o_1977r8vv9vk1ts2ms0kd8pksa.pdf

608 I. Zalud
artifactual variation in velocity as the sample volume
passes through different velocities in a laminar flow
state. Unintentional motion can cause a generalized
Doppler shift. Increasing the angle of Doppler interrogation
degrades the quality of the tracing and gives
the impression of spectral broadening. As angulation
approaches 908, directional ambiguity can occur, suggesting
bidirectional flow. Recognition of these artifacts
is essential for proper interpretation of Doppler
information and for rendering a correct diagnosis. It
is obvious that the display of color and pulsed-wave
Doppler information is a complicated, sometimes
confusing technology because of the many controls
and their interactions. Understanding what each of
these controls does independently and how the image
is affected by adjustment and change is essential.
More importantly, a permanent awareness of which
control to sacrifice and which to enhance for the particular
pelvic vessel is critical for obtaining the most
diagnostically useful Doppler information.
Conclusions
The color Doppler modality provides a valuable
approach to the pathology of female reproductive organs.
The results reported in the recent literature on
three-dimensional color and/or power Doppler are indeed
provocative and, not surprisingly, raise many
new questions about the regulation of tumor angiogenesis,
the density of tumor vessels, and the differences
between vessel architecture in benign and malignant
growths. Three-dimensional power Doppler depiction
of tumor angiogenesis has many clinical implications,
including early detection of ovarian and endometrial
cancers. Improved detection and classification of tumor
architecture after instillation of contrast agents
might contribute to better diagnostic accuracy. Early
detection of ovarian carcinoma is still the most attractive
argument for conducting additional studies.
References
1. DiSaia PJ, Creasman WT (1997) Clinical gynecologic
oncology, 5th edn. Mosby, St. Louis
2. Barber HRK, Graber EA (1971) The PMPO syndrome.
Obstet Gynecol 38:921±922
3. Campbell S, Bhan V, Royston P et al (1989) Transabdominal
ultrasound screening for early ovarian cancer.
BMJ 199:1363±1367
4. Luxman D, Bergman A, Sagi J, Manachem D (1991)
The postmenopausal adnexal mass: correlation between
ultrasonic and pathologic findings. Obstet Gynecol 77:
726±729
5. Bourne T, Campbell S, Steer C et al (1989) Transvaginal
color imaging: a possible new screening technique for
ovarian cancer. BMJ 199:1376±1379
6. Weiner Z, Thaler I, Beck D et al (1992) Differentiating
malignant from benign ovarian tumors with transvaginal
color flow imaging. Obstet Gynecol 79:159±163
7. Kawai M, Kano T, Kikkawa F et al (1992) Transvaginal
Doppler ultrasound with color flow imaging in the
diagnosis of ovarian cancer. Obstet Gynecol 79:163±167
8. Kurjak A, Zalud I, Alfirevic Z (1991) Evaluation of
adnexal masses with transvaginal color ultrasound. J
Ultrasound Med 10:295±299
9. Kurjak A, Schulman H, Sosic A, Zalud I, Shalan H
(1992) Transvaginal ultrasound, color flow and Doppler
waveform of the postmenopausal adnexal mass. Obstet
Gynecol 80:917±921
10. Fleischer AC (2001) New developments in the sonographic
assessment of ovarian, uterine, and breast vascularity.
Semin Ultrasound CT MR 22:42±49
11. Kinkel K, Hricak H, Lu Y, Tsuda K, Filly RA (2000) US
characterization of ovarian masses: a meta-analysis.
Radiology 217:803±811
12. Brown DL, Doubilet PM, Miller FH et al (1998) Benign
and malignant ovarian masses: selection of the most
discriminating gray-scale and Doppler sonographic features.
Radiology 208:103±110
13. van Nagell JR Jr, DePriest PD, Reedy MB, Gallion HH,
Ueland FR, Pavlik EJ, Kryscio RJ (2000) The efficacy of
transvaginal sonographic screening in asymptomatic
women at risk for ovarian cancer. Gynecol Oncol
77:350±356
14. Takac I (1998) Analysis of blood flow in adnexal tumors
by using color Doppler imaging and pulsed spectral
analysis. Ultrasound Med Biol 24:1137±1141
15. Aslam N, Tailor A, Lawton F, Carr J, Savvas M, Jurkovic
D (2000) Prospective evaluation of three different
models for the pre-operative diagnosis of ovarian cancer.
BJOG 107:1347±1353
16. Schelling M, Braun M, Kuhn W, Bogner G, Gruber R,
Gnirs J, Schneider KT, Ulm K, Rutke S, Staudach A
(2000) Combined transvaginal B-mode and color Doppler
sonography for differential diagnosis of ovarian
tumors: results of a multivariate logistic regression
analysis. Gynecol Oncol 77:78±86
17. Zalud I (2002) Doppler evaluation of the ovary: clinical
applications and challenges. Contemp Obstet Gynecol
47:37±59
18. Fleischer AC, Cullinan JA, Peery CV, Jones HW (1996)
Early detection of ovarian carcinoma with transvaginal
color Doppler ultrasonography. Am J Obstet Gynecol
174:101±116
19. Lerner JP, Timor-Tritsch IE, Federman A, Abramovich
G (1994) Transvaginal ultrasonographic characterization
of ovarian masses with an improved, weighted
scoring system. Am J Obstet Gynecol 170:81±85
20. Timmerman D, Valentin L, Bourne TH, Collins WP,
Verrelst H, Vergote I; International Ovarian Tumor
Analysis (IOTA) Group (2000) Terms, definitions and
measurements to describe the sonographic features of
adnexal tumors: a consensus opinion from the International
Ovarian Tumor Analysis (IOTA) Group. Ultrasound
Obstet Gynecol 16:500±505
21. Orden MR, Gudmundsson S, Kirkinen P (2000) Contrast-enhanced
sonography in the examination of benign
and malignant adnexal masses. J Ultrasound Med
19:783±788