Inversion Image Analysis and Doppler: A Technique to Characterize Preoperatively the Benignity or Malignancy of Ovarian Lesions

To simplify the preoperative diagnosis of ovarian masses identified during ultrasound examination. Women with at least one ovarian mass (n = 363) underwent preoperatively transvaginal ultrasound, based on IOTA protocol. The stored 3D data were analyzed; the main image was obtained and inverted. Using the ImageJ system, we expressed numerically the image appearance. Doppler images were divided based on the location of the pulse beat compared with the horizontal axis: a/ the pulse beat is limited above the axis, b/ the pulse beat barely traceable is observed beneath, and c/ the pulse beat is situated on both sides. The % of difference between the first and the inverted volume was significantly different between benign and malignant (Serous cysts:214±21, Endometriomas:80±7, Cystadenomas:158±20, Teratomas:91±15, Inothecomas: 157±37, Hemorrhagic:131±28, Hydrosalpinx: 87±9, Simple Cysts:136±23, Borderline:182±105, Malignant: 60±3 ;p<0.01). 91% of the benign masses changed significantly after inversion. In the malignant group, 30 lesions altered significantly after inversion (56%). In these masses, the pulse beat was situated on both sides (23) or beneath the horizontal axis (7), while 97% of the benign masses showed pulse beat pattern limited above it (p = 0.01). Although we present preliminary data, we suggest that the combination of the % of change between the main image and its inversion volume with the Doppler appearance could delineate the nature of an ovarian lesion during preoperative ultrasound examination.