Ultrasound Quarterly

Ultrasound Findings in Endosalpingiosis

Endosalpingiosis is a rare, benign condition characterized by ectopic cystic glands lined with ciliated cuboidal epithelium, histologically resembling the fallopian tube. Its etiology remains uncertain but is hypothesized to result from either ectopic implantation of fallopian tube tissue or metaplastic transformation of multipotential peritoneal cells. While frequently misdiagnosed as endometriosis, endosalpingiosis coexists with endometriosis in ~35% to 40% of cases. The condition can affect both women of reproductive age and postmenopausal individuals, with a median age of diagnosis between 50 and 52 years. While often asymptomatic, patients may present with infertility, pelvic pain (including dysmenorrhea and dyspareunia), pelvic masses, or urinary symptoms such as hematuria or dysuria when lesions involve the urinary bladder. Lesions primarily localize to the peritoneal surfaces of the uterus, fallopian tubes, ovaries, and cul-de-sac but can rarely extend to the bladder, ureters, bowel serosa, omentum, lymph nodes, appendix, cervix, and even the skin. Endosalpingiosis is considered part of the spectrum of peritoneal serous lesions and may be associated with or progress to borderline or low-grade ovarian serous neoplasms. Sonographic evaluation typically reveals multiple small, anechoic, and avascular cystic structures forming a “bunch-of-grapes” pattern along pelvic and peritoneal surfaces.

Diagnostic Efficiency of Gynecologic Imaging Reporting and Data System Combined With 3-dimensional Contrast-enhanced Ultrasound Scoring System in Evaluating Ovarian Tumor

Abstract To estimate the value of gynecologic imaging reporting and data system (GI-RADS) combined with 3-dimensional contrast-enhanced ultrasound (3D-CEUS) scoring system in the differential diagnosis of ovarian tumor. Both of 2-dimensional ultrasound (2D-US) and 3D-CEUS were performed on 114 patients with ovarian masses by Voluson E8 with SonoVue (Bracco, Italy). Besides, dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) (Siemens Magneton Verio 3.0T, Germany) was performed on the patients. There were totally 62 benign and 52 malignant ovarian tumors in all patients. The ability of GI-RADS combined with 3D-CEUS scoring system to distinguish benign and malignant ovarian tumors was superior to conventional ultrasound GI-RADS classification. The sensitivity, specificity, and accuracy of GI-RADS combined with 3D-CEUS scoring system were 96.2% and 98.1%, 87.10%, whereas those of MRI were 87.10%, 91.23%, and 92.11% respectively, indicating that there was high concordance in ovarian tumors assessment between the 2 diagnostic methods. The new scoring system has a good correlation with microvessel density (P = 0.000, r = 0.73), estrogen receptor (P = 0.000, r = 0.59), progesterone receptor (P = 0.000, r = 0.56), and matrix metalloproteinase-9 (P = 0.000, r = 0.61). The GI-RADS combined with 3D-CEUS scoring system was valuable in clinical diagnosis and differential diagnosis of ovarian tumor and show good agreement with MRI.

Improved Sonographic Detection of Epithelial Ovarian Cancer

Ultrasound Characteristics of Cystadenofibromas

Abstract Cystadenofibromas (CAFs) are relatively rare benign ovarian tumors. This study was to describe the ultrasound (US) findings of CAFs. Preoperative US information of 86 CAFs was retrospectively collected. To better illustrate their characteristic, 173 cystadenomas (CADs), 103 borderline ovarian tumors (BOTs), and 129 cystadenocarcinomas (CACs) were recruited as match groups. Besides morphology evaluation, tumors were categorized by the Ovarian-Adnexal Reporting and Data System US system. Higher-risk stratification in CAFs was more often being seen than CADs (63% of CAFs classified as Ovarian-Adnexal Reporting and Data System 4 or 5 vs 35% in CADs). Cystadenofibromas more commonly appeared as unilocular or multilocular solid than CADs. Solid components presented in 59% of CAFs and papillary projections presented in 45%. More CAFs contained solid components and papillary projections than CADs (P < 0.0001). When compared with BOTs and CACs, less CAFs contained solid components (P < 0.017 and P < 0.0001). However, no significant difference was found in CAFs versus BOTs or CACs about the presence of papillary projections. Shadowing was identified in 58% of CAFs; however, in CADs, BOTs, and CACs, the proportion was 2%, 11%, and 11%, respectively. Presence of shadowing in CAFs was noticeably more than CADs, BOTs, and CACs (P < 0.017 or P < 0.0001). Similar to CADs, most CAFs were avascular (76%) and without ascites (99%), which were significantly different from BOTs and CACs. We concluded that the sonographic markers for CAFs that differ from malignant were presence of shadowing, avascular, and absence of ascites.

Nonvisualized Ovaries on Ultrasound

Abstract The risk of malignancy in nonvisualized ovaries on pelvic ultrasound is presumed to be close to zero per imaging correlation; the goal of this manuscript is to define the risk of malignancy in nonvisualized ovaries on pelvic ultrasound as defined by surgical pathology. Records for patients with pelvic ultrasound and surgical pathology containing the word “ovary” or “ovaries” performed at our institution between 10/1/2015 and 9/30/2021 were reviewed. Data for ovarian visualization were extracted from the radiology report and correlated with surgical pathology results within each ovary. Eighty-seven ovaries in 71 patients out of 422 ovaries (20.6%) in 215 eligible patients were not visualized on ultrasound. Twenty ovaries were excluded because imaging showed large pelvic mass, and 19 ovaries were excluded because surgical pathology for the ovary of interest was not available. A total of 48 ovaries in 37 patients were nonvisualized and had available surgical pathology. Out of 48 nonvisualized ovaries, 31 were normal on surgical pathology and 17 had abnormalities, with 15 benign lesions (12 of which were ≤1 cm in size). Two ovaries in 1 patient contained malignant lesions; although the ovaries were not visualized on ultrasound, the scan demonstrated peritoneal carcinomatosis. In conclusion, a high proportion of ovaries (20.6%, 87/422) are not visualized on pelvic ultrasound, and surgical pathology reveals ovarian lesions in 35.4% (17/48) of nonvisualized ovaries on pelvic ultrasound, with the majority being subcentimeter benign lesions. In the absence of peritoneal carcinomatosis, nonvisualized ovaries had no malignant lesions.