Papel de la angiografía ecográfica con Power Doppler tridimensional (sistema vocal) en el manejo de masas anexiales sospechosas de malignidad

Autor: Rodríguez Morante, David
Jazyk: španělština
Rok vydání: 2009
Předmět:
Zdroj: TDX (Tesis Doctorals en Xarxa).
Druh dokumentu: Doctoral Thesis
Popis: OBJETIVO. El objetivo de este estudio fue explorar la capacidad de la ecografía tridimensional con Power Doppler (3DPD) para discriminar los tumores benignos y malignos dentro del grupo de masas anexiales sólido-quísticas con vascularización central y definir los puntos de corte de los índices 3DPD que se deben utilizar en un entorno clínico. MÉTODOS. Un total de 143 mujeres consecutivas (edad media, 50,4 años, rango, 17-82 años) con diagnóstico de lesión sólido-quística o sólida en modo B y con vascularización central en el 2DPD fueron evaluadas con ecografía 3D PD antes de la cirugía. El 3DPD se utilizó para evaluar la vascularización en las proyecciones papilares y áreas sólidas. Los índices vasculares (índice de vascularización [VI], índice de flujo [FI], y el índice vascularization-flujo [VFI]) se calculan automáticamente. El diagnóstico histológico definitivo se obtuvo en cada caso. RESULTADOS. Un total de 113 masas (74%) eran malignas y 39 (26%) fueron benignoa. La evaluación morfológica reveló 30 uniloculares sólidas (19,7%), 43 multilocular sólidas (28,3%), y 79 masas sólidas (52%). La media VI (9,365% frente al 3,3%, P
OBJECTIVE. The purpose of this study was to explore the role of 3-dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic-solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. METHODS. A total of 143 consecutive women (mean age, 50.4 years; range, 17-82 years) with diagnoses of cystic-solid or solid vascularized adnexal masses on B-mode and 2-dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three-dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer-aided analysis program.Three-dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularizationflow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS. A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P < .001), FI (34.318 versus 28.794; P < .001), and VFI (3.233 versus 1.15; P < 0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69-0.85), 0.71 (0.60-0.81), and 0.75 (0.66-0.83) for the VI, FI and VFI, respectively. For reducing the false-positive rate by almost one-third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. CONCLUSIONS. Three-dimensional PD vascular indices could be helpful for reducing the false-positive rate in cystic-solid and solid vascularized adnexal masses. KEY WORDS: adnexal mass; ovarian cancer; 3-dimensional power Doppler sonography.
Databáze: Networked Digital Library of Theses & Dissertations
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