![Page 1: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/1.jpg)
Editable text hereBASIC TRAININGBasic Training
ISUOG Basic TrainingExamining the Ovaries and Adnexa
![Page 2: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/2.jpg)
Editable text hereBASIC TRAININGBasic Training
Learning objectives
At the end of the lecture you will be able to:
• Use International Ovarian Tumor Analysis (IOTA) terms,
definitions and measurements
![Page 3: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/3.jpg)
Editable text hereBASIC TRAININGBasic Training
Key questions
1. How do I describe my ultrasound findings using the
standardised (IOTA) terminology?
2. How do I measure different components of an adnexal
lesion?
3. How do I assess and describe vascular flow in adnexal
lesions?
![Page 4: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/4.jpg)
Editable text hereBASIC TRAININGBasic Training
Key points
• Understand how to use IOTA terminology
• Understand how to assess and measure different
components of an adnexal lesion
• Understand how to arrange ultrasound settings to
assess vascular flow in ovarian lesions
![Page 5: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/5.jpg)
Editable text hereBASIC TRAININGBasic Training
Terms, definitions and measurement methods
International Ovarian Tumor Analysis
(IOTA)
![Page 6: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/6.jpg)
Editable text hereBASIC TRAININGBasic Training
Definitions• Ovarian lesion
• Solid component
• Papillary projection – cyst wall irregularity
• Complete – incomplete septum
• Five tumor types
• Different types of cyst content
• Acoustic shadowing
• Colour score
• Ascites
![Page 7: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/7.jpg)
Editable text hereBASIC TRAININGBasic Training
Ovarian lesion
• Part of an ovary inconsistent with normal physiology
• Adnexal mass inconsistent with normal physiology
![Page 8: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/8.jpg)
Editable text hereBASIC TRAININGBasic Training
IOTA definition of a solid component
• A structure that has (high) echogenicity suggestive of
tissue (myometrium, myomas, fibromas)
![Page 9: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/9.jpg)
Editable text hereBASIC TRAININGBasic Training
IOTA definition of a solid component
• The white ball in a dermoid cyst is NOT solid tissue
![Page 10: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/10.jpg)
Editable text hereBASIC TRAININGBasic Training
IOTA definition of a solid component• Blood clot, amorphous material or solid tissue?
• Push on the lesion
• Use color doppler
If in doubt – classify as solid tissue!
![Page 11: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/11.jpg)
Editable text hereBASIC TRAININGBasic Training
Push on the lesion
![Page 12: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/12.jpg)
Editable text hereBASIC TRAININGBasic Training
Use colour Doppler
![Page 13: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/13.jpg)
Editable text hereBASIC TRAININGBasic Training
IOTA definition of a papillary projection
• A papillary projection is any solid protrusion into the cyst cavity from
the cyst wall with a height of ≥ 3mm
• Papillary projection = solid tissue
![Page 14: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/14.jpg)
Editable text hereBASIC TRAININGBasic Training
A protrusion <3mm: cyst wall irregularity
![Page 15: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/15.jpg)
Editable text hereBASIC TRAININGBasic Training
IOTA definition of septum and incomplete septum
• Septum = thin strand of tissue that runs from one internal cyst surface to
another
• Incomplete septum = thin strand of tissue that does not reach the
opposite wall of the cystic structure in some scanning planes (seen in
diseased tubes)
![Page 16: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/16.jpg)
Editable text hereBASIC TRAININGBasic Training
Five types of lesions
• Unilocular
• Unilocular-solid
• Multilocular
• Multilocular-solid
• Solid
![Page 17: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/17.jpg)
Editable text hereBASIC TRAININGBasic Training
Unilocular
Timmerman et al. Ultrasound Obstet Gynecol, 2000,16:500-5
![Page 18: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/18.jpg)
Editable text hereBASIC TRAININGBasic Training
Definition of a unilocular cyst
• ONE cyst locule
• No complete septa
