الفهرس 
Anatomy of the AdnexaOnly 14 pages are availabe for public view
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Abstract
Ovarian cancer is the most lethal gynecological malignancy and accounts for fifth most common cause of cancer related death in females involving a variety of histological diagnosis. It accounts for 6% of all cancers. This study aims to assess the role of trans-vaginal and transabdominal sono-elastography and color Doppler findings in gynecologic imaging reporting and data system (GIRADS) for classification of different adnexal lesions and evaluate their tissue elasticity with sono-elastography. This study enrolled twenty female patients. Their age ranged from 28 to 72 years. The masses divided into 10 malignant masses, 2 border line and 8 benign lesions. The adnexal lesions in this study evaluated according to GIRADS system which is depending on size, echogenicity, consistency, intramural vascularity and RI by conventional and power Doppler ultrasound. Concerning GIRADs classification, in the present study the benign lesions were mainly of GIRADs III (75%) and, less commonly IV, while malignant masses were mainly of GIRADs V (83%) and less commonly IV (p<0.001*). The GI-RADS system had facilitated report understanding for other physicians and so it helps in better decision-making for the patients. Our results indicated that this system has appropriate accuracy for distinguishing malignant cases. Overall, it is suggested that GI-RADS could be used as a diagnostic tool in this regard. This study showed that patients with malignant / borderline malignant masses had a statistically higher mean CA125 and B-HCG levels Sono-elastography was used to evaluate the qualitative parameter (Elasticity score) and the quantitative parameter (Strain ratio) of benign and malignant adnexial lesions. The elasticity score ranged from 1 to 5. Scores 1,2 and 3 are considered benign and score 4 and 5 are considered malignant. The SR is the ratio between the reference area and the lesion. According to this study there were statistically significant differences between benign and malignant masses in the distribution of transabdominal and transvaginal color pattern (p<0.001*), with malignant lesions most commonly showing higher scores of color pattern. Significantly lower mean transabdominal (p=0.031*) and transvaginal (p=0.02*). SR values were noted in patients with malignant lesions. Sonoelastography examination showed a sensitivity of 91.7%, and specificity of 87.5%. The present study presented the diagnostic values of SR (TA), SR (TV) to predict the malignant cases. SR (TA) and SR (TV) and showed statistically significant performance in diagnosis of malignant patients (p=0.014* and 0.007*). SR (TV) showed the highest AUC (0.87), sensitivity (0.93%), and specificity (0.91%), Elastography is an effective technique added to conventional ultrasound that helps to proper differentiation between benign and malignant adnexial lesions by measuring the compressibility and mechanical properties of the lesion. Benign tumors tend to be soft and malignant tumors tend to be hard and less compressible lesion on elastography is more likely to be malignant. The current study has some limitations including relative small sample size of patients, uni-centeric study, hemorrhagic necrosis and cystic degeneration associated with malignant masses, which can’t give useful information about them. As well as, it seems difficult to examine patients with masses infiltrated both sides of the pelvic wall.