Comparative Ultrasonographic Evaluation of Morphology and Vascularization in Endometriomas and Ovarian Mature Cystic Teratomas †
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Ultrasonographic Examination and Data Analysis
- 1.
- Morphological Parameters: The morphological assessment included the largest tumor diameter, volume (calculated using the prolate ellipsoid formula: length × height × width × 0.523), laterality, capsule thickness, and internal echogenicity (categorized as anechoic, homogeneous low-level “ground-glass”, hyperechoic, or mixed/heterogeneous). The presence of septa, papillary projections, solid components, acoustic shadowing, free fluid in the pouch of Douglas, and signs of tumor fixation were also recorded.
- 2.
- Hemodynamic Parameters: Assessed using color and pulsed Doppler techniques. The location of blood flow (pericystic, intracystic, in septa) was noted. The peak systolic velocity (Vmax), end-diastolic velocity (Vmin), and Resistance Index (RI) were measured from spectral Doppler waveforms. Measurements were also taken from the ipsilateral uterine artery to obtain its Resistance Index (AURI).
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ANDEX | Adnexal Mass Evaluation System |
AU | Uterine Artery |
AURI | Resistance Index in Uterine Arteries |
ΔAURI | Difference in AURI between Tumor and Contralateral Sides |
ΔVmaxAU | Difference in Uterine Artery Vmax between Tumor and Contralateral Sides |
Doppler RI | Doppler Resistance Index |
FGF | Fibroblast Growth Factor |
HIF-1A | Hypoxia-Inducible Factor 1 Alpha |
IOTA | International Ovarian Tumor Analysis |
MCT | Mature Cystic Teratoma |
MIF | Macrophage Migration Inhibitory Factor |
O-RADS | Ovarian-Adnexal Reporting and Data System |
RI | Resistance Index |
SD | Standard Deviation |
SPSS | Statistical Package for the Social Sciences |
sVEGFR-2 | Soluble Vascular Endothelial Growth Factor Receptor-2 |
TVUS | Transvaginal Ultrasonography |
VEGF | Vascular Endothelial Growth Factor |
Vmax | Maximal Systolic Flow Velocity |
Vmin | Minimal Diastolic Flow Velocity |
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Parameter | Patients with Endometrioma (n = 47) | Patients with MCT (n = 47) | p-Value |
---|---|---|---|
Age (years), mean ± SD | 37.8 ± 10.2 | 38.4 ± 13.3 | 0.8 |
Menopausal status, n (%) | 0.2 | ||
Premenopausal | 41 (87.2%) | 36 (76.6%) | |
Menopausal | 6 (12.8%) | 11 (23.4%) | |
Duration of menopause (years), mean ± SD | 2.0 ± 2.9 * | 8.1 ± 9.5 ** | 0.1 |
Parity, median [IQR] | 0 [0–1] | 1 [0–2] | 0.02 *** |
Parameter | Endometriomas (n = 47) | MCTs (n = 47) | p-Value |
---|---|---|---|
The largest tumor dimension (mm), mean ± SD | 78.2 ± 3.3 | 81.9 ± 4.3 | 0.6 |
Tumor volume (cm3), mean ± SD | 247.9 ± 65.2 | 254.3 ± 75.3 | 0.7 |
Tumor capsule thickness (mm), mean ± SD | 2.87 ± 1.1 | 2.9 ± 1.1 | 0.9 |
Septal thickness (mm), mean ± SD | 2.6 ± 0.7 | 2.7 ± 1.4 | 0.7 |
Free fluid in the pouch of Douglas, n (%) | 1 (2.1%) | 2 (4.3%) | 0.500 |
Tumor fixation **, n (%) | 7 (14.9%) | 3 (6.4%) | 0.200 |
