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Ovarian Doppler
Last reviewed: 06.07.2025
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The optimal time for ultrasound Dopplerography of suspicious formations of the female reproductive system is days 3-10 of the menstrual cycle. In this phase, vascular resistance is quite high due to the effects of estrogen. It decreases significantly by the middle of the cycle and remains low until its second half. In the postmenopausal period, in women not receiving hormone replacement therapy, ovarian perfusion is characterized by high resistance with the appearance of an early diastolic notch on the spectrum. Such a blood flow pattern is typical for normal perfusion of the ovaries, uterus and fallopian tubes.
Malignant tumors are characterized by the formation of their own pathological vessels and general hypervascularization, the absence of a muscular layer of the vessel wall and the development of sinusoids and numerous arteriovenous shunts. This causes a low resistance pattern with a resistance index of less than 1.0 and a pulsation index of less than 0.4. The velocity graph has a smooth slope from systole to late diastole without a notch. The same vascularization pattern is observed in rapidly growing metabolically active benign tumors, follicular maturation, scarring and inflammatory processes.
Very low indices in the wall of a mature follicle or cyst can be confused with a similar picture in mixed solid-cystic ovarian cancer, especially in premenopausal women or those receiving hormone replacement therapy. This determines the great importance of other differential diagnostic features, for example, the prevalence of vessels within the pathological formation. Detection of intraseptal vascularization in cystic formations of the ovary may indicate malignancy. The combined use of ultrasound Dopplerography and determination of the tumor marker CA-125 can significantly increase the sensitivity of diagnosis. CDS signs of a tumor and an elevated level of CA-125 indicate the presence of a malignant neoplasm of the ovaries, but invasive methods such as laparotomy are necessary for final confirmation of the diagnosis.
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