To investigate the value of ultrasound elastography in differentiating endometriomas from ovarian hemorrhagic cysts

The participants will be subjected to:

• Personal, Obstetric and gynecological History taking.

• Clinical examination.

• B-mode ultrasonography was performed to characterize the adnexal masses morphologically.

• Color Doppler ultrasound.

• Grayscale and elastographic ultrasound examination, which will be done using acoustic radiation force impulse (ARFI) imaging with virtual touch quantification (VTQ). Five consecutive measurements were recorded for each lesion from the region identified as the region of interest (ROI) and the median of these measurements was recorded as the shear wave velocity (SWV) value of the lesion. In virtual touch quantification (VTQ) the shear wave speed is expressed in m/s. Only numerical results will be taken into consideration.

  . Realtime elastographic and B-mode images simultaneously will appear as a two-panel image. Elastogram appeared in the region of interest (ROI) box to determine the target ovarian lesion and surrounding tissue, then elasticity colour code will be classified in 5 patterns : pattern 1, an absent or a very small hard area; pattern 2, hard area 45 per cent; pattern 4, peripheral hard and central soft areas; pattern 5, hard area occupying entire solid component with or without soft rim. Strain index will be analyzed, which will be obtained by comparing the absolute strain value of solid component of ovarian cyst with that of surrounding soft tissue.

• The invistigator will reevaluate the lesions 4 weeks after the initial assessment to see the possible changes in the size and/or configuration of the lesions with B-mode and elastographic ultrasonography.

• Lesion will be evaluated as endometriomas and referred for surgery when shows no significant changes in size and configuration.

• Hemorrhagic cyst diagnosis will be made if the lesion had resolved on follow-up.

Inclusion Criteria:

• Patient suspected to have endometrioma or hemorrhagic ovarian cysts.

Exclusion Criteria:

• Simple cysts which were defined as a sonolucent thin-walled (<3 mm thick) cyst larger than 3 cm in diameter without septations or papillary projections [12].
• Hemorrhagic cysts containing septations or mural nodules with detectable flow on Doppler ultrasonography

Single investigator