Donald School Textbook of Transvaginal Sonography Asim Kurjak, Jose Bajo Arenas
INDEX
Page numbers followed by f refer to figure, and t refer to table.
A
Abdomen 38
suprapubic zone of 241
transverse section of 38f
Abdominal aorta, cross-section of 83f
Abdominal wall 10, 44
defects 43
Abortion 54, 119, 122f
causes of 116
first trimester 182
frequency 126
incomplete 395
missed 120f, 127f, 395
probability 119
spontaneous 51, 116, 117t, 182
therapeutic 280
threatened 129f
Abruptio placenta 112, 450
Abscess 297, 323, 459
formation of 321
rupture of 321
Achondrogenesis 45
Acquired brain abnormalities in utero 112
Acrania 42, 105, 105f, 185, 442
Adenocarcinoma
endometrioid 336, 467f
intestine 302f
invasive 264
Adenomyosis 200, 207, 264, 390, 397, 397f, 399
diagnosis of 400
Adenomyotic foci 201
Adnexal cystic masses 460
Adnexal lesions
benign 477
complex 477
malignant 477
Adnexal masses 455, 465
benign 457
cystic 458
evaluation of 467
high-risk 239
malignant complex 477
nonspecific 276
source of 417
Adnexal torsion 272
Adnexal tubular mass, left extraovarian 345f
Albumin 56
Alloimmune thrombocytopenia 112
Alobar holoprosencephaly 42, 108f, 444
Alpha-fetoprotein 93
Amenorrhea 121, 199, 258, 397, 406, 407
American Fertility Society 183
Amnionicity, determination of 440
Amnioperitoneal membrane 67
Amniotic band syndrome 105
Amniotic cavity 55, 438f
single 190f
Amniotic fluid 22, 44, 436
meconium stained 22, 23
Amniotic membrane 105f, 433, 442
Amniotic vesicle 118
Anal borders 294
Anal canal 24
Anal fistula 297, 299
Anal incontinence 357, 360, 362t
Anal levator muscle 293, 293f, 294f, 296f
Anal secretion 297
Anal sinus 294
Anal sphincter 358f
complex 362
injury 360
external 351, 362
internal 351, 362
transversal volumetric section of 308f
visualization of 358f
Anembryonic gestation 52
Anencephaly 41, 42, 44, 106f, 185, 442
diagnosis of 42, 442
Anesthesia, epidural 27
Aneuploid fetuses 67
Aneuploid pregnancies, detecting 61
Aneuploidy 67
fetal ultrasound markers of 61
Angiogenesis 207, 417
types of 420
Animal fetal skull 14
Anorectal angle 309
Anorectal atresias 184
Anorectal canal pathologies 25
Anovulation, chronic 254
Antepartum bleeding 135
risk of 135
Antibiotics, prophylactic 337
Antihypertensive drugs 341
Anti-Müllerian hormone 250, 253, 255
Antiseptic solution 334
Antral follicle 222, 252f, 258, 259
count 252, 254, 255
Aorta 85f
ascending 84f
Aortic stenosis 8890
Apoptosis 18
extrinsic 18
hepatic 14
index 17
intrinsic 18
physiologic 18
nature of 18
Appendicitis 26, 272
acute 327, 328
Appetite, lack of 456
Aqueduct of Sylvius 36
Arachnoid cyst 110
Arcuate arteries 197, 429
blood flow 429
Arcuate wreath encircling uterus 429
Arnold-Chiari malformation 42
Arrhythmia 92
Arterial vascularization 384
Arteries
internal iliac 429
intervillous 127, 127f
intracranial 435
pulmonary 85f
retrochorionic 408
small pulmonary 90
uteroplacental 407, 430
Arteriovenous malformation, diagnosis of 278
Arteriovenous shunts 417, 419, 465
Artificial reproduction techniques 222, 283
Ascites 26, 238
Asherman's syndrome 390, 397
Asphyxia 112
Assisted reproduction techniques 178, 211, 250
Atresia, aortic 88, 89, 92f
Atrial septal defects 88, 89
Atrioventricular septal defect 43, 85, 8789, 89f
Atrioventricular valves, motion of 36
Atrophic endometrium 203, 340, 341
Atrophic ovary, normal 343, 345f
Atrophic vaginae 4
Auslender's study 239
Automated volume calculation 251
Autosomal recessive inheritance 46
Avascular granulosa cell 384
Axillary lymphadenopathy 79f
B
Back pain 460
lower 456
Baden-Walker system 348
Balloon, placement of 332f
Banana sign 42, 43f, 106, 107f
Basal cell nevus syndrome 463
Basal endometrial layers 383f
Basal ganglia 444
Beads-on-a-string sign 459
Beam deflection 376
Bicornuate uterus 183
Bilateral ventricles, enlargement of 103f
Biopsy, placental 143, 149
Biplanar probe 25
Birth prevalence 43
Bishop score 165
Bizarre thin-walled tortuous vessels 419
Bladder
hypoplastic 44
neck
craniocaudal displacement of 306f
descent 353
displacement, anteroposterior 303
symphysis 354
Blastocyst 406
implantation 393
Bleeding 26
corpus luteum 272
postmenopausal 207, 341
Blood
cells, concentration of 375
flow 204
appearance of 432
arborization 189
diastolic 377
index 227
information 425
intervillous 406, 408, 411, 412
intraovarian 395
intraplacental 143
intratumoral 201
parameters 456
velocity, high 385f
velocity 429
vessel 374
analysis of 420
growth 417
intraembryonic 56
Body mass index 227, 255
Body stalk anomaly 45
Bone shape abnormalities 490
Bonney test 291, 303
Bowel
herniation 36
obstruction 41
Bradycardia 122
Brain 37f
atrophy 41
cavities, hypoechogenic 434
coronal cutting section of 99f
frontal part of 42
sagittal cutting section of 98f
surface 14
ventricular system of 99f
vesicles 35
Breast 491
cancer
family history of 456
postmenopausal 199
disease 268
benign 268
small parts 491
Brenner tumors 418
C
Calvarian bones, development of 442, 442f
Cancer 336
family history of 478
Carcinoma, endometrioid 463
Cardiac activities, determination of 179
Cardiac defects 8688
detection rate of 87t
Cardiolipin antigen 21
Cardiovascular system 269
Carotid artery 432
bilateral internal 102f
internal 268, 434
Catecholaminergic stimulation 257
Caudal regression syndrome 45
Cavity, abdominal 36, 272
Cells, adequate representation of 346
Central nervous system 98
anomalies, congenital 103
defects 42
Cephalic flexure 434
Cephalopelvic dimensions 451
Cerebellum, displacement of 42
Cerebral
arteries, middle 102f, 432
hemispheres 436
palsy 22
vein, internal 104
venous circulation, normal 104f
Cerebrospinal fluid 101, 443
Cerebrovascular system 268, 269
Cervical
assessment, use of 158
canal 334
cancer staging 26
carcinoma 26f
cerclage 26, 28, 168
incompetence 157
insufficiency 168
length 162, 173, 173t
measurement 152, 163f, 168, 172
ultrasonographic 167, 167t
pregnancy 280
diagnosis of 280
surgical removal of 280
transvaginal color Doppler scan of 280f
true 280
surgery 175
ultrasonography 165
Cervico-isthmic
complex 174
length 173
Cervicometry 174, 175
Cervicovaginal fetal fibronectin 154
