Usefulness of transabdominal real-time sonoelastography in the evaluation of ovarian lesions: preliminary results

Objective: We aim to evaluate and describe the tissue elasticity characteristics of various ovarian lesions with sonoelastography. Methods: 35 patients (age range 16-85 years; mean age 40.8 years) underwent sonoelastography and later MRI. Histopathological confirmation of all lesions was carried out, except eight of endometriomas and six of septated cysts which were confirmed on MRI and follow-up ultrasonography. Strain ratios and elastogram patterns were recorded. Lesions were classified into three groups (Group 1: cystic lesions, Group 2: benign tumours and Group 3: malignant lesions) and findings were compared between groups for both observers. Interobserver agreement was analyzed. Optimal cut-off values for strain ratios were achieved with receiver operating characteristic curve analysis. Results: Ovarian endometriomas and complex cystic lesions were observed hard on elastograms with high strain ratios, and malignant lesions were observed mostly soft with very small strain ratios. Benign tumours had average tissue stiffness, observed harder than the malignant lesions, and strain ratios ranged from 4 to 14. The differences in patterns and strain ratios between groups were statistically significant (p < 0.05 for both observers). Conclusion: Our study revealed that malignant ovarian lesions have softer tissue property than benign lesions and cystic lesions in terms of elastogram patterns and strain ratios. Advances in knowledge: Most ovarian lesions contain solid and cystic parts which make the malignant and benign lesions look similar on imaging modalities. Using real-time sonoelastography as an adjunct to other imaging modalities may improve the differentiation of malignant ovarian lesions from benign lesions.