Contrast‐Enhanced Ultrasound of the Ovary Technique and Lexicon Recommendations

Diagnosis of ovarian malignancy in radiology is challenging, as there is significant overlap in imaging appearances along the spectrum of benign to malignant disease. In 2021, the American College of Radiology introduced the Ovarian-Adnexal Reporting and Data System (O-RADS) to standardize lesion description and improve consistency of interpretation and management of suspicious masses based on standard greyscale and Doppler ultrasound. Although endovaginal ultrasound (EVS) is well-established as a first-line investigation for ovarian lesions, it previously lacked the ability to show blood flow at the capillary level, severely limiting its contribution to patient care. The introduction of microbubble contrast agents and the subsequent development of contrast-enhanced ultrasound (CEUS) software techniques for endovaginal probes have allowed ultrasound to characterize perfusion-level vascularity of ovarian masses comparable to magnetic resonance (MR) and computed tomography (CT) scans. Today, there is limited North American literature addressing the utilization of CEUS in ovarian cancer. Given the advantages of EVS and CEUS, we propose a lexicon to standardize the description of qualitative and quantitative CEUS parameters with respect to ovarian masses. We emphasize the need for future development of specific CEUS criteria, including quantitative thresholds to aid in the differentiation of benign and malignant blood flow criteria. Our recommendation includes a safe, non-invasive, readily available technique, which provides high accuracy for diagnosis.