Adnexal mass: Pre operative characterization in the emergency department transvaginal color Doppler sonographic early diagnosis and serial assessment: Best predictor

ABSTRACT

This prospective cohort study aimed at evaluating the value of transvaginal color doppler sonography [TV-CDS] in the early detection and serial assessment of adnexal masses. Serial TV-CDS was performed on 102 women with adnexal masses referred over 18 months. 66 women having adnexal masses with negative pregnancy test were examined at 3, 6, 12 weeks after initial examination [group I]and 36 women hating positive pregnancy test with ectopic pregnancies [EPs] were examined [4-11] weeks [mean 6.3w] postmenstrual [group II]. 83% of high impedance flow masses underwent regression whereas only 22% of lesions with low impedance flow did. 20% of lesions that regressed had a significant drop in pulsatility index [PI] Probability of regression was the greatest in young women [less than 40 years of age] and in masses < 5cm. Changes in PI were more predictive of regression than morphology or patient age. 91% of women received progestational suppression demonstrated regression with decrease of PI and peak systolic velocity [PSV] and the rest of patients completed regression on 6 months follow up treatment. The mean systolic velocity of the EPs seas 35.4 cm/s compared with 28.4 cm/s in corpus luteum cysts [CLCs] with no significant statistical difference [P = 0.1]. The resistive index [RI] of BPs ranged front 0.15 to 1.6 [mean +/- SD. 0.61 +/- 0.24] compared with 0.4 to 0.7 [mean +/- SD. 0.52 +/- 0.10] in CLCs with a significant statistical difference [P = 0.003]. The RI of less than 0.4 had a specificity of 100% and a positive predicative value PPV of 100% for diagnosing EP but was present in only [sensitivity] 15% [confidence interval 7% - 23%] of EPs. A RI of greater than 0.7 had a specificity of 100% and a PPV of 100% for diagnosing EP and was present in only 31% [confidence interval 21% - 41%] of EPs. Serial TV - CDS is a useful non-invasive parameter in early detection of adnexal lesions.starting serious acute abdomen and those lesions which may spontaneously regress avoiding unnecessary surgeries. Changes in PI were predictive of regression [90%] than morphology or patient age. Bath low and high RI discriminate EP from a CLC before management