Cervicovaginal secretion 165
Cervix 172, 330, 346f
measurement of 166
sonography of 154157
transvaginal
assessment of 162
measurement of 164, 167
Cesarean
deliveries 317, 318, 362
scar hysterotomy 450
section 363, 397
rate of 55
surgery 451f, 452
Chocolate cysts 421
Choriodecidual tissue 53
Chorionic
bumps group 129
cavity 35
small 122f
plate 53
sacs 179
thickness and volume 410
tissue 409
villi 430
primary 430
volume 410, 412
Chorionicity, determination of 440
Choroid plexus 102f, 105f
cyst 68, 112, 112f
appearance of 112
Circle of Willis 437f
Cleft lip 444, 490
Cleft palate 444, 490
Clomiphene citrate 224
Clubfoot 482
Coelomic fluid 56
Cogwheel, sign of 324f, 325f
Coitalgia 454
Complex anatomic structures, assessment of 425
Compressor urethrae 350
Conception cycles 222
Constipation 313, 456
Cord complication 112
Corpus callosum 98f, 101, 108, 109f
absence of 44
agenesis of 108
Corpus hemorrhagicum 383
Corpus luteum 4f, 242f, 277, 248f, 379, 380, 384, 417, 458
blood flow 416
cyst 417, 418, 458
hemorrhagic 458f
function 419
ipsilateral 276f
Craniocaudal bladder neck displacement 303
Craniofacial deformities 117
Cranium bifidum 103, 104
Crohn's disease 297, 301f
Crown-rump length 35, 40t, 52, 61
Cuboidal epithelial cells 57
Cul de sac 202, 460
Cumulus oophorus 225f
Cysts
adnexal 347
capsule of 247f
echogenic 460
functional 243f, 244f, 248, 417
interhemispheric 110
luteal 243f
mucinous 237
multiloculated 237
multiple 465
paraovarian 237, 345f, 457, 458, 460
paratubal 237
peritoneal 237
physiologic 456
porencephalic 112
postmenopausal 237
simple 4f, 5f
size of 241
small simple 238f
unilocular 236
Cystadenocarcinomas, serous 462
Cystadenofibroma 462, 476
Cystadenomas 457, 462
mucinous 237, 417, 463
serous 237, 239, 417, 462, 462f
Cystic
adnexal masses, types of 458
lesions, multiloculated 463
structures, small 199
teratomas, mature 461
tumors, unilocular 237
Cystocele 351, 353f
prevalence of 351
Cystourocele 303
Cytotrophoblast 53, 406, 430
Cytotrophoblastic cells 431
plugs of 430
D
Dandy-Walker complex 109
Dandy-Walker malformation 44, 109
diagnosis of 110
early stage of 110f
Dandy-Walker variant 109, 110
Decidua 430
parietalis 437
Decidual sign 52
Deep myometrial invasion 203
Dehiscent myometrium 454
Dermoid cyst 8, 10f, 421, 457, 461, 461f, 476
Detrusor dyssynergia 305, 305t, 306, 307, 307f
Dextrocardia 80f
Diabetes mellitus 357
Diaphragm
agenesis of 79
defect, congenital 80f
Dichorionic/diamniotic twins 441f
Didelphic uterus 184f
Dieker syndrome 108
Diencephalon 36, 434
Digital flexion, abnormal 496
Distant ovarian lesions 26
Diverticulitis 272
Doppler examinations, basic limitations of 375
Doppler flow
alterations 127
information 376
wave studies 18
Doppler indices 371
Doppler insonation 82
Doppler instruments, continuous wave 376
Doppler spectroscopy, accuracy of 371
Doppler spectrum 370f
Doppler system 372
Doppler technique 369
Doppler ultrasound
intensity 15
studies 407
Double artery system 294
Ductus omphalomesentericus 433
Ductus venosus
Doppler blood flow 17
flow, abnormal 91f
pulsatility index, measurement of 66
study 67
velocimetry 66
waveform 66
normal 66f
Dysmenorrhea 200, 335f, 454
acquired 460
Dyspareunia 262, 460
Dysplasia 88, 89
cerebellar 111f
Dysraphia 105
Dystrophic changes, sign of 440
E
Echocardiography, midgestational 81
Echogenic tumor, heterogeneous 335f
Echography 288
Ectoderm 461
Ectopia cordis 43, 44
Ectopic gestational sac 276f
hyperechoic 281
Ectopic pregnancy 26, 128, 272274, 282, 283
diagnosis of 273, 274, 282
management of 282
pseudogestational sac of 51
size-appropriate 282
Ellipsoid 222
formula 393
Embryo 120, 126f, 434f
abnormal 71
developing 406
fetal development, stages of 408
subsequent transfer of 379
transfer 382
Embryochorionic unit 411
Embryogenesis 420
Embryonal death 71, 73f
Embryonic abdomen 438
Encephalocele 44, 185, 443
Endoanal ultrasound 360, 362
Endocervical
canal 175f
channel 452
dilatation 162
length 173
mucosa 163f
echogenic 162
Endoderm 461
primary 55
Endodermal layer, inner 56
Endometrial
adhesions 397
amplitude mapping 213f
atrophy 264
biopsy 206
blood flow 199
breakdown 198
cancer 204, 332, 336, 341f
risk of 264
carcinoma 199, 201203, 207, 332
diagnosis of 203, 344f
incidence of 264
invasion of 204t
vessels, transvaginal color Doppler scan of 202f
cavity 200f, 230, 272, 451f
lesions 208
cells 418
cyst 418
large 418
disease 347
echogenicity, patterns of 212
evaluation 228
flow index 218
fluid collection 343
echogenic 343f
hyperplasia 201, 203, 206
images, resolution of 265
layers 229
lesions 203t, 397
malignant complex 206
premalignant 206
malignancy 203, 203t, 207, 207t, 267
myometrial
border 203
interface 336
junction 198
neoplasms 202
outer layer, hyperechogenic 213
pathology 203
assessment of 333
pattern 212, 228, 388
perfusion 211, 389f
three-dimensional Doppler indices of 216
polyps 30, 31, 198, 199, 203, 206, 332, 334, 335, 343f, 390, 396
distinguising 208
number of 335
small 198f
receptivity 211, 231, 400
sampling 206, 265
sonography 380
spiral arteries 212
thickness 201, 207, 211, 212, 230, 266, 267, 283, 332
and vascularity 388
assessment of 207
cut-off level of 340
hyperechoic 336
measurement of 212f, 264
vascularity
pulse Doppler of 231f
zones 230f
vascularization 400
index 218
vessels 379
number of 211
volume 203, 207, 214, 215, 231t
assessment of 216f
Endometrioma 243f, 457, 458, 460f
Endometriomyometrial interface 228
Endometriomyometrium junction 229
Endometriosis 242f, 262, 268, 272, 301f, 390, 400, 418, 460
Endometriotic
cysts 237
foci 460
implants 460
tissue 463
Endometritis 321, 328, 329, 329f, 390
Endometrium 35, 55, 198, 211, 212, 228230, 265, 267, 334f, 341, 381, 383, 388, 427, 460
abnormal echogenicity of 341
adenocarcinoma of 203
assessment of 211
atrophies 340f
destruction of 397
Doppler of 212
heterogeneous 267
homogeneous 341
hyperechoic 202, 342f
hyperplastic 202
measuring 265
microscopy 380
morphology of 228
multilayered 382
normal 340
polyp 31f
polypectomy 29f
power Doppler of 214
thick hyperechoic 12f
thickness 207
tissue 451
types of 382
vascularity of 228
