The new possibilities of differenzial diagnosis of endometriomas

Objective: Endometriomas are found in 17% to 44% of patients with endometriosis and represent 35% of benign ovarian cysts requiring surgery. In recent years, laparoscopy has become the gold-standard for the treatment of endometriomas. But with two-dimensional pelvic ultrasound sometimes it is difficult to differentiate them from other diffuse, low-level echoes cysts, that increases the frequency of unnecessary surgical treatment. Our aim was to estimate the three-dimensional power Doppler ultrasound parameters for the discrimination of ovarian endometriomas from hemorrhagic cysts.

Methods: Our study included 81 patients of reproductive age (mean age 30.8±4.4) who had unilocular ovarian cysts with diffuse, low-level echoes contents on a two-dimensional conventional sonography. All patients also underwent transvaginal 3D ultrasound examination (Voluson 730 Exp, Australia). In the VOCAL programm the volume of the cyst, MGV(mean grey value) of cyst contents and cyst wall were measured, the serum level of CA-125 was also evaluated. After laparoscopic cystectomy all parameters were compared between the group with histologically proven endometriomas (group1) and hemorrhagic cysts (group 2).

Results: The MGV of cyst contents was significantly higher in endometriomas than in hemorrhagic cysts (39.693%±7.23 vs. 22.968%±2.46), p<0.005. We did not find the relationship between the cysts volume and MGV of their contents and there was no significant difference in MGV of the cyst wall in the both groups (43.261%±6.440 vs. 48.341%±7.969), p>0.05. The serum concentration of CA-125 was significantly higher in group1, but we found little correlation between CA-125 and the volume of the endometriomas including between MGV of their contents.

Conclusion: MGV is a new method of objective and quantitative evaluation for endometriomas echogenicity. The calculation is performed automatically, excludes a subjective component of evaluation and is not difficult. MGV allows with high performance conduction of differenzial diagnosis endometriomas with diffuse, low-level echoes hemorrhagic cysts.