Journal of Infection and Public Health 14 (2021) 84–88

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Journal of Infection and Public Health

journal homepage: http://www.elsevier.com/locate/jiph

A quantitative analysis infection of ovarian cyst based on examination

data of computed tomography and type-B ultrasonography
Yan Tang, Ting Han ∗
Hunan Maternal and Child Health Hospital, No.53 Xiangchun Road, Changsha City, Hunan Province, 410008, China

a r t i c l e i n f o a b s t r a c t

Article history: In order to explore the accuracy of computed tomography (CT) and type-B ultrasonography in the exam-
Received 22 May 2019 inations infection of ovarian cyst, the computed tomography and type-B ultrasonography were used for
Received in revised form 1 August 2019 the examinations of 50 patients with infection of ovarian cysts, whose results were analyzed to determine
Accepted 4 August 2019
the accuracy. Results have shown that the misdiagnosis rates of CT for patients with infection of ovarian
cyst reached 18%, in which the misdiagnosis rate of small lesion 2.1 × 1.5 × 1.8 cm was relatively higher;
Keywords:
in addition, the misdiagnosis rates of type-B ultrasonography reached 26%, in which the misdiagnosis
CT
rate of large lesion 2.6 × 1.6 × 1.5 cm was relatively higher; however, the misdiagnosis rates of the joint
Type-B ultrasonography
Lesions
examination of these methods were only 2%. In summary, the deficiencies of CT and type-B ultrasonog-
Ovarian cyst raphy may lead to misdiagnosis; therefore, in the clinical practices, the examinations of patients with
infection of ovarian cyst should combine CT and type-B ultrasonography together to avoid the misdiag-
nosis and obtain the most accurate results as much as possible, which is important to both the patients
and the development of medical examinations.
© 2019 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud Bin Abdulaziz
University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction examinations [4,5]. However, large cysts could cause compression

The infection of ovarian cyst often occurs to the broad ligament
between the ovaries and the uterus; it is a common cystic lesion
of the uterine adnexa, which accounts for about 10%–20% of the
adnexal mass [1]; the incidence rates of children and adolescents
are about 7.3%, in which the vast majority are benign simple cysts;
however, studies have reported that nearly 25% of the infection
of ovarian cysts are neoplastic cysts, thereby the correct diagno-
sis before surgeries is difficult to obtain [2,3]; thus, the neoplastic
cysts are easily misdiagnosed as other cystic lesions of the pelvic
cavity. The reasons for misdiagnosis include the similarity infection
of ovarian cysts and other cystic lesions, which makes it difficult to
identify the infection of ovarian cysts, and the ignorant of certain
examiners who know nothing about the diagnosis infection of ovar-
ian cysts. Based on the sources of tissues, the infection of ovarian
cysts are classified into 3 types, i.e. the Wolffian duct, the Mullerian
duct, and the mesothelium sources. Ovarian cysts are often sim-
ple cysts, most of which have no symptoms, and are often found
by accidental findings during surgeries or female pelvic imaging
∗ Corresponding author.
E-mail address: hanting9027@126.com (T. Han).
symptoms and rare complications in correspondence, such as the
torsions of the cysts, the complicated hemorrhage, and the rup-
ture of the cysts; in addition, rare complications also include the
boundary or the malignant cystadenoma occurred to the infec-
tion of ovarian cysts [6]. Most of the infection of ovarian cysts are
benign cystic lesions, and the rate of malignant transformation is
extremely low. It is reported in the literature that about 2–3% the
infection of ovarian cysts transformed from benign to malignant,
and the situation is more common in patients in reproductive ages
whose cyst diameter exceeds 5 cm.
Patients whose cyst diameter has exceeded 5 cm should be
actively treated with surgical treatments; the reason is that with
the increase of the cysts, various discomfort symptoms would occur
[7]; especially, the medium-sized cysts are prone to acute torsion of
pedicle, in which the venous return is blocked, the tumor is highly
congested, and even the blood vessels are ruptured, resulting in
a sharp increase in the tumor body [8]; consequently, the arterial
perfusion is blocked, and the tumor necrosis becomes purple-black
which is prone to rupture and secondary infections. Surgical treat-
ments are laparoscopy and laparotomy. Currently, the laparoscopic
removal of ovarian cyst is the primary treatment for the disease
[9,10].

