
John Wiley & Sons
external identifiers
  • wos:000273077700015
  • scopus:73449114942
ISSN
1469-0705
DOI
10.1002/uog.7464
language
English
LU publication?
yes
id
61846e37-cb8c-4046-99d7-b3a5c5ca5fc6 (old id 1531818)
date added to LUP
2010-01-29 11:54:05
date last changed
2017-03-12 03:55:41
@article{61846e37-cb8c-4046-99d7-b3a5c5ca5fc6,
  abstract     = {Objective To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology. Methods In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue (R). Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The sensitivity and specificity with regard to malignancy were calculated and receiver-operating characteristics (ROC) curves were drawn for gray-scale, power Doppler and contrast variables and for pattern recognition (subjective assignment of a certainly benign, probably benign, uncertain or malignant diagnosis, using gray-scale and power Doppler ultrasound findings). The gold standard was the histological diagnosis of the surgically removed tumors. Results After exclusions (surgical removal of the mass > 3 months after the ultrasound examination, technical problems), 72 adnexal masses with solid components were used in our statistical analyses. The values for peak contrast signal intensity and area under the contrast signal intensity curve in malignant tumors were significantly higher than those in borderline tumors and benign tumors, while those for the benign and borderline tumors were similar. The area under the ROC curve of the best contrast variable with regard to diagnosing borderline or invasive malignancy (0.84) was larger than that of the best gray-scale (0.75) and power Doppler ultrasound variable (0.79) but smaller than that of pattern recognition (0.93). Conclusion Findings on ultrasound contrast examination differed between benign and malignant tumors but there was a substantial overlap in contrast findings between benign and borderline tumors. It appears that ultrasound contrast examination is not superior to conventional ultrasound techniques, which also have difficulty in distinguishing between benign and borderline tumors, but can easily differentiate invasive malignancies from other tumors. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.},
  author       = {Testa, A. C. and Timmerman, D. and Van Belle, V. and Fruscella, E. and Van Holsbeke, C. and Savelli, L. and Ferrazzi, E. and Leone, F. P. G. and Marret, H. and Tranquart, F. and Exacoustos, C. and Nazzaro, G. and Bokor, D. and Magri, F. and Van Huffel, S. and Ferrandina, G. and Valentin, Lil},
  issn         = {1469-0705},
  keyword      = {ultrasonography,transvaginal ultrasound,contrast media,ovarian neoplasms},
  language     = {eng},
  number       = {6},
  pages        = {699--710},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {Intravenous contrast ultrasound examination using contrast-tuned imaging (CnTI (TM)) and the contrast medium SonoVue (R) for discrimination between benign and malignant adnexal masses with solid components},
  url          = {http://dx.doi.org/10.1002/uog.7464},
  volume       = {34},
  year         = {2009},
}