The aim of the study was to evaluate the usefulness of 4D Power Doppler tissue evaluation to discriminate between normal ovaries and ovarian cancer tumors. This was a prospective observational study. Twenty-three cases of surgically confirmed ovarian High Grade Serous Carcinoma (HGSC) were analyzed. The control group consisted of 23 healthy patients, each matching their study-group counterpart age wise (±3 years) and according to their menopausal status. Transvaginal Doppler 4D ultrasound scans were done on every patient and analyzed with 3D/4D software. Two 4D indices-volumetric Systolic/Diastolic Index (vS/D) and volumetric Pulsatility Index (vPI)-were calculated. To keep results standardized and due to technical limitations, virtual 1cc spherical tissue samples taken from the part with highest vascularization as detected by bi-directional Power Doppler were analyzed for both groups of ovaries. Values of volumetric S/D indices and volumetric PI indices were statistically lower in ovarian malignant tumors compared to normal ovaries: 1.096 vs. 1.794 and 0.092 vs. 0.558, respectively (p < 0.001). The 4D bi-directional Power Doppler vascular indices were statistically different between malignant tumors and normal ovaries. These findings could support the rationale for future studies for assessing this technology to discriminate between malignant and benign tumors.

Department of Gynecology and Obstetrics Charles University 1st Faculty of Medicine and Bulovka University Hospital Budinova 67 2 181 00 Prague Czech Republic

Department of Gynecology Obstetrics and Oncological Gynecology Faculty of Medical Sciences Medical University of Silesia Batorego 15 41 902 Bytom Poland

Department of Obstetrics and Gynecology Clínica Universidad de Navarra University of Navarra Avenida Pio XII 36 31008 Pamplona Spain

Department of Perinatology and Oncological Gynecology Faculty of Medical Sciences Medical University of Silesia Medyków 14 40 752 Katowice Poland

Gynecologic Oncology Centre Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University General University Hospital Apolinarska 18 12851 Prague Czech Republic

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