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Aim: The purpose of this study is to analyze whether the addition of volumetric pulsatility indices (vPI) derived from spatiotemporal image correlation (STIC) assessment could improve the diagnostic performance of conventional two-dimensional (2D) ultrasound for discriminating benign from malignant adnexal tumors used as a third sequential step. Study design: Ours was an observational prospective cohort study between September 2014 to September 2016. Women diagnosed as having a persistent ovarian tumor evaluated at our center were included in this study. All women underwent transvaginal ultrasonography before surgery to assess the ultrasonographic characteristics of the lesion by gray-scale morphological analysis classifying the lesion as benign or suspicious based on “pattern recognition”. In benign lesions, no further test was conducted. For those tumors regarded as suspicious, assessment of the vascularization was performed by using conventional 2D high-definition flow color Doppler (2D-HDF), classifying the lesion as suspicious if vascularization within solid component was detected. In those lesions with intratumoral vascularization, four-dimensional (4D)-STIC technology with HDF was applied for calculating vPI. We used two reference standards: Definitive histology when the mass was surgically removed and in case the mass was not removed, those with spontaneous resolution or persistent without change and follow-up longer than 12 months were considered as benign. We compared diagnostic performance of conventional approach (pattern recognition followed by 2D-HDF) vs pattern recognition followed by 2D-HDF followed by 4D-STIC. Results: A total of 214 patients were included; 175 had a benign tumor and 39 a malignant tumor. We observed that vPI was significantly lower in malignant masses as compared with benign masses when 4D-STIC was used. Sensitivity and specificity of B-mode + 2D-HDF were 0.95 [95% confidence interval (CI): 0.83–0.98] and 0.92 (95% CI: 0.87–0.95) respectively. Sensitivity and specificity of B-mode + 2D-HDF + 4D-STIC were 0.95 (95% CI: 0.83–0.98) and 0.94 (95% CI: 0.90–0.96) OriGinal article 1,7,8Professor, 2-6Attending Physician 1-6,8Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain 7Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Monserrato, Italy Corresponding Author: Juan L Alcázar, Professor, Department of Obstetrics and Gynecology, Clinica Universidad de Navarra School of Medicine, Pamplona, Spain, Phone: +34 948245400 e-mail: jlacazar@unav.es 10.5005/jp-journals-10009-1560 respectively. No significant differences by adding the STIC were observed (McNemar test p > 0.05). Conclusion: The 4D-STIC does not improve the diagnostic performance of conventional ultrasound in the differential diagnosis of ovarian tumors as compared with conventional assessment using 2D ultrasound. However, a low vPI increases significantly the probability of malignancy in questionable masses.

donald school journal of ultrasound in obstetrics and gynecology

Evaluation of the Four-dimensional “Spatiotemporal Image Correlation” Technology with High-definition Color Doppler as Third Step for Preoperative Differential Diagnosis of Ovarian Tumors: A Prospective Study