According to the results of clinical and anamnestic study, it was found that the course of the disease without complaints was observed in 37 (24.8%) women, the rest – was characterized by a number of disorders in the reproductive system, including ovarian and menstrual disorders in 62 (41.6%) patients , abdominal pain – 84 (56.4%), intermenstrual bleeding – 34 (22.8%), and 29 (19.5%) patients complained of increased abdominal size. It was determined that only a quarter of all women did not have concomitant pathology, and the most common comorbidity that accompanied the formation of the ovaries was obesity, which was found in 55.7% of women. Almost half of all patients had endometrial pathology (63 cases out of 149 – 42.3%), uterine fibroids were slightly less common (57 (38.3%) patients), a third had uterine endometriosis and cervical pathology.
Sonographic polymorphism of different histological types of tumors of the uterine appendages complicates the differential diagnosis of benign and malignant ovarian tumors. In the process of identifying three-dimensional ovarian formations, it was found that Doppler modes are of great importance in the recognition of the formation. A 4-point gradation of blood flow patterns was used to characterize the qualitative indicators. It was determined that tumor-like formations always corresponded to KD-1 (100%), in patients with benign formations KD-2 was more often observed – 21 (41.2%) cases, only 3 (5.9%) women had KD-4. In malignant pathology, CD-3 was dominated in 20 (47.1%) cases and CD-4 in 18 (37.5%) patterns of intranodular blood flow. Quantitative indicators of blood flow, such as maximum blood flow velocity (Vmax) and pulsation index (PI), have been shown to increase slightly in tumor-like and benign tumors, but in malignant tumors almost double compared to controls (p <0.05), and the resistance index (RI), on the contrary – halves in malignant pathology (p <0,05): in 33 (68.8%) cases of malignant ovarian tumors RI was <0.5 um. units, and none of the benign tumors had an RI <0.4 um. units. Most benign tumors (82.4%) had an RI> 0.6 IU (p <0.005).
Summarizing the qualitative and quantitative criteria of the images, we were the first to use a comprehensive approach to evaluate the results of compression sonoelastography. It was found that the Strain Ratio stiffness index in ovarian tumors averages (0.83 ± 0.14) um. units, the highest rate was observed in corpus luteum cysts – (1.9 ± 1.16) um. units, and the lowest – in paraovarian cysts – (0.6 ± 0.07) um. units. After analyzing the obtained stiffness index in benign ovarian tumors, it was found that to determine the average stiffness index for benign formations, taking into account all histological species, will be illogical, as it will average (6.08 ± 1.25) um. units, and such indicators are characteristic of malignant tumors. When determining the average stiffness index for benign ovarian formations, without taking into account the stiffness index of mature teratomas and fibers, it was found that this figure decreases significantly and is (1.3 ± 0.51) um. units. from and is closely related to the representatives of tumor-like formations. Analyzing the level of stiffness index among malignant tumors, it was noted that its level ranges from 4.2 to 29.3 um. units. The highest Strain Ratio was present in dermoid cysts with malignancy, and the lowest – in mucinous carcinomas. On average, this indicator, taking into account all histological types of malignant ovarian tumors, is (7.4 ± 4.22) um. units.
The determined diagnostic efficiency of compression sonoelastography at differentiation of character of ovarian neoplasms substantiates expediency of its inclusion in a complex of methods of ultrasonic research. It is proved that ultrasonic compression sonoelastography provides qualitatively new information on the state of tissue density, which depends on the nature of the lesion, and the inherent non-invasiveness, simplicity and speed justify its use in the differential diagnosis of ovarian disease, especially in early stages.
Key words: multiparametric ultrasound examination, compression sonoelastography, dopplerometry, ovarian tumors, functional ovarian cysts, ovarian cancer, reproductive potential, menstrual disorders, infertility, risk factors, treatment, tumor markers, hormonal processes, hormonal status and hormonal profile. Branch- Medicine.
