The contribution of CNTI-SonoVue in the classification of adnexal masses as benign or malignant: a multicenter study.

Objectives: To determine if time intensity curves obtained after the combined use of ultrasound contrast (SonoVue®) and contrast tuned imaging (CnTI) can discriminate between benign and malignant adnexal lesions with predefined gray-scale ultrasound morphology. Methods: This European multicenter study involved eight ultrasound centers. Women with adnexal masses containing solid components at transvaginal ultrasound examination (International Tumor Analysis, IOTA, terms and definitions used) were examined with a transvaginal CnTI technique after injection of 2.4 mL SonoVue® contrast. A 3-min CnTI recording was started as soon as the contrast had been injected; the examiner did not move the transducer during the recording. The recording was saved electronically for later analysis offline using QontraXtTM software. The following variables were calculated in the region of interest (ROI), i.e. in the solid intracystic area: peak intensity, sharpness, time to peak, area under the intensity curve (AUC) and 1/2 washout time. Results: Of 136 tumors examined with SonoVue® and CnTI, 47 were excluded, leaving 89 for analysis: 52 benign tumors, 10 borderline tumors and 27 invasive malignancies. The time intensity curves of benign and borderline tumors were similar, but those of the invasive malignancies differed clearly and significantly from those of both benign and borderline tumors (median peak intensity 19.4 vs. 8.1 and 13.2, P < 0.0001; median AUC 1769 vs. 648 and 859, P < 0.0001). Conclusions: Time intensity curves in tumors with solid components are very similar in benign and borderline tumors but are different in invasive malignancies.