• No solid components
• Any type of cyst fluid
![Page 19: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/19.jpg)
Editable text hereBASIC TRAININGBasic Training
Unilocular-solid
Timmerman et al. Ultrasound Obstet Gynecol, 2000,16:500-5
![Page 20: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/20.jpg)
Editable text hereBASIC TRAININGBasic Training
Multilocular
Timmerman et al. Ultrasound Obstet Gynecol, 2000,16:500-5
![Page 21: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/21.jpg)
Editable text hereBASIC TRAININGBasic Training
Multilocular-solid
Timmerman et al. Ultrasound Obstet Gynecol, 2000,16:500-5
![Page 22: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/22.jpg)
Editable text hereBASIC TRAININGBasic Training
Solid
Timmerman et al. Ultrasound Obstet Gynecol, 2000,16:500-5
![Page 23: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/23.jpg)
Editable text hereBASIC TRAININGBasic Training
Five types of cyst content
Anechoic Low level Hemorrhagic
Mixed Ground glass
![Page 24: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/24.jpg)
Editable text hereBASIC TRAININGBasic Training
Acoustic shadowing
![Page 25: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/25.jpg)
Editable text hereBASIC TRAININGBasic Training
Irregular cyst wall
• Irregularity in the inner wall of a cyst
• Irregularity of outer contour of a solid tumor or irregularity
of the inner wall of a cystic component in a solid tumor
![Page 26: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/26.jpg)
Editable text hereBASIC TRAININGBasic Training
Colour score
![Page 27: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/27.jpg)
Editable text hereBASIC TRAININGBasic Training
Use of colour or power Doppler
![Page 28: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/28.jpg)
Editable text hereBASIC TRAININGBasic Training
Use of Pulse Repetition Frequency (PRF)
0.1
0.3
0.9
0.6
1.3
1.8
![Page 29: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/29.jpg)
Editable text hereBASIC TRAININGBasic Training
PRF fixed at 0.3, lower GAIN…
![Page 30: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/30.jpg)
Editable text hereBASIC TRAININGBasic Training
Ascites
• Fluid outside the pouch of Douglas
![Page 31: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/31.jpg)
Editable text hereBASIC TRAININGBasic Training
How to measure an ovary, a lesion or a
solid component in a lesion• Three orthogonal diameters
• Where the lesion/ ovary/ solid component appears
to be at its largest
– Maximum diameter
– Mean diameter
– Volume: (L x D x W x 0.5)
X
Y Z
![Page 32: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/32.jpg)
Editable text hereBASIC TRAININGBasic Training
How to measure a papillary projection• All papillary projections are measured in two
perpendicular planes: height and base
![Page 33: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/33.jpg)
Editable text hereBASIC TRAININGBasic Training
How to measure a papillary projection
![Page 34: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/34.jpg)
Editable text hereBASIC TRAININGBasic Training
Maximum diameter of largest solid component
![Page 35: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/35.jpg)
Editable text hereBASIC TRAININGBasic Training
Key points• Using IOTA terms and definitions can help standardise the way we describe
and classify masses
• There are 5 types of ovarian lesions: unilocular, unilocular-solid,
mutlilocular, multilocular-solid, solid
• A solid component = structure that has (high) echogenicity suggestive of
tissue
• A papillary projection is a solid component attached to the ovarian cyst wall
that measures ≥3mm (<3mm is a cyst wall irregularity)
• The PRF must be adjusted to 0.3-0.6 KHz (3-6 cm/s) when assessing
vascularity with Doppler
![Page 36: ISUOG Basic Training · • There are 5 types of ovarian lesions: unilocular, unilocular-solid, mutlilocular, multilocular-solid, solid • A solid component = structure that has](https://reader036.vdocuments.net/reader036/viewer/2022081402/605784b5349dd576410ce39f/html5/thumbnails/36.jpg)
Editable text hereBASIC TRAININGBasic Training
ISUOG Basic Training by ISUOG is licensed under a Creative Commons Attribution-NonCommercial-
NoDerivatives 4.0 International License.
Based on a work at https://www.isuog.org/education/basic-training.html.
Permissions beyond the scope of this license may be available at https://www.isuog.org/