volume ultrasound assessment of 231
Endopelvic vascularization 309
Endosalpingeal folds 459f
Endosalpinx, mucosa of 277
Endothelial trophoblast 430
Endovascular trophoblast 431
Energy, lack of 456
Enterocele 355, 356f
Enuresis 313
Epilepsy 43
Episodic rectorrhaphy, joint occurrence of 299
Erythrocytes 376
reflect, single 370
Esophageal atresia 184
Estradiol 250
concentration, serum 215
levels 222
serum 391
pellets 263
Estriol 263
Estrogen 265, 269
deficiency 262
postmenopausal 268
production, absence of 386
progesterone ratio 386
receptors 262
replacement therapy 268
Estrone 263
European Familial Breast Cancer Collaborative Group 475
Exencephaly 442
Exomphalos 43, 44, 67
diagnosis of 44
Exophthalmos 71
Extraembryonic
celomic cavity 438
mesenchyme, layer of 56
mesoderm 55, 430
structures 51
Extraovarian disease 456
F
Face 37f
Facial
anomaly 75f
cleft 46, 68
Fallopian tube 321, 322f325f, 327, 328f, 398, 398f
dilated 327
fold in 325f
septa inside 325f
stenosis of 326
wall of 329f
Fecal incontinence 310
Female infertility, management of 379
Female pelvic floor 288, 309
disorders, causes of 309
Female pelvis 350f
bones of 349f
tumors of 204
Fertilizable oocytes, mature 391
Fertilization rate 391, 392
Fetal
abdominal abnormalities 71
abnormality, early detection of 71
anal muscle 22
anatomy 35, 37
eighth week 36
examination of 39
fifth week 35
fourth week 35
seventh week 35
sixth week 35
aneuploidy 68
anomalies 425
early detection of 442
aorta 432
arachnoid cyst 111f
asphyxia, hypoxic 22
back surface 100f
behavior 483, 493
biopsy 490
bladder 39f, 65, 68
measurement of 65f
body 36
bone structures 487
brain 98
circulation 102f
echogenicity 22, 23
cardiac activity 10
cardio mode 489, 489f
cardiography 490
cardiovascular system 408
central nervous system, assessment of 98
chromosome 77f
test 72
clubfoot 71, 75f
cranial structure 100f
demise 21
development 493
echocardiography 43, 81, 82, 9294, 373
early 81, 83, 83f86f, 86t, 88f, 88t, 92
extremity, bone elements of 487
fibronectin 165
finger
contracture of 494
positioning 497
foot, surface-rendered 488f
growth
disorders 63
restriction 21, 149
hand 39f
contracture of 494
normal 488f
positioning 497
head 61
and neck 18
heart 280f, 432, 483, 489f, 490
anomalies 87, 88t, 89t
examination 82
rate 35, 36, 67, 122
rate monitoring 22
visualization of 94
hydrops 72
iliac angle measurement 68
iliac bones 68
information in utero 71
intelligent navigation echocardiography 93
karyotype 74, 78, 78f, 79
kidney 68, 39f
limb
abnormalities 71
movements 446
visualization of 437
liver 22
apoptosis 18
lung 22
immature 22, 23
maturity 22
macrosomia 309
macrostomy 301
malformations 183
medicine foundation criteria 62, 64
membranes, junction of 441f
mice head anomaly 17
morphology 490
movement 122, 490, 493
pattern of 127
neuromyopathy genetic diseases 490
nose, visualization of 64
nuchal cystic hygroma 63
organs, visualization of 39
origin cultured cells 17
pelvic, transverse section of 67f
pole 35
cephalic part of 35
measuring 35
profile 64, 37f
sensorimotor development 497
skeletal
anatomy 425
system 487f
skeleton 425
spatial anomalies 482
steroid therapy 22
stomach 83f
structural anomaly 71
structures 425
thoracoabdominal part 80f
trisomy 18
upper limb movement 493
volume evaluation 490
wrist, abnormal 496
Feticidal agents 282
Fetiform mass, development of 185
Fetoplacental circulation 408
Fetoscopy, thin-gauge 496
Fetus 11f, 44, 75f, 189, 440, 483, 493
abnormal 127
aborted 75f, 76, 77f79f
chromosomal structure of 427
midsagittal section of 61f, 442f
Fibroid 268, 344f
submucosal 335, 397
subserous 344f
Fibroma 418, 457, 463, 464
range 464
Fibrous tissue 429
Flexion movements 493
Flow index 145, 145f, 317
Fluid in cavity, accumulation of 329f
Follicles
arrangement of 255
demonstrate 391
mature 222
stimulating hormone 250, 379, 380
Follicular
assessment 222, 224, 226
circumference 223
cysts 458f
multiple 457
epithelium 384
fluid 324f
monitoring 222
number per ovary 254
phase 380, 384
volume 225, 227t
Folliculogenesis 420
stages of 458
Foramen ovale 83f
flapping 83
Forebrain, developing 433
Fossa
anomalies, posterior 109
middle 110
Fourchette lies anterior 29
Frontal bones 490
Fukuyama congenital muscular dystrophy 108
Functional ovarian cysts, evaluation of 241
Fundal uterine fibroid 28f
Fusiform enlargement 455
G
Gastric epithelium 36
Gastroenteritis 272
Gastrointestinal defects 41
Gastroschisis 44
Genital tract abnormalities, congenital 26
Genitourinary anomalies 184
Germ cell tumor 457
benign 461
Germinal epithelium 415
Germline mutations 475
Gestation, multiple 93
Gestational age 35, 40t, 41t, 51, 52, 52t, 54, 56, 118f, 119, 120f, 121, 122f, 147t, 165t, 173, 178f, 179, 179f, 181f, 445t
range of 87
Gestational sac 183f, 428f, 438f
anomalies of 122
diameter 120
normal 52f
number of 51, 180f
small 275f
surface of 430
Glenohumeral and elbow joints, movements of 494f
Gonadal stroma, germ cells of 415
Gonadomimetic therapy 263
Gonadotropin
doses of 259
releasing hormone 215, 262
Granulosa
cell 393, 463
cell layer 384
hypoxic 384
vascularize 385
lutein cells 383
theca cell 390
Gray-scale ultrasonography 201, 345
Great arteries 85f
Growth retardation 46
Gynecological
disorders 267, 332
malignancy 471
cause of 236
surveys 292
ultrasounds 236
H
Hand deformity 496
Heart 38
anatomy 40t
beat, embryonic 82
block, complete 85
defects 43
congenital 43, 81, 85
development of 82
disease, congenital 72, 184
embryonic developmental of 82
four-chamber view 38f
frequency
alterations of 122
anomalies of 122
monoventricular 43
motion 35
normal 82
rate, embryonic 121
three-vessel view 38f
Hematocolpometrium 31
Hematoma 54, 122, 124126
presence of 54
retrochorionic 125
retroplacental 54
subchorionic 54, 125
types of 126
Hematopoietic stem cells 57
Hemorrhage 136
cysts 248, 460
exists, moderate 126
extensive 244f
intracranial 112
intraluminal 467
massive 279
postpartum 135
subchorionic 53f, 54, 55
Hemorrhagic phenomena 243f
Hemorrhoid
prolapse 297
diagnosis of 299
structure, loss of 297
syndrome, severe 297, 298, 299f
Hemorrhoidal plexus 291, 294, 297f, 298f
