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Ultrasound Technique and Anatomy
Douglas Rogers, MD; Marc S. Tubay, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        TERMINOLOGY

        • Abbreviations

          • Transabdominal ultrasound (TAUS)
          • Transvaginal ultrasound (TVUS)
          • Saline-infused sonohysterogram (SIS)
        • Definitions

          • Ultrasound is imaging modality that transmits high-frequency sound waves into tissues and generates images from reflected waves
            • TAUS provides large field of view
              • Lower frequencies are used to allow for greater depth of view
                • Results in lower resolution images
              • Useful for large masses
              • Characterizes lesions that are out of range of vaginal probe
              • Mid- to late gestations are generally better evaluated with TAUS
            • TVUS provides higher resolution images of uterus, cervix, and adnexa
              • Higher frequencies allow for higher resolution images but with constrained field of view
              • Key modality for uterine, cervical, and adnexal pathology
              • Useful to evaluate early pregnancy
          • B-mode (grayscale, 2D mode) ultrasound
            • Reflected sound wave data is reconstructed to produce 2D grayscale image of plane of tissue
            • Most commonly used mode
          • M-mode ultrasound
            • Column of tissue perpendicular to probe is interrogated to evaluate for motion/velocity
            • Demonstrates embryonic/fetal cardiac activity and heart rate
          • Doppler ultrasound uses frequency shifts of reflected sound waves to detect flowing blood
            • Color Doppler: Flow is assigned color based on direction of flow and overlaid on B-mode images
            • Power Doppler: Measures intensity of Doppler shift overlaid on grayscale image; more sensitive than color Doppler for detection of slow flow
            • Pulsed-wave (spectral) Doppler: Velocity tracing is generated, allowing for waveform analysis
              • Duplex Doppler: Pulsed-wave Doppler displayed with grayscale anatomic images
              • Triplex Doppler: Pulsed-wave Doppler displayed with grayscale images overlaid with color Doppler
            • Superb microvascular imaging: New technique with high sensitivity for blood flow within small diameter and slow-flow vessels
          • 3D ultrasound
            • Acquires volume of ultrasound data that can be manipulated at ultrasound machine or at dedicated workstation to produce multiplanar images or 3D reconstructions
            • Can produce images of similar orientation and quality to MR
          • 4D ultrasound: 3D ultrasound data is acquired continuously over time
            • Allows generation of 3D sonographic movies