https://doi.org/10.1016/j.jiph.2019.08.003
1876-0341/© 2019 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 Y. Tang, T. Han / Journal of Infection and Public Health 14 (2021) 84–88
In summary, computed tomography and type-B ultrasonog-
raphy were used for the examinations of 50 patients with the
infection of ovarian cysts, whose results were analyzed to deter-
mine the accuracy. The research results have shown that the
misdiagnosis rates of computed tomography for patients with the
infection of ovarian cyst reached 18%, in which the misdiagnosis
rate of small lesion 2.1 × 1.5 × 1.8 cm was relatively higher; in addi-
tion, the misdiagnosis rates of type-B ultrasonography reached 26%,
in which the misdiagnosis rate of large lesion 2.6 × 1.6 × 1.5 cm
was relatively higher; however, the misdiagnosis rates of the
joint examination of these methods were only 2%. In summary,
it was explained that the single examination results of either
computed tomography or type-B ultrasonography may be misdiag-
nosis; therefore, the joint examinations of computed tomography
and type-B ultrasonography could avoid the misdiagnosis and
obtain the most accurate results as much as possible, which is
important to both the patients and the development of medical
examinations.
Methodology
Research objects
A total of 50 cases with infection of ovarian cyst in 2005–2015
who were diagnosed by surgeries and pathological sections with
complete examination data of computed tomography (CT) and
type-B ultrasonography were obtained through the Hospital Infor-
mation System (HIS) and the Picture Achieving and Communication
System (PACS); patients of the selected cases aged 18–75 years
old, with an average of 45 ± 11 years old. Among all the 50 cases,
10 cases were admitted to the hospital due to lower abdominal
discomfort; 16 cases were discovered through physical examina-
tions or accidental findings without any symptoms; 24 cased were
unintentionally discovered due to the surgeries of other lesions
(such as including uterine myoma, ovarian cystadenoma, teratoma,
endometriosis, endometrioid carcinoma of ovaries, and ovarian
cystic adenofibroma).
Ovarian cysts
The infection of ovarian cyst is the tumor occurred to ovaries
often found in younger patients with benign to malignant progno-
sis. The infection of ovarian cyst has uncleared etiological factors
with latent onset, which should be diagnosed through the com-
prehensive results of imaging examinations and tumor markers,
and the final diagnosis requires the results of pathological sec-
tions. The primary therapeutic plans for the infection of ovarian
cysts are surgeries; however, the appropriate surgical treatments
should be individualized with strict follow-ups. In patients with
early stage and desirous to preserve fertility, if no high-risk factors
are found, adnexectomy or cystectomy of the lesion side may be
performed. However, long-term follow-ups must be performed to
these patients for the timely discovery of recurrence and appropri-
ate therapeutic plans. In patients with late-stage or unnecessary to
preserve fertility, radical surgeries should be performed. With the
advance of medicine and the implementation of minimally invasive
treatments, laparoscopy has been widely applied as surgical treat-
ments. However, the diagnostic and therapeutic system of ovarian
cyst with infection is immature, which requires further research
and practices to standardize and improve the therapeutic plans
infection of ovarian cyst with infection.
Computed tomography and type-B ultrasonography
Computed tomography obtains the anatomical images of the
cross-sections of the human body through perspective X-rays;
85
the type-B ultrasonography obtains the echogenic images through
ultrasonic waves, which are also cross-section images. In terms of
the harmful effects on the human body, the X-rays used in CT scans
would have certain side effects on humans once being over-used;
in addition, pregnant women must not be submitted to CT scans;
on the contrary, type-B ultrasonography is generally safe. In terms
of the application scopes, CT is applicable to any parts and sites
of the human body; however, since type-B ultrasonography uses
ultrasonic waves, it is inapplicable to certain parts of the human
body, such as the intestines and lungs that are full of air, and the
head that is osseous, etc.
Examination procedures of computed tomography
(1) The information data of the examinees are input based on the
CT examination application forms, such as names, genders, ages, CT
identifiers, examination sites, and special annotations, etc. Then,
the parameters such as the directions and positions of the exam-
inees on the examination bed are selected, such as the choice of
head-in or foot-in, supine or prone positions, the left or right lateral
positions, etc.
(2) The choice of CT body positions refers to the process of accu-
rately and safely placing the examinees on the examination bed
based on the requirements of the CT examination application forms.
The examinees should be placed as comfortable as possible with-
out affecting the scan. At the same time, it is necessary to use the
auxiliary devices provided by the machine reasonably, such as the
head gantry. The directions and positions of the examinees on the
examination bed must be consistent with the orientations of the
registered input. The height of the examination bed is generally set
at the center of the inspection site, and the length into the scan
module should be determined in accordance with the length of the
scan sites and the positioning images.
(3) The scan positioning images determine the positive position-
ing images or the lateral positioning images of the scan based on the
characteristics of the inspection sites. The length of the positioning
images is determined by the length of the inspection sites. After the
positioning images are scanned and displayed, the starting line and
the ending line of the scan, the field of views of the scanned images,
and the angles of the scanning tilt, etc. are determined based on the
positioning images.
(4) The scan examination is performed. Based on the require-
ments of clinicians and the characteristics of each site, the
reasonable scan parameters are determined, such as slice thick-
ness, scan velocity, bed spacing, kV, mA, etc., as well as the modes
of axial scan and helical scan. In terms of the enhanced scan, the
optimal scan time and scan phase should be selected. After all the
scan parameters have been determined, the exposure button is
pressed to start the scan. During the scan, the operator must care-
fully observe the display of the images and the conditions of the
examinees. After the exposure is over, the clearance of all scanned
images is observed. If it is determined that no additional scans or
other processes are required, the end button is pressed to exit the
scan.
(5) At the end of the examination, the back button is pressed to
lower the height of the examination bed and the examinees should
leave the scan room.
Examination procedures of type-B ultrasonography
The working environment conditions are that the ambient tem-
perature is 10–40 ◦ C, the relative humidity is 30–80%, and the
atmospheric pressure is 700–1060 hPa. The working power sup-
ply environment conditions are that the voltage allowable range is
200–400 V, the frequency is 50–60 Hz, the input power is 500 mA,
the output power of the host socket is ≤250 mA. Afterward, the
86 Y. Tang, T. Han / Journal of Infection and Public Health 14 (2021) 84–88

