1 Is Ultrasonography helpful Gynecologic Diagnosis ? Azza Al-Yamani inGynecologic Diagnosis ?Azza Al-YamaniProf. of Obstetrics andGynecology
2 The objectives of this slide show are : * Know the principles of Ulrtasuond imaging.* Be familial with the US normal appearance ofdifferent pelvic structures.* Be able to interpret US images in commongynecologic pathology.* Be able to differentiate between USappearance of benign and malignant pelvicmasses.* Know the advantages of TV/ US overabdominal transducers in Gyn.
3 US imaging is a simple and noninvasive procedure that has the advantage of avoidingradiation hazards.It is especially helpful in patients in whompelvic exam. is difficult as children ,virgins &incooperative.
4 vaginal oocyte collection. Doppler sonographyCan measure the velocity profile of blood flowing through pelvic bl. vessels to differentiate benign from malignant adnexal masses.FinallyTV/US can be used to assist in performing invasive gynecological procedures asvaginal oocyte collection.
5 Transvaginal ultrasound (TV/US) has the advantage over the abdominal US in gynecology , becausethe close proximity of the intravaginal trancducerallows for high – frequency scanning and betterresolution of the pelvic organs .However , every TV/US examination should bepreceded by transabdominal imaging .
6 Technology Intermittent high – frequency sound waves are generated by applying an alternating electriccurrent to a transducer made of a piezoelectricmaterial.The transducer is connected to the abdominalwall by placing a water –soluble gel on the skinto diminish the loss of US waves at the interfacebetween the transducer and the skin.
7 The transducer emits a pulse of sound waves that passes through structures of different tissuedensities , some of the energy proportional tothe difference in densities is reflected or echoedback to the transducer.This in turn ,stimulates the transducer to generatea small electrical voltage that is then amplifiedand displayed on a screen .
9 Clinical Applications in gynecology The use of ultrasonography in the diagnosisof gynecological lesions can be summarizedin 3 indications :(1) Pelvic mass differentiation* Uterine masses.* Ovarian masses.cystic or solid* Adnexal masses.cystic or solid.
10 (2) evaluation of the uterine cavity including IUCD localization.(3) Early pregnancy complicationsincluding ectopic pregnancy.
11 (1) Pelvic Masses Uterine masses 1. Leiomyoma ( fibroid ) • more in the midline position.• contiguous with the uterus.• well defined.• homogeneous ,hypoechoic mass.• may have small cysts ( degeneration) ,or calcified areas (calcification).
12 N. Secretory N. proliferative endometrium endometrium
23 4. endometrial carcinoma • very important that it may not alter theuterine echo pattern.• prominent endometrial echo complex> 4mm in postmenopausal woman.• loss of the normal endometrial / myometrialjunction.• pyometria , or hematometria.
26 Ovarian masses 1.Cystic cystic mass free in the adenexal area not related to the uterus.a) Benign• < 5cm ( cystic ovary ) physiological .• walls of the cyst are well delineated .• echolucent .• sharply defined posterior border .• uniocular ,if multiocular the septa arethin walls.• no significant internal echo .
32 b) malignant Examples: * Serous cystadenocarcinoma. • > 5 cm .• bilateral in the majority.• multilocular.• echoic.• thick walls.• thick incomplete septa.• may, intracystic papillary projections.• may ,fluid in cul de sac.Examples:* Serous cystadenocarcinoma.* Mucinous cystadenocarcinoma.* Endometriod carcinoma.
33 malignant ovarian cyst with intracystic papillary projections
34 2. Solid Predominent solid ovarian mass in the adnexal area. a) benign • usually , bilateral.• well defined outlines.• hypoechoic.Examples:* Brenner ′ s tumors.* teratomas.* fibroma.
51 Key points 1. TV sonography with or without saline instillation is a primary investigation indiagnosis of uterine pathology in womenwith abnormal uterine bleeding.2.TV/S is useful in evaluation of ovarianmasses combined with color Doppler.3. Vaginal US is a gold standard fordiagnosis of PCO.4. TV/S has a crucial role in monitoring ofovulation ( folliculometry) in infertility .5. TV sonography is helpful in evaluationof early pregnancy complications.