        PREPROCEDURE

        • Indications

          • Contraindications

            • Getting Started

              PROCEDURE

              • Patient Position/Location

                • Equipment Preparation

                  • Procedure Steps

                    • Findings and Reporting

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Expected Outcome

                          • Things to Do

                            Selected References

                            1. Shwayder JM: Normal pelvic anatomy. Obstet Gynecol Clin North Am. 46(4):563-80, 2019
                            2. Cunningham RK et al: Adenomyosis: a sonographic diagnosis. Radiographics. 38(5):1576-89, 2018
                            3. Van den Bosch T et al: Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Pract Res Clin Obstet Gynaecol. 51:16-24, 2018
                            4. Armstrong L et al: Three-dimensional volumetric sonography in gynecology: an overview of clinical applications. Radiol Clin North Am. 51(6):1035-47, 2013
                            5. Sakhel K et al: Begin with the basics: role of 3-dimensional sonography as a first-line imaging technique in the cost-effective evaluation of gynecologic pelvic disease. J Ultrasound Med. 32(3):381-8, 2013
                            6. Shek KL et al: Pelvic floor ultrasonography: an update. Minerva Ginecol. 65(1):1-20, 2013
                            7. Andreotti RF et al: Sonographic evaluation of acute pelvic pain. J Ultrasound Med. 31(11):1713-8, 2012
                            8. Langer JE et al: Imaging of the female pelvis through the life cycle. Radiographics. 32(6):1575-97, 2012
                            9. Hajishaiha M et al: Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions. Int J Womens Health. 3:353-7, 2011
                            10. American Institute of Ultrasound in Medicine: AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med. 29(1):166-72, 2010
                            11. Dietz HP: Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 202(4):321-34, 2010
                            12. Forsberg F et al: Comparing image processing techniques for improved 3-dimensional ultrasound imaging. J Ultrasound Med. 29(4):615-9, 2010
                            13. Fleischer AC et al: Contrast-enhanced transvaginal sonography of benign versus malignant ovarian masses: preliminary findings. J Ultrasound Med. 27(7):1011-8; quiz 1019-21, 2008
                            14. Saul LL et al: Is transabdominal sonography of the cervix after voiding a reliable method of cervical length assessment? J Ultrasound Med. 27(9):1305-11, 2008
                            15. Valsky DV et al: Three-dimensional transperineal ultrasonography of the pelvic floor: improving visualization for new clinical applications and better functional assessment. J Ultrasound Med. 26(10):1373-87, 2007
                            16. Timor-Tritsch IE et al: Three-dimensional inversion rendering: a new sonographic technique and its use in gynecology. J Ultrasound Med. 24(5):681-8, 2005
                            17. Bega G et al: Three-dimensional ultrasonography in gynecology: technical aspects and clinical applications. J Ultrasound Med. 22(11):1249-69, 2003
                            18. Jermy K et al: The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol. 17(2):140-4, 2001
                            19. Brown DL et al: Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology. 208(1):103-10, 1998
                            20. Lee W: How to interpret the ultrasound output display standard for higher acoustic output diagnostic ultrasound devices. J Ultrasound Med. 17(8):535-8, 1998
                            21. Langer RD et al: Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. Postmenopausal Estrogen/Progestin Interventions Trial. N Engl J Med. 337(25):1792-8, 1997
                            22. Lev-Toaff AS: Sonohysterography: evaluation of endometrial and myometrial abnormalities. Semin Roentgenol. 31(4):288-98, 1996
                            23. Levine D et al: Sonography of ovarian masses: poor sensitivity of resistive index for identifying malignant lesions. AJR Am J Roentgenol. 162(6):1355-9, 1994
                            24. Freimanis MG et al: Transvaginal ultrasonography. Radiol Clin North Am. 30(5):955-76, 1992
                            25. Levine D et al: Simple adnexal cysts: the natural history in postmenopausal women. Radiology. 184(3):653-9, 1992
                            26. Lyons EA et al: Transvaginal sonography of normal pelvic anatomy. Radiol Clin North Am. 30(4):663-75, 1992
                            27. Platt JF et al: Ultrasound of the normal nongravid uterus: correlation with gross and histopathology. J Clin Ultrasound. 18(1):15-9, 1990
                            28. Forrest TS et al: Cyclic endometrial changes: US assessment with histologic correlation. Radiology. 167(1):233-7, 1988
                            29. Fleischer AC et al: Sonographic depiction of normal and abnormal endometrium with histopathologic correlation. J Ultrasound Med. 5(8):445-52, 1986
                            30. Schwimer SR et al: The effect of ultrasound coupling gels on sperm motility in vitro. Fertil Steril. 42(6):946-7, 1984
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Preprocedure

                                • Procedure

                                  TERMINOLOGY

                                  • Abbreviations

                                    • Transabdominal ultrasound (TAUS)
                                    • Transvaginal ultrasound (TVUS)
                                    • Saline-infused sonohysterogram (SIS)
                                  • Definitions

                                    • Ultrasound is imaging modality that transmits high-frequency sound waves into tissues and generates images from reflected waves
                                      • TAUS provides large field of view
                                        • Lower frequencies are used to allow for greater depth of view
                                          • Results in lower resolution images
                                        • Useful for large masses
                                        • Characterizes lesions that are out of range of vaginal probe
                                        • Mid- to late gestations are generally better evaluated with TAUS
                                      • TVUS provides higher resolution images of uterus, cervix, and adnexa
                                        • Higher frequencies allow for higher resolution images but with constrained field of view
                                        • Key modality for uterine, cervical, and adnexal pathology
                                        • Useful to evaluate early pregnancy
                                    • B-mode (grayscale, 2D mode) ultrasound
                                      • Reflected sound wave data is reconstructed to produce 2D grayscale image of plane of tissue
                                      • Most commonly used mode
                                    • M-mode ultrasound
                                      • Column of tissue perpendicular to probe is interrogated to evaluate for motion/velocity
                                      • Demonstrates embryonic/fetal cardiac activity and heart rate
                                    • Doppler ultrasound uses frequency shifts of reflected sound waves to detect flowing blood
                                      • Color Doppler: Flow is assigned color based on direction of flow and overlaid on B-mode images
                                      • Power Doppler: Measures intensity of Doppler shift overlaid on grayscale image; more sensitive than color Doppler for detection of slow flow
                                      • Pulsed-wave (spectral) Doppler: Velocity tracing is generated, allowing for waveform analysis
                                        • Duplex Doppler: Pulsed-wave Doppler displayed with grayscale anatomic images
                                        • Triplex Doppler: Pulsed-wave Doppler displayed with grayscale images overlaid with color Doppler
                                      • Superb microvascular imaging: New technique with high sensitivity for blood flow within small diameter and slow-flow vessels
                                    • 3D ultrasound
                                      • Acquires volume of ultrasound data that can be manipulated at ultrasound machine or at dedicated workstation to produce multiplanar images or 3D reconstructions
                                      • Can produce images of similar orientation and quality to MR
                                    • 4D ultrasound: 3D ultrasound data is acquired continuously over time
                                      • Allows generation of 3D sonographic movies

