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Dopplerography of the ovaries
Last reviewed: 23.04.2024
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The optimal time for ultrasonic dopplerography of suspicious formations of the female reproductive system is 3-10 days of the menstrual cycle. In this phase, the vascular resistance is high enough due to the effects of estrogen. It significantly decreases by the middle of the cycle and remains low to the second half. In the postmenopausal period, in women who do not receive hormone replacement therapy, ovarian perfusion is characterized by high resistance with the appearance of an early diastolic bar on the spectrum. This pattern of blood flow 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 the muscular wall of the vessels and the development of sinusoids and numerous arteriovenous shunts. This results in a low resistance pattern with a resistance index of less than 1.0 and a ripple index of less than 0.4. The speed graph has a smooth descent from systole to late diastole without a notch. The same picture of vascularization is observed with fast-growing metabolically active benign tumors, ripening of follicles, scarring and inflammatory processes.
Very low indices in the wall of the mature follicle or cyst can be confused with a similar picture in mixed solid-cystic ovarian cancer, especially in premenopausal women or receiving hormone replacement therapy. This causes the great importance of other differential diagnostic signs, for example, the prevalence of blood vessels within pathological formation. Identification of intraperitoneal vascularization in ovarian cyst formations may indicate malignancy. The combined use of ultrasound dopplerography and detection 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, however, in order to finally confirm the diagnosis, invasive methods such as laparotomy are necessary.
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