Transvaginal sonographic evaluation of multiple peripherally distributed echogenic foci of the ovary: prevalence and histologic correlation.

Abstract

Our aim was to determine the prevalence, histopathologic correlation, and clinical significance of multiple peripherally distributed echogenic foci seen within ovaries on transvaginal sonography. Transvaginal sonograms of 264 ovaries in 135 patients were prospectively analyzed for the presence of peripheral echogenic foci that were then characterized as linear, punctate, or globular. Previous examinations, when available, were reviewed for this sonographic feature, and the time interval between studies was recorded as a measure of stability. Sonograms were correlated with available surgical specimens in six patients, five of whom underwent hysterectomy and bilateral oophorectomy and the remaining patient who underwent laparoscopic ovarian wedge biopsy. Multiple peripheral echogenic foci were common and were found in 66 patients (49%) and 97 ovaries (37%). The punctate pattern was seen in 63 (95%) of 66 patients. The linear and globular patterns were present in only three and four patients, respectively. These echogenic foci were found on previous examinations in 18 patients. No suspicious sonographic features were seen in the ovaries of any of these patients. Histologic evaluation revealed multiple superficial epithelial inclusion cysts and associated psammomatous calcifications in all five patients who underwent bilateral oophorectomy. An additional finding in one of these patients was extensive endosalpingiosis. Multiple peripheral echogenic foci involving the ovaries is a common incidental finding on routine transvaginal sonography of the pelvis. Our data suggest that this sonographic finding represents psammomatous calcifications associated with superficial epithelial inclusion cysts.