external 294
internal 294
Hepper's findings 446
Hereditary disease 463
Heterozygote state, expression of 44
High pulse rate frequency system 372
Holoprosencephaly 41, 42, 68, 444
Hormone
influence of 198
luteinizing 227, 262, 380
therapy, postmenopausal 236
Hormone replacement therapy 262, 267, 340, 341
assessment 266
effect of 266, 269
protocols 263
route of 263
Human chorionic gonadotropin 93, 211, 213f, 218f, 222, 272, 385
Human reproduction, mystery of 379
Hydatid cyst of Morgagni 457
Hydatidiform moles 128
Hydrocephalus 104f, 105f, 184
progressive 105f
stages of 105f
ultrasound images of 103f
Hydrocephaly 443
diagnosis of 443
Hydronephrosis 41
Hydropic fetus 72, 78f
Hydrops 79f, 92
Hydrosalpinges 237, 458, 459
Hydrosalpinx 237, 328, 329f, 330f, 398f, 400, 457, 459
simple 455
Hygroma 92
cystic 63, 66f, 72, 79f
presence of 87
Hyperdense stroma 255
Hyperinsulinemia 257
Hypermenorrhea 335f
Hyperplasia 336
Hyperstimulation, risk of 419
Hypertelorism 46
Hypertension, pregnancy-induced 430
Hyperthecosis 256
Hypoechoic lacunae, multiple 136
Hypoechoic tissue 485
Hypogastric vein 381
Hypogenesis 109f
Hypomenorrhea 199, 397
Hypophosphatasia 46
Hypoplasia 202
cerebellar 44, 110
Hypoplastic left heart syndrome 90
Hypothalamic gonadotropin-releasing hormone 379
Hypothalamopituitary function 379
Hystero-contrast-salpingography 398, 398f, 398t
Hysterosalpingography 333
Hysterosalpingosonography 330
Hysteroscopy 206
Hysterosonography, three-dimensional 199
Hysterotomy 452f, 453t
derived scars 454
incisions 454
made scars 450
echography survey of 450
segmentary 450
strategy 451
transverse segmentary 450f
I
Ilium 348
In vitro fertilization 211, 333, 382, 428
embryo transfer 188, 225, 400
treatment 419
Incomplete septa, sonographic sign of 326
Infection, intracavitary 337
Infertility 204, 333, 419, 460
causes of 390t
ovarian causes of 390
tubal causes of 398
uterine causes of 395
Inflammation, chronic 297, 420
Inflammatory disease, chronic 300
Infundibulopelvic ligament 415
Inotropism 269
Insonation, angle of 64
Insulin resistance, assessment of 255
Interfetal membranes, junction of 181
Internal carotid artery, intracerebral part of 436f
Interstitial fibroids, multiple 344f
Interstitial pregnancy 279, 280
diagnosis of 279
nonviable 279
transvaginal color Doppler scan of 279f
Interventricular septum 83, 84f
Intracavitary development, degree of 335
Intracranial pressure 101, 103, 104f, 105f, 108f
Intracranial structure, normal 101f
Intracystic septal structures, presence of 242
Intracytoplasmic sperm injection 230
Intramural fibroids, small 279
Intraovarian
resistance index 250
vessels 418
Intraperitoneal fluid 455, 457
Intrauterine
abnormalities 332, 400
adhesions 390, 397f
bleeding 54, 122, 124, 126
contraceptive device 26
device 263, 272
fetal growth 150
fluid 202
growth
restriction 55
retardation 55
hemorrhage 54
diagnosis of 125
insemination 215, 224, 227, 253
lesions, diagnosis of 333
placental development 429
pregnancies 51, 278, 280
synechiae 199, 200f, 206, 396
Intrinsic vascular system 384
Irregular placental volume technique 145f
Ischemia 198
Ischium 348
Isoechoic stroma 252
Isthmus rhombencephaly 436
J
Japan industrial standard 14
K
Karyotype 44
abnormal 72
incidence of 496
of trisomy, abnormal 71
Kidneys 38
echogenic 44
Klinefelter syndrome 63
Kyphoscoliosis 46f
severe 45
Kyphosis 107f, 482
severe 75f
L
Lambda sign 181
Laparoscopy 326
Laparotomy 326
Leiomyoma 204, 208
pedunculated 335
submucosal 332, 335, 335f, 390, 397
submucous 204, 396
subserosal 204
vasculature 205
Leiomyosarcoma 205, 208
neovascularization of 205
Lemon sign 42, 43f, 106, 107f
Letrozole 227
Leukomalacia 22f
periventricular 22
Levator ani 349
muscle 363
Levator hiatus area 309, 315
Levator muscle modulates 292
Ligament leiomyoma, broad 418
Limb deformity 494
Liver 22
apoptosis of 17, 18
Lobar holoprosencephaly 444
Low end-diastolic flow 429
Low resistance index 276f
Low velocity, loss of 376
Lung
hypoplastic 79
liver border, abnormal 80f
Luteal blood flow 395, 416f
Luteal phase defect 379, 390, 394
Luteinized unruptured follicle 241, 243f, 390
syndrome 393
Luteinizing hormone, release of 379
Lymphadenitis 321
Lysophosphatidic acid 473
M
Magnetic resonance imaging 12, 133, 354, 472
Marginal placenta previa 134f, 135f
Masses
benign 20
complex 461
cystic 458
hyperechogenic 36
nonovarian 457
Maternal disease 43
Maternal serum
alpha-fetoprotein 54
biochemical markers, second trimester 93
placental growth factor 93
Maternal steroid administration 22
Maternofetal transportation 439
Mean blood flow velocity 373
product of 373
Mean venous velocity 149
Meckel-Gruber syndrome 44, 45
Meconium 22
stained amniotic fluid, diagnosis of 22
Mega cisterna magna 109
Megacystis 44, 65
severe 65f
Meigs’ syndrome 463
Membranes, preterm premature rupture of 26, 152, 157, 166
Meningocele 71, 105
Menometrorrhagia 200
Menopause 340
symptoms, physiology of 262
Menorrhagia 454
Menstrual cycle 215, 334f, 379, 380, 383f
luteal phase of 385f
normal 389
phase of 380
Menstruation 380
Mercedes sign 441f
Mesencephalic cavity 434, 436
Mesencephalon 36, 434
Mesenchymal cells 415, 430
Mesenteric inferior artery 294
Mesoderm 461
Mesosalpinx 278
arteriovenous malformation of 278
Methotrexate 282, 283f
absorption of 279
injection of 281
treatment 282
Metrorrhagia 204
Micrognathia 71, 74f
Midbrain ventricles 434
Migration disorder 108
Miscarriage 393
diagnosis of 124
Mitral stenosis 88
Modern-day transabdominal ultrasound 340
Monochorionic-monoamniotic twin 190f
pregnancy 486f, 487f
Morgagni columns 294
Moving erythrocytes, quantity of 375
Mucinous cysts, benign 462
Mucinous tumors 462, 463
benign 463
Mucosal star appearance 357f
Müllerian anomalies 183
congenital 333
Multicystic dysplastic kidneys 41
Multifollicular ovarian response 390
Multiplanar imaging, advantages of 182f
Multiple anechoic lacunae 136
Multiple pregnancy 124f, 156, 166, 178, 181, 184f, 189, 440
management of 182f
Muscular complex, longitudinal 294
Myelocystocele 71, 105
Myelomenin, large 107f
Myelomeningocele 75f, 105, 106, 107f
types of 71
Myeloschisis 71, 107f
