TRANSVAGINAL ULTRASOUND WITH COLOR DOPPLER MAPPING IN THE DIAGNOSTIC WORK‑UP OF UTERINE MASS LESIONS: A PRACTICAL ALGORITHM AND HEMODYNAMIC CRITERIA (SINGLE‑CENTER CLINICAL SERIES)

Abstract

Background: Uterine mass lesions (most commonly leiomyomas) are frequently encountered in women of late reproductive age and beyond. Accurate differentiation between benign myometrial disease, atypical leiomyomas, and rare malignant tumors remains challenging when based on grayscale imaging alone.
Objective: To summarize and formalize a pragmatic diagnostic algorithm based on transvaginal ultrasound (TVUS) combined with color Doppler mapping (CDM) and pulsed Doppler, and to report hemodynamic criteria derived from a single‑center clinical series.
Materials and methods: The dissertation‑based cohort included 115 women with suspected pelvic tumors, distributed into diagnostic groups including uterine myoma, adnexal tumors, inflammatory adnexal disease, adenomyosis, suspected uterine sarcoma, and tumors of unclear pelvic origin. All patients underwent TVUS with CDM/energy Doppler and pulsed Doppler; in diagnostically difficult cases additional MRI and/or CT was used. Intra‑tumoral vascularity was graded using a standardized color‑signal count. Hemodynamic indices (resistance index, RI/IR) and velocities were analyzed in uterine, arcuate, and intra‑tumoral vessels.
Results: TVUS+CDM enabled structured phenotyping of myometrial pathology and guided escalation to cross‑sectional imaging in selected patients. Hemodynamic profiles differed across simple myoma, ischemic/degenerative myoma, myoma with adenomyosis, and proliferative myoma, with the latter showing lower resistance indices and more central vascularity. A dedicated comparison between proliferative myoma (n=60) and uterine sarcoma (n=5) demonstrated overlapping qualitative vascular patterns but quantitatively lower resistance and heterogeneous, low‑resistance intra‑tumoral flow, supporting the need for a multimodal approach.
Conclusion: A standardized TVUS+CDM protocol with predefined vascularity grading and Doppler indices improves consistency of reporting and provides actionable criteria for stepwise diagnostic decision‑making. Integration with contemporary risk‑stratification systems for adnexal masses (O‑RADS US v2022) and modern sarcoma guidelines strengthens clinical pathways.