Fig. 1. Flowchart of type-B ultrasonography.

probe should be rinsed and disinfected. The probe to be used should

be checked then rinsed and disinfected based on the purposes of
use. The regulated power is switched on; once the voltage is stable,
the instrument is switched on, the images are frozen; after proper
pre-heating, the scan is started. The power of the instrument should
be switched off once the scan is terminated, the images are frozen,
the VCR tapes and other recording devices are rewound, the instru-
ment is switched off, and the regulated power is switched off, as
shown in Fig. 1.

Image processing and analysis

Results of CT and type-B ultrasonography were analyzed in

terms of the analysis of lesion sites, the dimensions, the mor-
phology, the thickness of oviduct walls and septum, the signals of
cystic fluid, the enhanced performances, and the positional rela-
tions between the lesion site and the ovary on the same side.
Results and discussion
Results of type-B ultrasonography
All the 50 patients were submitted to pelvic and abdominal col-
ored Doppler ultrasonography before surgeries, in which patients
with sexual experiences were submitted to the transvaginal pelvic
and abdominal colored Doppler ultrasonography, patients without
sexual experiences were submitted to abdominal colored Doppler
ultrasonography. Of all the lesions, there were 10 cases of misdi-
agnosis with the largest lesion of 2.6 × 1.6 × 1.5 cm; in addition, 18
cases involved bilateral ovaries and 11 cases involved unilateral
Fig. 2. misdiagnosis rates of type-B ultrasonography.
ovaries. Moreover, there were 4 cases of cystic lesions, 3 cases of
solid-cystic lesions, and only 1 case of solid lesions. It was seen
that the tumor components are mainly solid-cystic, and some of
the tumors are accompanied by a nipple-like structure. In terms
of serous boundary tumors, the single-atrial and nipple-containing
cysts are the majority, and the average diameter is relatively small;
in terms of the fluid boundary tumors, most of the cysts are accom-
panied by atrial septum with uneven intracystic signals, solid areas,
or dense atrial septum, and are larger in volumes, whose aver-
age diameter is larger than that of the serous boundary tumors.
All patients with ovarian tumors were showed in colored Doppler
ultrasonographic images, which indicated that the misdiagnosis
rate of ovarian cysts with infection of type-B ultrasonography was
26%, as shown in Figs. 2 and 3.
 Y. Tang, T. Han / Journal of Infection and Public Health 14 (2021) 84–88 87

Fig. 3. Images of type-B ultrasonography (a: the largest lesion was 2.6 × 1.6 × 1.5 cm; b: the smallest lesion was 2.1 × 1.5 × 1.8 cm).

Fig. 4. misdiagnosis rates of computed tomography.