Myoma 30, 200, 202
location of 205
pedunculated 11f
submucous 197, 206
Myomata 264, 265
Myomectomy 397
Myometrial
density, evaluation of 208
endometrial border 429
invasion 203
layer 197, 279
malignancy 208
perfusion, normal 418
vessels
hyperemia of 138f
interruption of 138f
Myometritis 321
Myometrium 197, 256, 343, 388, 430, 450, 460
anterior 228
heterogeneous 397
hypoechogenic 381
hysterotomy affected 452
tissue 450
N
Nasal bone 64
examination of 64
National Council on Radiation Protection and Measurements 14
Negative predictive value 124, 241, 475
Neoangiogenesis 257
Neonatal
intensive care unit 55
surfactant therapy 22
Neoplasia, malignant 23
Neovascular signals 202
Neovascularization 238, 417
Neural tube defects 184
Neurogenic bladder 305
Neurological diseases 357
Neurulation disorders 103, 105
Nocturia 313
Nonconception cycles 225
Nondominant ovary 395
Nonsepta cystic hygroma 63f, 63f
Nonthermal safety with mechanical index 15
Novel preterm pregnancy management 22
Nuchal fluid 43, 44
Nuchal translucency 35, 61, 441
measurement 62, 62f, 442f
thickness 61f
O
Obstetrical anal sphincter injury 360
Oligoamnion, precocious 122, 122f
Oligohydramnios hinders 45
Omphalocele 43, 67, 77f, 92, 482
Oocyte 225
maturity 385
number of 392
Oophorectomy, prophylactic 476
Oophoritis 321, 326
Osteogenesis imperfecta 46
Osteoporosis 262
Ovarian
abscess 321
area 256
artery 384, 415, 416f
blood flow 238f, 416f
cancer 471, 473476
algorithm, risk of 480
early 473
epithelial 471
family history of 456
screening 345, 471, 472, 475, 480
carcinoma 474
circulation 384
cyst 30, 30f, 31, 346f, 391, 458
asymptomatic simple 236
dysfunctional 245f
functional 243f247f
hemorrhagic 458
persistent simple 239
physiologic 457, 458
simple 11f, 239
unilocular 474
cystadenofibroma 476
cystic tumors, unilocular 236, 237
dermoid
adnexal mass of 461f
cysts 461
endometrioid tumors 463
fibroma 457, 464, 476
follicle 384, 391
hilus 384
hyperstimulation syndrome, diagnosis of 379
lesions, malignant 465
malignancy, diagnosis of 464t
malignant neoplasia 20
masses 457, 464, 467
angiogenesis in malignant 419
benign 466
evaluation of 464
malignant 466
mucinous tumors 462, 463
neoplasm
benign 462
cystic 459
origin 457
pathologies, advantage of detecting distant 27f
pregnancy 281
diagnosis of 281
serous tumors 462
sonography 380
stimulation, types of 388
stroma 250, 393, 418
hyperechogenic 393
stromal blood flow 251f, 391, 419
stromal vascularity 390, 392
structural changes 415
tissue vascularity 419
tumor 466f
angiogenesis in benign 417
benign 466f, 478
complex 462f, 478f
diagnosis of 456t
epithelial-stromal 461, 462
fibrous 463
malignant 467
microcirculation anatomy 466
tumoral pathology 241
volume 250, 252f, 256, 257, 392
Ovary 321, 345, 379, 418, 428
active 416
Doppler evaluation of 415
hyperstimulated 391f, 394f
low reserve 253, 253f
morphology of 266
normal 252, 253f, 455
postmenopausal 236, 238f
premenopausal 417
three-dimensional power Doppler volume of 251f
transvaginal sonography of 379
Ovulation, sign of 383f
Ovum, blighted 52, 53f, 119
P
Pain, abdominal 456
Palmar flexion, abnormal 496
Pap smear examination 347
Papillary projections 238, 456
Para-aortic lymph node enlargement 345
Parametritis 321
Parenchyma 455
Park ligament 291, 294
Pars compacta 380
Pars functionalis 381
Pars spongiosa 380
Partial placenta previa 134f
Peak systolic velocity 149, 201, 250
Pearl necklace
sign of 330f
sonographic sign of 324f
Pelvic 460
abscess 321, 323
perforation 331
anatomy 24f, 348, 418
area
anterior 291
posterior 291
cavity 350f
cellulitis 321
endometriosis 460
floor 292, 302, 349, 360
dysfunction 302t, 363
exploration 291t
muscle 349f, 362, 363
ultrasound assessment of 363t
fluid 238
infection, sonography of 321
inflammatory disease 321, 328, 397, 418
incidence of 272
laparoscopic classification of 327t
stages of 321t
masses 455, 457t, 458
diagnoses of 457
sonographic differential diagnosis of 457
types of 457
organ prolapse 348, 363
quantification system 348
pain 200, 204
peritoneum 460
physiotherapy 362
region
anterior 303
posterior 297
sonography 455
vessels 386
wall
anterior 349
lateral 349
posterior 349
Pelviperitonitis 321, 323f, 324f
Pelvis
bones of 348
muscles of 349
Perifollicular
flow 224
vascularity, angiomode of 226f
vascularization 226
vessels 226
Perineal abscess 300
Peritoneal inclusion cysts, possibilities of 347
Peritoneum 321
Peritrophoblastic
activity 52
blood 280
flow 52f
Periurethral vascularization 309, 316, 317
assessment of 318
Placenta 427, 430
abnormally low 133
accreta 135, 136, 136f, 138f, 450
decidual plate of 429
increta 136, 137f
invasive 138f
percreta 136
previa 54, 133, 134, 136, 450, 491
complete 134f, 138f
resolution of 134
transvaginal evaluation of 133
Placental intervillous space fibrin 21f, 23
Placental vascular biopsy 143, 144
method, validation of 145
technique 144f
Placental vascular tree 146f
Placental vascularization, assessment of 143
Placental volume 145, 145f
Plasma follicle-stimulating hormone 262
Plastic speculums 29
Polycystic kidneys, bilateral 44
Polycystic ovarian
disease, diagnosis of 256
syndrome 390, 392, 419
management of 254
Polycystic ovaries 30f, 31, 250, 254256, 392f, 393, 393f
characteristic of 254
cystic 255
diagnosis of 254
peripheral 258
peripheral cystic pattern 255
Polycystic pattern, peripheral 255f
Polydactyly 44
Polyps 197, 202
vascularization of 198
Polyvinylidene fluoride 361f
Positive predictive value 163, 218, 241
Post-abortion surgical curettage 397
Postmenopausal palpable ovary syndrome 236
Potassium chloride, injection of 280
Pouch of Douglas 30, 400
Preeclampsia 54, 55, 112
Pregnancy 230, 281, 309
abnormal early 412
anembryonic 53, 119121, 128
angular 283
biochemical 116
ductus venosus blood flow wave 15
extrauterine 51
first trimester of 35, 117, 127f, 172, 438f, 444
heterotopic 280, 282
high-order 180
implanted 280
internal 119
interrupted 119
intra-abdominal 281
loss
early 129, 129t
midtrimester 165
recurrent 333
multifetal 184, 187
normal 143, 147f, 410, 440
first trimester of 406
poor prognosis of 121
rate 212, 391, 392
