Gynecological Ultrasound

Gynecological Ultrasound Pelvic Ultrasound: Sagittal Orientation Anterior Transabdominal Head Foot Transvaginal Posterior TA TV Uterus; Sag...
Author: 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 (