                                  PREPROCEDURE

                                  • Indications

                                    • Contraindications

                                      • Getting Started

                                        PROCEDURE

                                        • Patient Position/Location

                                          • Equipment Preparation

                                            • Procedure Steps

                                              • Findings and Reporting

                                                • Alternative Procedures/Therapies

                                                  POST PROCEDURE

                                                  • Expected Outcome

                                                    • Things to Do

                                                      Selected References

                                                      1. Shwayder JM: Normal pelvic anatomy. Obstet Gynecol Clin North Am. 46(4):563-80, 2019
                                                      2. Cunningham RK et al: Adenomyosis: a sonographic diagnosis. Radiographics. 38(5):1576-89, 2018
                                                      3. Van den Bosch T et al: Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Pract Res Clin Obstet Gynaecol. 51:16-24, 2018
                                                      4. Armstrong L et al: Three-dimensional volumetric sonography in gynecology: an overview of clinical applications. Radiol Clin North Am. 51(6):1035-47, 2013
                                                      5. Sakhel K et al: Begin with the basics: role of 3-dimensional sonography as a first-line imaging technique in the cost-effective evaluation of gynecologic pelvic disease. J Ultrasound Med. 32(3):381-8, 2013
                                                      6. Shek KL et al: Pelvic floor ultrasonography: an update. Minerva Ginecol. 65(1):1-20, 2013
                                                      7. Andreotti RF et al: Sonographic evaluation of acute pelvic pain. J Ultrasound Med. 31(11):1713-8, 2012
                                                      8. Langer JE et al: Imaging of the female pelvis through the life cycle. Radiographics. 32(6):1575-97, 2012
                                                      9. Hajishaiha M et al: Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions. Int J Womens Health. 3:353-7, 2011
                                                      10. American Institute of Ultrasound in Medicine: AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med. 29(1):166-72, 2010
                                                      11. Dietz HP: Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 202(4):321-34, 2010
                                                      12. Forsberg F et al: Comparing image processing techniques for improved 3-dimensional ultrasound imaging. J Ultrasound Med. 29(4):615-9, 2010
                                                      13. Fleischer AC et al: Contrast-enhanced transvaginal sonography of benign versus malignant ovarian masses: preliminary findings. J Ultrasound Med. 27(7):1011-8; quiz 1019-21, 2008
                                                      14. Saul LL et al: Is transabdominal sonography of the cervix after voiding a reliable method of cervical length assessment? J Ultrasound Med. 27(9):1305-11, 2008
                                                      15. Valsky DV et al: Three-dimensional transperineal ultrasonography of the pelvic floor: improving visualization for new clinical applications and better functional assessment. J Ultrasound Med. 26(10):1373-87, 2007
                                                      16. Timor-Tritsch IE et al: Three-dimensional inversion rendering: a new sonographic technique and its use in gynecology. J Ultrasound Med. 24(5):681-8, 2005
                                                      17. Bega G et al: Three-dimensional ultrasonography in gynecology: technical aspects and clinical applications. J Ultrasound Med. 22(11):1249-69, 2003
                                                      18. Jermy K et al: The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol. 17(2):140-4, 2001
                                                      19. Brown DL et al: Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology. 208(1):103-10, 1998
                                                      20. Lee W: How to interpret the ultrasound output display standard for higher acoustic output diagnostic ultrasound devices. J Ultrasound Med. 17(8):535-8, 1998
                                                      21. Langer RD et al: Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. Postmenopausal Estrogen/Progestin Interventions Trial. N Engl J Med. 337(25):1792-8, 1997
                                                      22. Lev-Toaff AS: Sonohysterography: evaluation of endometrial and myometrial abnormalities. Semin Roentgenol. 31(4):288-98, 1996
                                                      23. Levine D et al: Sonography of ovarian masses: poor sensitivity of resistive index for identifying malignant lesions. AJR Am J Roentgenol. 162(6):1355-9, 1994
                                                      24. Freimanis MG et al: Transvaginal ultrasonography. Radiol Clin North Am. 30(5):955-76, 1992
                                                      25. Levine D et al: Simple adnexal cysts: the natural history in postmenopausal women. Radiology. 184(3):653-9, 1992
                                                      26. Lyons EA et al: Transvaginal sonography of normal pelvic anatomy. Radiol Clin North Am. 30(4):663-75, 1992
                                                      27. Platt JF et al: Ultrasound of the normal nongravid uterus: correlation with gross and histopathology. J Clin Ultrasound. 18(1):15-9, 1990
                                                      28. Forrest TS et al: Cyclic endometrial changes: US assessment with histologic correlation. Radiology. 167(1):233-7, 1988
                                                      29. Fleischer AC et al: Sonographic depiction of normal and abnormal endometrium with histopathologic correlation. J Ultrasound Med. 5(8):445-52, 1986
                                                      30. Schwimer SR et al: The effect of ultrasound coupling gels on sperm motility in vitro. Fertil Steril. 42(6):946-7, 1984