Tumor localization, n (%) | 0.042 * | ||
Unilateral | 39 (83.0%) | 45 (95.7%) | |
Bilateral | 8 (17.0%) | 2 (4.3%) |
Morphological Type (IOTA Terminology) | Endometriomas (n = 55) | % | Teratomas (n = 49) | % | p-Value |
---|---|---|---|---|---|
Unilocular cyst with ground-glass echogenicity | 25 | 45.5% | 0 | 0% | <0.001 * |
Unilocular solid cyst with hyperechoic content | 1 | 1.8% | 10 | 20.4% | |
Multilocular cyst | 8 | 14.5% | 5 | 10.2% | |
Multilocular solid cyst | 9 | 16.4% | 25 | 51.0% | |
Cyst with papillary projections (unilocular or bilocular) | 1 | 1.8% | 1 | 2.0% | |
Solid tumor | 3 | 5.5% | 4 | 8.2% | |
Other/not otherwise specified | 8 | 14.5% | 4 | 8.2% |
Parameter | Endometriomas | MCTs | p-Value |
---|---|---|---|
Total number of analyzed blood vessels (across all tumors) | 168 | 149 | — |
Mean number of blood vessels (n ± SD) | 3.03 ± 1.67 | 3.00 ± 2.30 | 0.5 |
Localization of blood vessels (n) | 0.5 | ||
– Pericystic | 125 | 111 | |
– In septa | 24 | 20 | |
– Within the papillary projection | 6 | 2 | |
– Within the solid-appearing components * | 13 | 16 |
Parameter (n ± SD) | Endometriomas | Ovarian Teratomas | p-Value |
---|---|---|---|
RI | 0.57 ± 0.11 | 0.54 ± 0.13 | 0.04 * |
Vmax | 10.72 ± 5.56 | 10.28 ± 5.96 | 0.5 |
Vmin | 4.43 ± 2.24 | 4.34 ± 2.20 | 0.7 |
AURI tumor | 0.81 ± 0.14 | 0.83 ± 0.07 | 0.02 * |
AURI contralateral | 0.84 ± 0.07 | 0.85 ± 0.07 | 0.7 |
ΔAURI | 0.03 ± 0.11 | 0.01 ± 0.07 | 0.8 |
AUVmax tumor | 42.62 ± 21.73 | 38.10 ± 15.0 | 0.2 |
AUVmax contralateral | 36.80 ± 17.27 | 34.50 ± 13.45 | 0.5 |
ΔVmaxAU | 4.73 ± 24.28 | 3.23 ± 14.88 | 0.6 |
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Rakić, A.; Đaković, E.; Milovanović, Z.; Ristić, A.; Nejković, L.; Đorđević, A.; Brakus, J.; Štulić, J.; Jurišić, Ž.; Jurišić, A. Comparative Ultrasonographic Evaluation of Morphology and Vascularization in Endometriomas and Ovarian Mature Cystic Teratomas. J. Clin. Med. 2025, 14, 6912. https://doi.org/10.3390/jcm14196912
Rakić A, Đaković E, Milovanović Z, Ristić A, Nejković L, Đorđević A, Brakus J, Štulić J, Jurišić Ž, Jurišić A. Comparative Ultrasonographic Evaluation of Morphology and Vascularization in Endometriomas and Ovarian Mature Cystic Teratomas. Journal of Clinical Medicine. 2025; 14(19):6912. https://doi.org/10.3390/jcm14196912
Chicago/Turabian StyleRakić, Aleksandar, Elena Đaković, Zagorka Milovanović, Aleksandar Ristić, Lazar Nejković, Ana Đorđević, Jelena Brakus, Jelena Štulić, Žaklina Jurišić, and Aleksandar Jurišić. 2025. "Comparative Ultrasonographic Evaluation of Morphology and Vascularization in Endometriomas and Ovarian Mature Cystic Teratomas" Journal of Clinical Medicine 14, no. 19: 6912. https://doi.org/10.3390/jcm14196912
APA StyleRakić, A., Đaković, E., Milovanović, Z., Ristić, A., Nejković, L., Đorđević, A., Brakus, J., Štulić, J., Jurišić, Ž., & Jurišić, A. (2025). Comparative Ultrasonographic Evaluation of Morphology and Vascularization in Endometriomas and Ovarian Mature Cystic Teratomas. Journal of Clinical Medicine, 14(19), 6912. https://doi.org/10.3390/jcm14196912