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Gynecological Ultrasound
Gynecological Ultrasound Pelvic Ultrasound: Sagittal Orientation Anterior Transabdominal Head Foot Transvaginal Posterior TA TV Uterus; Sag...
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Theodore George
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Gynecological Ultrasound
Pelvic Ultrasound: Sagittal Orientation Anterior
Transabdominal Head
Foot
Transvaginal
Posterior
TA
TV
Uterus; Sagittal View Abdominal and Transvaginal Pre-menarchal z Adult z Post-menopausal z
Endometrium z z z z z z z
Proliferative Secretory Menstrual Postpartum Post-menopausal Post-menopausal + HRT Normal Sonohysterogram (Hysterosonogram)
Ovaries Pre-menarchal z Adult z Post-menopausal z
Follicular Development and Ovarian Flow
Day 10
Day 12
Early luteal
Late luteal
Colour doppler z
Vascular anatomy – Confirmation of normal architecture – Exploration of unusual or abnormal architecture – Patterns of shape and distribution
z
Guide for pulsed doppler – Location and identity of vessels – Direction of interrogation
z
Non-vascular – Fluids in motion – Surfaces in motion
Doppler Wave Forms and Arterial Structure
Sites for Colour and Pulsed Doppler Detection in Normal and Abnormal Ovaries
Neovascularization New blood vessel formation z
Benign conditions – – – – – – – –
Ovulation (follicular development) Corpus luteum Placentation Ectopic pregnancy Wound healing Arthritis Chronic inflammation Benign tumors z z
z
Endometriomas Occasional fibroids
Malignancies
Pelvic Tumor Neovascularity
z
Optimizing Low Velocities and Small Vessels Colour doppler – – – –
Wall filters 0 Persistance 0 Gain , short of widespread artifact Other settings specific to machine z
e.g. Siemens Versa has a ‘low velocities’ setting
– A steady hand (minimize transducer motion) z
Pulsed doppler – – – –
All of the above plus; Angle of insonation (parallel vs. perpendicular) Angle adjustment Open gate z z
z
Multiple small vessels Tortuous vessels
Systematic search of multiple vessels –
Central, perpheral,septal, papillary projections, areas of cyst wall thickening
Neoplastic Risk in Adnexal Masses Risk is age and state dependent
High 0
0.2
Intermediate 0.4
0.6
Resistance Index
Low 0.8
1.0
Borderline Serous Cystadenoma
Endometriosis, Adenomyosis, Endometriomas z
Endometriosis – no signs
z
Adenomyosis – thickened uterine wall
z
Endometrioma – ovarian mass
An Endometrioma
Cervical Cancer z
Ultrasound – useless for either screening or diagnosis
Congenital Malformations of the Reproductive Tract z
Uterus – Bicornuate – Septate – Didelphus – Rudementary horn
z
Gartner’s duct cysts
Abnormal Endometrium z z z z z z z z z
Polyps Submucosal fibroids Synechiae Retained products of conception Tamoxifen Endometrial hyperplasia/cancer Hematocolpos Cervical stenosis IUCDs
Small Endometrial Polyp
Endometrial Polyp
Another Small Endometrial Polyp
Endometrial Polyp
Endometrial Carcinoma z
Detectable flow is unusual in – Normal endometrium – Atrophic endometrium – Most endometrial hyperplasias
Flow is usually detectable (91%) of endometrial Ca z Flow pattern shows low resistance (average RI ~ 0.42) z
IUCD
Abnormal Myometrium Fibroids z Leiomyosarcoma z
Myometrial Tumors Fibroids (Myomas, leiomyomas)
Leiomyosarcoma
peripheral vascularization
thin irregularly spaced vessels
some end-diastolic flow (e.g. RI = 0.6)
Low velocities (
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