THE CHARACTERIZATION OF FLOW SIGNALS FROM TUBAL AND OVARIAN ARTERIES USING INTRAOPERATIVE CONTINUOUS-WAVE DOPPLER

Ovarian vascular Doppler is a promising screening test for early ovarian cancer detection. However, disagreements on flow indices used, flow signal shapes and ovarian vessel localization cause continuing controversy. We aimed at clarifying some of this confusion by direct[v measuring the adnexal arterial blood flow during laparotomy. A 10-MHz continuous Doppler probe was used to examine adnexal vessels in 24 patients undergoing laparotomy for benign gynecological pathology. Resistance (RI) and pulsatility (PI) indices were calculated for each vessel and the shape of the flow signals was noted. The tubal arteries showed a low-velocity flow pattern with relatively high end-diastolic flow when compared to the ovarian artery signals obtained from the infundibulopelvic ligament. The mean RIs for the tubal artery and ovarian artery in the infundibulopelvic ligament were 0.59 +/- 0.02 and 0.73 +/- 0.02, respectively. The mean PIs for the tubal and ovarian artery in the infundibulopelvic ligament were 1.11 +/- 0.09 and 1.53 +/- 0.1, respectively. The tubal artery showed a significantly lower RI and PI when compared to the ipsilateral ovarian artery at the infundibulopelvic ligament (p < 0.001 and p = 0.002, respectively) and its hilar branches (p = 0.03 for RI and p = 0.03 for PI). We conclude that tubal artery flow signals, which are measured directly for the first time in this study, are characteristic and are distinct from the ovarian artery signals. Tubal artery signals might be erroneously picked up during transvaginal color Doppler sonography of the ovaries, especially in the presence of conditions causing a decreased impedance to blood flow in the pelvis, such as ovarian tumors. Recognizing the flow signal from the tubal artery may help in differentiating ovarian and tubal vessels detected during color Doppler sonography.