An adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present. A patient with a mass with diffuse low-level internal echoes and other US features may benefit from additional imaging.

Maitray 0. Patel1'2 VickieA. Feldstein2 Scott 0. Lipson2 DillonC.Chen2 RoyA. Filly2OBJECTIVE. This studywasundertakento determineif the diagnosisof cysticteratomas of the ovary can be made by experiencedsonologistsusing only specificassociatedsono graphic features.MATERIALS AND METHODS. Two sonologistsindependentlyreviewed the sono gramsof 252 adnexalmasses. For eachmass,eachsonologist recordedsonographicfeatures using a standardized checklist, which included four descriptions associated with cystic terato mas. From a list of diagnostic possibilities, each reviewer chose one specific conclusion, with emphasis on achieving the highest combination of sensitivity and positive predictive value for any particular diagnosis. The sensitivity, positive predictive value, and positive likelihood ra tio for the diagnosis of cystic teratoma were evaluated for each sonographic finding and for each sonologist's interpretation.RESULTS. Of the 252 masses, 74 cysticteratomas were found,55 of whichshowedtwo or more associated sonographic features. Each reviewer had a 98% positive predictive value with 85% sensitivity for the diagnosis and identification of cystic teratomas (positive likelihood ratio = 152). The positive predictive value was 100% when an adnexal mass had two or more sonographic featuresassociatedwith dermoid masses. The positive predictive value for individual sonographic features associated with dermoid masses was 80% for a shadowing echodensity, 75% for region ally bright echoes, 50% for hyperechoic lines and dots, and 20% for a fluidâ€"fluid level.CONCLUSION. An adnexalmassshowingtwo or moreof the sonographic featuresas sociated with cystic teratomascan be confidently diagnosed as a cystic teratoma.

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