SWE of Ovarian and Adnexal Masses: Possibilities for Differentiating Benign and Malignant
Limitations of the Evidence Base
The provided source fragments lack materials dedicated to SWE of ovarian and adnexal masses. Numerical stiffness thresholds (kPa or m/s), diagnostic criteria, and validated consensuses for this localization are not presented in the fragments, thus making it impossible to provide them [clarify].
What Available Fragments Contain on Related Topics
The available data pertains to other organs and issues that may be partially useful in a methodological approach but do not replace specialized recommendations for ovaries:
- Elastography Methodology (Thyroid, Breast, Compression): First, identify the mass in B-mode (higher spatial resolution, real anatomical contours), then assess the stiffness distribution on the elastogram in the same plane. When calculating the strain ratio, place the ROI of the mass in the area of maximum stiffness, and the reference ROI in the surrounding tissue at a comparable depth.
- Artifacts of Compression Elastography: Dependence on pressure, depth, and preload; a hard halo may extend beyond real boundaries, a soft center (necrosis, colloid) may "hide" part of the mass. Boundaries are always determined by B-mode.
Differential Series of Adnexal Masses (B-mode, from Fragments)
Regarding tubular adnexal masses, the fragments provide the semiotics of hydrosalpinx:
| Sign | Characteristic |
|---|---|
| Shape | Tubular, S- or C-shaped cystic mass in the adnexal projection |
| Relation to Ovary | Separated from the ovary or closely adjacent — key to differential diagnosis |
| Pathognomonic Sign | Incomplete septa / longitudinal mucosal folds (“beads-on-a-string” in chronic form) — in hydrosalpinx |
| Content | Anechoic → hydrosalpinx; debris, increased echogenicity → blood/pus/inflammation |
| Pyosalpinx | Thickening and hyperemia of the wall on Doppler, tenderness on compression, free fluid, possible transition to tubo-ovarian abscess |
Conclusion
To accurately present the role of SWE in differentiating benign and malignant ovarian and adnexal masses, specialized sources with validated thresholds and criteria are necessary. Such data is absent in the provided fragments [clarify].
Frequently asked questions
Are there SWE stiffness thresholds for ovarian masses in the fragments?
No. Numerical SWE thresholds for ovaries and adnexa are absent in the provided fragments [clarify].
In what sequence should a mass be evaluated during elastography?
First B-mode (identification and boundaries of the mass on grayscale image), then elastogram — functional stiffness map in the same plane.
Where to place the ROI when calculating the strain ratio?
ROI of the mass — in the area of maximum stiffness or encompassing the entire mass; reference ROI — in the surrounding tissue at a comparable depth.
Why can't the elastogram be primarily relied upon?
Compression elastography depends on pressure, depth, and preload, with many artifacts; a hard halo may extend beyond boundaries, a soft center may hide part of the mass. Boundaries are always determined by B-mode.
What sign helps distinguish hydrosalpinx from an ovarian mass?
Tubular S/C-shaped mass separated from the ovary or closely adjacent; incomplete septa/mucosal folds (“beads-on-a-string”) are pathognomonic for hydrosalpinx.