3 IntroductionUltrasound or ultrasonography is a medical imaging technique that uses high frequency exceeding 20,000 Hz sound waves and their echoes. When sound waves are transmitted into the body, they interact with tissues and become attenuated (reduction of signal strength) by absorption, scattering, and beam divergence.Reflected sound waves (echoes) are displayed on an image as varying shades of gray (gray scale) relative to their intensity and are dependent on the number of binary digits that can be stored in the digital memory of the equipment.The technique is similar to the echolocation used by bats, whales and dolphins, as well as SONAR used by submarines.US SCAN: Sound waves that are beamed into the body causing return echoes that are recorded to 'visualize' structures beneath the skin."
4 Two dimensional ultrasound : Gel:"A trans-sonic material which eliminates the air interface between the transducer and the skin.“Velocity of sound:The speed that a sound way travels atTwo dimensional ultrasound :This process is the standard ultrasound performed.
5 Endoscopic ultrasound: "A procedure that combines endoscopy and ultrasound to obtain images and information about the digestive tract and the surrounding tissues and organs."Transvaginal ultrasound:A technique in which sound waves are sent out by an ultrasound probe that has been inserted in the vagina. The waves go through the vaginal wall and bounce off the ovaries, and a computer uses the ultrasound echoes to create a picture [which is known as a sonogram]."
6 Ultrasound Nomenclature • Echogenic: the ability of a structure to produce echoes • Anechoic: no echoes and sonolucent—appears black on ultrasound. • Hypoechoic: less reflective and low amount of echoes when compared with neighboring structures, appears as varying shades of darker gray. • Hyperechoic: highly reflective and echo rich when compared with neighboring structures, appears as varying shades of lighter gray; the term echogenic is often used interchangeably. • Isoechoic: having similar echogenicity to a neighboring structure.A hypoechoic (H) mass within the right lobe of the liverAnechoic distended urinary bladder
7 The kidney (K) is isoechoic to the liver. The liver (L) contains two areas (arrows) that are hyperechoic when compared with the rest of the moderate echogenicity of the liver parenchymaThe kidney (K) is isoechoic to the liver.
8 Posterior acoustic shadowing: Ultrasound wave hits a substance that causes near total reflectionEverything behind the blocking structure appears black (since no energy is getting through)Common causes: Bone ,gallstones, kidney stones, calcificationPosterior acoustic enhancement:Ultrasound waves pass through an area of low resistance with little attenuation (ie little loss of energy)As it hits a denser substance behind it, the energy is dispersed and “lights up” the deeper tissuesCommon causes Cyst, Gallbladder, BladderGallbladder stoneOvarian cyst
9 Ultrasound Texture• Homogeneous: organ parenchyma is uniform in echogenicity.• Inhomogeneous or heterogeneous: organ parenchyma is not uniform in echogenicity.Normal uniform texture of the liver. Anechoic structures within the liver represent vessels and ducts.Non uniformed appearance of the liver parenchyma representing metastatic liver disease.
10 Ultrasound Description of Masses Simple cyst (A transabdominal sagittal image of a female pelvis).A unilocular, anechoic, smooth-walled mass (M) with posterior enhancement is demonstrated that meets the criteria for a simple cyst.
11 Complex Cyst: • Septations that appear as echogenic hair-like strands within mass. • Multilocular compartments (cluster of cysts). • Internal low-level echoes that may indicate hemorrhage or infection. • Fluid-fluid layers that may represent blood, fluid, or fat layers • Calcification that appears as highly reflective echoes (hyperechoic) with posterior shadowingA transabdominal sagittal image of the left adnexa of a female demonstrating a large cystic mass (M) containing a thin, echogenic, hair-like structure (arrows).This is consistent with a septation in a benign complex cyst.A transabdominal transverse image of the left ovary demonstrates a large cystic mass with multiple loculations /compartments (*). Note the appearance, which looks like a cluster of cysts. This is characteristic of a multilocular cyst due to the absence of solid components and absence of irregularities.Urinary bladder (UB), uterus (U).
12 Complex cyst.A transvaginal sagittal image of the right adnexa in a female patient demonstrating a cyst (C) containing internal solid echogenic components representing hemorrhage.Echogenic hemorrhage within a cystic mass may mimic a malignant tumor. Doppler may be able to detect internal vascularity, which is frequently seen in malignant tumors.
13 Solid Mass • Homogeneous or inhomogeneous. • Hypoechoic to hyperechoic Solid Mass • Homogeneous or inhomogeneous. • Hypoechoic to hyperechoic. • May attenuate sound partially or completely. • May contain anechoic or hypoechoic areas within the solid mass representing necrotic changes. • Posterior enhancement that may be seen when necrotic changes occur.Solid mass.A trans-vaginal coronal image demonstrating a hypoechoic solid mass (M), which is inhomogeneous and has partial sound attenuation (A).