Common pitfalls of endovaginal color Doppler flow imaging.

Endovaginal color Doppler flow imaging is a relatively new technique that combines gray-scale sonography with duplex Doppler and color Doppler flow techniques. However, such imaging is associated with multiple pitfalls. Technical errors are caused by improper setting of the color flow parameters. The color velocity scale, color priority, color gain, color sensitivity, and color wall filter should be adjusted to optimize color flow information. Technical errors may result in false diagnosis of ovarian torsion, malignancy, and ectopic pregnancy. Errors in interpretation result from an inability to identify and correctly characterize tissue vascularity. Such errors include failure to distinguish placental from luteal flow and failure to characterize adnexal masses accurately. In addition, functional ovarian cysts may demonstrate increased vascularity throughout the menstrual cycle and simulate cancer. Recognition of the common pitfalls of endovaginal color Doppler flow imaging and integration of clinical and sonographic features will reduce misinterpretation and improve diagnostic accuracy.