stage of 433f
termination of 81
Pregnant rats 17
Prehormone replacement therapy 264
Preovulatory follicle 223f, 223f, 225f, 382f
Preterm birth 54, 162, 164
prediction of 153, 167
subsequent 166
Preterm delivery 152, 168, 172174
accounts 172
causes of 157, 168
low prevalence of 158
majority of 155
prediction of 153, 156, 164, 165
prevalence of 157
prevention of 168
rate of 158, 399
risk of 164
spontaneous 152, 158, 164
Preterm labor 54, 166
predictive of 176
Progesterone
challenge test 265
removal of 385
serum levels 420
Progestins, use of 264
Progestogens 263
Prosencephalic development, disorders of 106
Prostaglandin synthesis, abnormalities of 394
Prune-Belly syndrome 76f
Pseudodiverticular structures 301f
Pseudogestational sac 52, 52f, 52t
Pubic bones 349
Pubic symphysis 349, 293f, 348
Pubis 311f, 348
Pubococcygeal muscle 293f
Puborectal muscle 311f
Puborectalis 349
Pubourethral ligament 291
Pulsatile spectrum 372
Pulsatility index 199, 207, 231, 241, 371
Pulse
repetition frequency 143, 485
wave 15, 372
Pulsed Doppler system, particular pulse repetition frequency of 374
Puncture injections 282
Pyelectasis
bilateral 68
border of 68
Pyosalpinx 323, 324f326f
R
Radial arteries blood flow 429
Radiotherapy tandem insertion or removal 26
Ramus, superior 348
Randomized controlled trial 473
Rectal artery
inferior 294
superior 294, 301f
Rectal circular muscle 294
Rectal longitudinal muscle 294, 296f
Rectoanal canal pathologies 27
Rectocele 356, 356f
Rectoperineal fistula, distribution of 300f
Rectorrhaphy 297
Rectoscope 24
Rectovaginal septum 460
Rectum 351
Red-blue combination code 374
Reliable ovarian cancer screen 345
Renal agenesis 44
Renal pelvis anteroposterior diameter 68
Resistance index 207, 241, 384
Respiratory distress syndrome 22
Retrochorionic flow velocity waveforms 407
Retroplacental pulsatility index 149
Retroplacental systolic velocity 149
Retzius’ space 293
Rhombencephalon
cavity of 35, 36f
development of 433
Rib fractures 46
Robert syndrome 46
Rokitansky-Küster-Hauser syndrome 30, 31
S
Sagittal sinus, superior 104, 105f
Saline infusion 334f, 335f
counter-current of normal 334
sonography 206, 396f
Salpingitis 321, 323, 323f, 324f, 327
acute 321, 323f
initial acute 323f
Salpingo-oophorectomies, bilateral 239
Salpingostomy, laparoscopic 282
Santorini plexus 293f
Santorini vascularization 291
Scar
failures, detection of 450
stigma 452f
tissue, bands of 199
Sclerocystic ovaries 254
Scoliosis 482
severe 78f
Screening tests 472
Segmental uterine artery perfusion 229
Semilunar valves 83
ranges 90
Septate uterus 206, 396f
cases of 395
Septum pellucidum 103, 113f
absence of 444
Serous tumors, malignant 462
Sertoli-Leydig cell tumors 463
Sex cord-stromal ovarian tumors 463
Sexually transmitted diseases 272
Shark bite pattern 453
Sheep's adrenal glands 143
Shirodkar suture 168
placement of 168
Short-rib polydactyly syndrome 46
Sigmoid colon 24
Simple cysts, pathology of 237
Simple ovarian cysts, prevalence of 236t
Sirenomelia 45
Situs inversus 92
Situs solitus, normal 83f
Situs visceral 83f
Skeletal
defects 45
dysplasia 45, 490
Skin 294
Sonoembryology 493
Sonography
abdominal 332
three-dimensional 181, 246f, 444
Sonohysterography 266, 332, 341
three-dimensional 197
Spherical hyperechoic membrane 434f
Sphincter
injury 362
internal 294
trauma 25
urethrae 350
Spina bifida 42, 42f, 71, 77f, 103, 105, 107f, 185, 187, 490
lumbar 107f
occulta 106
Spinal cord 106
Spinal dysraphic defects 105
Spine 37f
deformations 482
Spiral arterioles 380
Spiral artery 53, 230, 429, 430f
perfusion 387f
transformation of 407
Spleen 437
Steroidogenesis 415
Stomach 38, 38f
Stress urinary incontinence 313, 350, 354, 361
Stroma, hyperechoic 256
Stromal abundance 255, 256
assessment of 256
Stromal blood flow velocity 259
Stromal echogenicity 256
Stromal flow 259
Stromal index 256
Stromal vascularity 257, 258
Stromal volume 251, 257
Subchorionic liquid 125
Subendometrial
blood 388
endometrial artery 213f
flow index 216
halo 203, 399
perfusion 389f
radial arteries 212
sonolucencies 333
Submucous fibroids, diagnosis of 208
Superficial myometrial invasion 204
Superior vena cava 86f
Suprapubic pressure 163
Surgery, laparoscopic 279
Swiss-Cheese appearance 138f
Swiss-Cheese morphology 138f
Sylvian aqueduct 434
Sylvian fissure 110
Symphysis pubis 351f
Syncytiotrophoblast 53
Synechiae 199
severe 333
T
Tachycardia 72
Tamoxifen 198, 199, 236, 237, 333
therapy 199
use of 268
Teratoma 185
cystic 461
Tetralogy of Fallot 89, 90f
Tetraphocomelia 46
Thalamus 444
Thecomas 418, 457, 463
Thermal index 14
Thermal safety 14
Thin-walled clear simple cyst 345f
Thoraco-omphalopagus 440, 441f
Thrombophlebitis 321
Tibolone 263
Tissue
characterization 20
ischemia 380
layers change Doppler angle 376
perfusion 219
Tonic hypersecretion 393
Transabdominal
convex probe 3
echocardiography 82, 83
echography 288, 289f
routes 94
scans 133
sonography 10, 25, 82, 381
techniques 61, 162
ultrasound 264, 273, 472, 473
echography 288
Transfundal pressure 163
Translabial techniques 162
Transmitted wave frequency 370
Transobturator tape 361
Transperineal
echography 288
sonography 153
techniques 162
tomographic ultrasound imaging 363
ultrasound 352, 358, 360, 363
Transrectal echography 289
Transrectal sonography 24, 24f, 27, 29f
indication of 25, 26t
probes 24f
Transurethral urine 306
Transvaginal cervical length 167
measurement 152f, 169
Transvaginal color Doppler 205, 415, 416, 476
Transvaginal echography 290, 290f, 291t, 450, 451
Transvaginal gray scale sonography 456, 464, 467, 478,
Transvaginal probe 3, 3f, 5, 222
accessories of 5
Transvaginal scan 14
ultrasound 14
Transvaginal scanning, safety of 133
Transvaginal sonogram 206, 458f, 462f
Transvaginal sonographic visualization 202
Transvaginal sonography 3, 7, 71, 79, 94, 99f, 133, 153, 178, 208, 222, 236, 241, 248, 265, 273, 332, 340, 379, 455, 455, 457, 459
modes of 471
three-dimensional 100
Transvaginal sonohysterography 341
Transvaginal techniques 162
Transvaginal transducer 334, 380
high-frequency 98
Transvaginal ultrasound 43, 71, 154, 169, 172, 205, 222, 265, 273, 280, 340, 380, 383f, 401, 471473
