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The presence of an ovarian mass is one of the leading indications for gynaecological surgery. Ultrasonographyis considered the primary imaging modality for confirmation of the ovarian origin of the mass and characterization of the nature of the mass as benign or malignant. Transvaginal sonography unquestionably provides excellent depiction of the pelvic organs. It has been used as a routine technique as a part of the gynaecological examination. when morphologic features alone are applied to the prediction of ovarian malignancy, there is a tendency to over diagnose malignant tumors because of a substantial overlap between malignant and benign appearing masses. In addition, transvaginal color Doppler imaging with pulsed Doppler spectral analysis improves the characterization of ovarian masses by means of quantitative blood flow measurements obtained from tumor vessels. Material & Methods: This is a prospective study conducted in the Department of Radiodiagnosis, G.S.V.M. Medical College & L.L.R Hospital, Kanpur, from December 2018 to November 2019. The study was conducted in collaboration with department of Obstetrics & Gynecology. The study was conducted on 50 patients with 53 masses (three have bilateral masses). Patients were selected from the outpatient department and from admissions in ward. All adnexal masses were subjected to sono-morphological evaluation followed by blood flow analysis using color, spectral and power Doppler sonography. Morphologic indexing of the adnexal masses was done using the Sassone score based on the visualization of inner wall structure and wall thickness, septae, solid parts and echogenicity. On spectral Doppler, the lowest RI, PI and maximum PSV detected at any point in the mass was used for analysis. The Doppler findings were considered as being suggestive of malignancy when: RI < 0.6, PI <1 and PSVmax>15cm/sec. Results: 22 out of 53 masses were considered suspicious of malignancy (Sassone score ≥9) of which 15 were malignant and 7 were benign in 31 mass lesions29 were benign and 2 were malignant. Malignant neoplasm offered lower resistance to blood flow due to presence of aberrant tumor vessels. In the present study 94.11% of malignant tumors showed RI < 0.6 in contrast to only 11.11% of benign tumor. PSV was more than 15 cm/sec in 15 (88.23%) malignant tumors as compared to only 5.55% of benign tumors. Conclusion: In conclusion to our study, there is considerable overlap in the morphologic patterns of various adnexal masses and hence a multi-parameter analysis incorporating morphologic scoring, vessel location, vessel arrangement and spectral waveform analysis is helpful in determining those patients in whom early intervention is necessary. Adding color Doppler to conventional sonography produced a specificity and positive predictive value higher than those of conventional sonography alone.

Role of transvaginal gray scale and color doppler ultrasound imaging in ovarian lesions