 Introduction/Background Ovarian cancer is the fifth leading cause of cancer mortality among women in the United States, showing little improvement in survival over the last several decades [1,2]. In 2023, it is estimated that 19,710 women will be diagnosed with ovarian cancer in the United States, and 13,270 will die from their disease [3]. Prognostic factors associated with survival include both stage at diagnosis and treatment at a high-volume center with management by a gynecologist oncologist [4,5]. High-grade serous carcinoma, now thought to arise typically from fallopian tube epithelium, is most often diagnosed at late stage and accounts for nearly 80% of ovarian cancer deaths [1,6]. Identification of early-stage cancers is paramount for cancer-specific survival in ovarian cancer, but only 16% of patients are diagnosed at early stages. Although the 5-year relative survival for ovarian cancer is 49.1%, it increases to nearly 93% for stage I disease (confined to the ovaries/adnexa) [3]. Special Imaging Considerations Contrast-enhanced ultrasound: Contrast-enhanced ultrasound (CEUS) can be a useful real-time technique to demonstrate the presence of internal vascular soft tissue component in an indeterminate ovarian lesion that increases the risk of malignancy. Soft tissue enhancing earlier than or concurrent to the myometrium was found in 93.8% of malignant lesions in 1 study compared with 12.5% of benign lesions [11]. The International Ovarian Tumor Analysis (IOTA) simple rules performed well when applied to CEUS in 1 study, with reduction in indeterminate masses from 36.7% to 11.7% when using CEUS after conventional pelvic ultrasound (US) in a surgical cohort of suspected malignant masses [12]. Three-dimensional CEUS and 3-D contrast-enhanced power Doppler may be useful as adjunct to conventional US and 2-D CEUS [13,14].
Clinically Suspected Adnexal Mass No Acute Symptoms.  Introduction/Background Ovarian cancer is the fifth leading cause of cancer mortality among women in the United States, showing little improvement in survival over the last several decades [1,2]. In 2023, it is estimated that 19,710 women will be diagnosed with ovarian cancer in the United States, and 13,270 will die from their disease [3]. Prognostic factors associated with survival include both stage at diagnosis and treatment at a high-volume center with management by a gynecologist oncologist [4,5]. High-grade serous carcinoma, now thought to arise typically from fallopian tube epithelium, is most often diagnosed at late stage and accounts for nearly 80% of ovarian cancer deaths [1,6]. Identification of early-stage cancers is paramount for cancer-specific survival in ovarian cancer, but only 16% of patients are diagnosed at early stages. Although the 5-year relative survival for ovarian cancer is 49.1%, it increases to nearly 93% for stage I disease (confined to the ovaries/adnexa) [3]. Special Imaging Considerations Contrast-enhanced ultrasound: Contrast-enhanced ultrasound (CEUS) can be a useful real-time technique to demonstrate the presence of internal vascular soft tissue component in an indeterminate ovarian lesion that increases the risk of malignancy. Soft tissue enhancing earlier than or concurrent to the myometrium was found in 93.8% of malignant lesions in 1 study compared with 12.5% of benign lesions [11]. The International Ovarian Tumor Analysis (IOTA) simple rules performed well when applied to CEUS in 1 study, with reduction in indeterminate masses from 36.7% to 11.7% when using CEUS after conventional pelvic ultrasound (US) in a surgical cohort of suspected malignant masses [12]. Three-dimensional CEUS and 3-D contrast-enhanced power Doppler may be useful as adjunct to conventional US and 2-D CEUS [13,14].