echography 288
examinations 282
safety and accuracy of 133
Tricuspid
atresia 88, 89
regurgitation 92
valve 93
Triploidy 44, 63
Trophoblast 277, 278, 427, 430
cork 53
inner layer of 406
Trophoblastic
plugs 431
system 53
thickness 124
Tubal
abscess 321
ectopic pregnancy, assessment of 277
fimbriae 322f
gestation 278
lesions 347
mucus 324
patency 333, 336, 400
assessment of 336
rupture 283
wall, thickening of 326f
Tubo-ovarian
abscess 321, 323, 326, 327f, 455, 457, 459
complex 325, 327f, 459
Tumor
adhesions 462
angiogenesis in borderline 419
benign 238
blood vessels 465
cells 419
cystic 462, 463
endometrioid 463
hyperemia 417
lakes 419
malignant 238, 420
mucinous 463
marker 456
serum 471, 472
microcirculation 419
morphologic appearance 478
multilocular 462
neovascularization, malignant 466f
serous 462
vascularity 417
vessels
density of 421
malignant 467f
Turner syndrome 63, 72, 75
Twins
conjoined 184, 185, 187, 187f, 441f
false diagnosis of 180
monoamniotic 179, 189
monochorionic 440
monozygotic 178
peak sign 181
to-twin transfusion syndrome 184
vanishing 440, 441f
U
Ultrasonography, three-dimensional 406
Ultrasound 348
absorption of 17
three-dimensional 214, 309, 420, 427, 432, 440, 441
Umbilical
artery 67f, 128, 435
normal 149
pulsatility index of 67
single 74f
blood flow 434
cord 36, 67
entanglement 191f
insertion 38f
proximal 435f
types of 189
pulsatility index 149
resistance index 149
systolic velocity 149
vesicle 56, 146f
Unicornuate uterus 183
United Kingdom National Familial Ovarian Cancer Screening Study 474t
Urethra 311f
height measurement of 351f
three-dimensional ultrasound of 352f
tomographic ultrasound imaging of 353f
transvaginal ultrasound of 351f
Urethral
atresia 44
polyps 305
sphincter volume 309, 314
valves, posterior 44
Urethrocystography 303
Urethrocystomanometry 303
Urethrovaginal
sphincter 350
structures, morphology of 292
Urethrovesical
angle, posterior 303, 313, 352f
dyssynergia 289
joint 289
Urge urinary incontinence urgency 313
Urinary bladder 138, 350
dilatation of 44
longitudinal transabdominal sonogram of 351f
transabdominal ultrasound of 351f
Urinary incontinence 303, 307, 310, 358, 363
pathologies 305
Urinary stress incontinence 308f
pathologies 303t
Urinary tract 437
defects of 44
Urogenital hiatus 311f
Urogenital ligaments 262
Urogynecological survey 303
Uropathy, obstructive 44
Uterine
abnormalities 396
activity, monitoring of 165
anomalies
congenital 390, 395, 396, 399
prenatal classification of 183
artery 197, 204, 258, 266f, 386, 387, 387f, 429
blood flow 387f, 429
embolization 208
utero-ovarian branch of 384
waveform, preovulatory 231f
bleeding
abnormal 332
anomalous 454
blood flow 384, 386
cavity 12, 12f, 127f, 199, 341f, 380, 398f, 399
empty 279
lesions 206, 399
lower 332f
normal 395f
circulation 386
fibroid 31, 386
fundus 11f
implantation 278
isthmus 454
leiomyoma 333, 335
leiomyosarcoma 206
lesions 197
ligaments 460
morphology, assessment of 207
origin 457
perfusion 387, 388, 427f
receptivity, normal 389f
rupture 136
sarcoma 206f
diagnosis of 208
typical of 206f
scar patterns 454
segment, lower 176
septum 396
surface 399
surgery 397
synechiae 333, 397
tumor
transvaginal color Doppler scan of 206f
vascularization of 208
vasodilatory 386
vessels 268
volume 215
wall 45f
anterior 453
asymmetrical thickening of 208
posterior 335
Uteroplacental decidual arteries 198
Uterus 197, 321, 332f, 379, 427
adenomyosis of 200
cervicocorporal junction of 386
didelphys 183
dysdynamogenesis 451
fibromyoma of 268
morphology of 266
normal 197, 334f
retroverted 9f, 26, 27, 266f
sagittal section of 12f
transvaginal
color Doppler scan of 205f
sonography of 379
V
Vagina 311f
Vaginal anterior wall anchors 310
maximum height of 315
Vaginal atresia 26
Vaginal bleeding 54, 126
abnormal 267
Vaginal delivery 318
spontaneous 362, 363
Vaginal examination 7
Vaginal fornix 7, 8
Vaginal septum, transverse 26
Vaginal shortening, postoperative 26
Vaginal speculum 24
Vaginal transducer, high-frequency 71
Valsalva maneuver 288, 303, 305, 306, 306f, 307, 307f, 310, 315
Valvular stenosis 87
Vasa previa 135
Vascular endothelial growth factor 400
serum 258
Vascularity flow index 226, 251
Vascularity index 207
Vascularization flow index 144, 145, 145f, 215, 215f, 218f, 252f, 409, 427
Venoatrial connections, abnormal 88, 89
Venous pulsation, disappearance of 105
Ventricle outflow tract, left 83
Ventricular septal defect 41, 43, 87, 88, 89, 91
Vessels, abnormal calibration of 345
Villous chromosome 71
Villous vascular
assessment of 410
tree 410
Virtual organ computer-aided analysis 409
Viscous chocolate-colored liquid 418
Vitelline duct 433
Vitellointestinal duct 56
Vulvovaginal
atrophy, postmenopausal 27
lesions 26
W
Wall defect, anterior 45
Whole cervical length 175f
World Federation of Ultrasound in Medicine and Biology 13
Wrist flexion, abnormal 79f
Wrist malposition, left 496
Y
Yolk sac 35, 52, 55, 57f, 118f, 127f, 430, 433, 437, 439, 440
abnormal 71
absence of 57
anomalies of 122, 123
calcified 58
characteristics
abnormal 59t
normal 59t
circulation of 56
cystic 434
development 55
abnormalities of 57
diameter 71
echogenicity 432
function of 56
huge 72f, 73f
hyperechogenic 71
hyperechoic 73f, 74, 432
large 58f
morphology, abnormal 439
normal 57
secondary 55
small 58, 58f
structure of 56
vascularity 128, 440
Y-shaped telencephalon 36
Z
Zagreb ovarian cancer 478
screening trial 477
×
Chapter Notes

Save Clear


1GENERAL ASPECTS
  • Transvaginal Probe: Technical Aspect
  • Basis of Transvaginal Scanning
  • Safety of Transvaginal Scan Estimated from Ultrasonic Bioeffects
  • Tissue Characterization with Gray Level Histogram Width in Obstetrics and Gynecology2
  • Transrectal Sonography

Transvaginal Probe: Technical AspectCHAPTER 1

Kazunori Baba
 
INTRODUCTION
Transvaginal sonography gives more accurate and more detailed information on pelvic organs and masses than vaginal examination. It is preferable to set an ultrasound scanner with a transvaginal probe by each gynecological examination table (Fig. 1.1).