Fig. 5. Images of computed tomography (a: the largest lesion was 2.6 × 1.6 × 1.5 cm; b: the smallest lesion was 2.1 × 1.5 × 1.8 cm).

Results of computed tomography
There were 50 ovarian cysts in 50 cases; only 3 cases were diag-
nosed accurately before surgeries; 23 cases were misdiagnosed,
and the misdiagnosis rate was as high as 46%. Among the 23 mis-
diagnosed lesions, the largest lesion was 2.6 × 1.6 × 1.5 cm, and the
11 lesions with a maximum diameter of less than 2.0 cm were
all missed; 2 lesions were misdiagnosed due to ipsilateral or con-
tralateral larger ovarian or oviduct lesions. In addition, of all the 23
misdiagnosed lesions, the smallest lesion was 2.1 × 1.5 × 1.8 cm; 8
cases were misdiagnosed as ovarian cysts, 1 case was misdiagnosed
as ovarian cystadenoma, 1 case was misdiagnosed as hydrosalpinx,
1 case was misdiagnosed as ovarian teratoma, and 1 case was gen-
erally misdiagnosed as the adnexal cyst. Through the retrospect of
the image analysis, it was found that CT had detected a total of 27
lesions, in which 8 cases were not shown on the CT images due to
small lesions (<0.5 mm), 2 cases were unclear in CT images due to
large ovarian mucous cystadenoma and severe hydrosalpinx, and
3 cases were difficult to identify since the lesion sizes were simi-
lar to that of the ipsilateral ovarian multiple cysts and multi-atrial
cystadenoma, and the sizes of normal follicles; therefore, the mis-
diagnosis rate infection of ovarian cysts by CT was 18%, as shown
in Figs. 4 and 5.
Joint results of type-B ultrasonography and computed tomography
It was seen from Fig. 6 that in the case of joint examination
of type-B ultrasonography and computed tomography, the diag-
88 Y. Tang, T. Han / Journal of Infection and Public Health 14 (2021) 84–88
Fig. 6. misdiagnosis rates of joint examination of type-B ultrasonography and computed tomography.
nosis rate of patients with ovarian cysts can reach 98%, which
greatly reduced the rate of misdiagnosis. It was inferred from
the above figures that the misdiagnosis rate of CT in small-sized
lesions was relatively high, and that of type-B ultrasonography in
large-size lesions was relatively high; therefore, the combination
of them could make a more accurate diagnosis of the disease. The
above-mentioned CT manifestations infection of ovarian cyst were
summarized as circular, oval, or gourd-like cystic lumps next to
the uterus in the pelvic cavity, with thin cystic walls and even den-
sity of cystic fluids; occasionally, the “thin-line-like” septum was
seen inside the cysts; features such as strengthened cystic walls
and cystic fluid and “thin-line-like” septum distributions in the
cysts were unseen through enhanced scans. Therefore, cystic lumps
with similar CT manifestations in the pelvic cavity could indicate
the diagnosis infection of ovarian cysts; especially if the normal
ovary of the lesion side was clearly shown through the multi-planar
reconstruction of multi-slice computed tomography (MSCT), the
diagnosis of the ovarian cyst was considered.
Conclusion
Computed tomography and type-B ultrasonography were used
for the examinations of 50 patients with an ovarian cyst, whose
results were analyzed to determine the accuracy. Results have
shown that the misdiagnosis rates of computed tomography for
patients with ovarian cyst reached 18%, in which the misdiagno-
sis rate of small lesion 2.1 × 1.5 × 1.8 cm was relatively higher; in
addition, the misdiagnosis rates of type-B ultrasonography reached
26%, in which the misdiagnosis rate of large lesion 2.6 × 1.6 × 1.5 cm
was relatively higher; however, the misdiagnosis rates of the joint
examination of these methods were only 2%. In summary, the defi-
ciencies of computed tomography and type-B ultrasonography may
lead to misdiagnosis; therefore, in the clinical practices, the exam-
inations of patients with ovarian cyst should combine computed
tomography and type-B ultrasonography together to avoid the mis-
diagnosis and obtain the most accurate results as much as possible,
which is important to both the patients and the development of
medical examinations. There are certain deficiencies in the research
progress; for example, the collected sample capacity is not large
enough in the experiment to accurately explored the mechanism.
Therefore, it is necessary to increase the sample capacity to conduct
a more detailed exploration of the characteristics.
Conflict of interest
None declared.
Acknowledgment
This work was supported by the scientific research project of
Hunan health commission (C2019027).
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