A transvaginal probe consists of a head, shaft, and a grip (Figs. 1.2A to C). A straight-type probe (Figs. 1.2A and B) may be easier to manipulate for obtaining a desirable tomographic image than a bending-type probe (Fig. 1.2C). A bending-type probe may be favorable to vaginosonographical-guided aspiration.
The head of the probe houses transducers and its shape is determined mainly by the scanning method, scanning angle, and scanning direction (forward, obliquely forward, or lateral). A mechanical sector probe (Fig. 1.3A) or a convex (curved-array) probe (Figs. 1.3B and C) is used as a transvaginal probe. A phased-array probe is not used for the transvaginal approach because a transvaginal probe should have a wide scanning angle and the shape of the tip is preferable to be either hemispherical-shaped or arc-shaped.
zoom view
Fig. 1.1: An ultrasound scanner with a transvaginal probe by a gynecological examination table
 
CONVEX PROBES
Many small transducers are aligned on the convex surface of the probe head. The principle of scanning is the same in a transabdominal convex probe.1 But the radius of the convex surface of the transvaginal probe is much smaller than that of a transabdominal probe, since a transvaginal probe must have a wide scanning angle in the narrow vagina.
A convex probe performs electronic beam focusing1 and dynamic focusing,1 and the depth of the focal zone is selectable (Fig. 1.4). There are many grating lobes2 on both sides of the main lobe from a convex probe. These grating lobes as well as side lobes cause artifacts (Fig. 1.4). A convex probe has the capability of color, power, and pulsed Doppler as well as B-mode imaging (Fig. 1.5).
zoom view
Figs. 1.2A to C: Transvaginal probes. (A) A straight-type mechanical sector probe; (B) A straight-type convex probe; (C) A bending-type convex probe (H, head; S, shaft; G, grip)
4
zoom view
Figs. 1.3A to C: Probe heads. (A) A mechanical sector probe; (B) A convex probe; (C) A convex probe for obliquely forward scanning
zoom view
Fig. 1.4: An image of a simple cyst obtained with a convex probe. The focal zone (depth) is indicated by a semicircle (arrow) on the left side. Grating and side lobes from the probe make many artifacts (triangles) and the inner outline of the cyst is not shown clearly
zoom view
Fig. 1.5: Images of an ovary obtained with a convex probe. Left, a B-mode image. Right, a power Doppler image of the same section showing blood flows surrounding the corpus luteum
zoom view
Fig. 1.6: Principle of the scanning of a mechanical sector probe.3 The head is filled with acoustically transparent liquid and two transducers rotate in it at high speed. One transducer is for a low-frequency and the other for a high-frequency. The ultrasonic frequency is changeable by switching the active transducer
 
MECHANICAL SECTOR PROBES
Figure 1.6 illustrates the principle of a mechanical sector probe. Two transducers are rotated in the head of the probe constantly by an ordinary motor in the grip of the probe or a small direct-driving motor attached directly to the transducers. Each transducer has its proper frequency and ultrasound frequency can be selected by switching the active transducer.
The tip of a mechanical sector probe is a small hemisphere, and thus a mechanical sector probe can be easily inserted into the vagina. This is especially preferable for examining virgins and old women with atrophic vaginae. The scan angle can be easily widened to more than 200°. The focal zone is fixed at a constant depth determined by the shape of the transducer and there appears no mark indicating the focal zone (Fig. 1.7).5
zoom view
Fig. 1.7: An image of a simple cyst obtained with a mechanical sector probe (the same cyst in Figure 1.4). The focal zone is not indicated on the image because it is fixed. The inner outline of the cyst is clearer than in Figure 1.4 because a mechanical sector probe has no grating lobe and causes less artifacts
zoom view
Figs. 1.8A to C: Three-dimensional transvaginal probes. (A) A mechanical sector probe is housed in the head; (B and C) A convex probe is housed in the head
zoom view
Fig. 1.9: Principle of three-dimensional (3D) scanning. A mechanical sector probe or a convex probe housed in the probe head swings and a bunch of tomographic images is acquired automatically for 3D data set construction4
A mechanical sector probe is superior to a convex probe in B-mode image quality, mainly because there is no grating lobe (compare Figs. 1.4 and 1.7).
The transducer is always in motion in a mechanical sector probe and consequently it has not the capability of color, power or pulsed Doppler which requires that the ultrasonic beams be transmitted to the same direction several times successively.
 
THREE-DIMENSIONAL TRANSVAGINAL PROBES
A three-dimensional (3D) transvaginal probe is used in 3D ultrasound (Figs. 1.8A to C). The head of the probe houses either a convex probe or a mechanical sector probe, which swings to acquire 3D data4 as a large number of consecutive tomograms (Fig. 1.9). A 3D probe can also be used for B-mode imaging, when 3D scanning is not activated.
A 3D image and any arbitrary section can be seen by 3D ultrasound.4 In obstetrics, a 3D image of a fetus and the standard section for crown-rump length measurement can be easily obtained regardless the position and orientation of the fetus.5 In gynecology, a coronal section of the uterus, which cannot be obtained by a conventional transvaginal probe, can be obtained easily.5
 
Accessories of a Transvaginal Probe
Both the head and the shaft of the transvaginal probe should be covered with a condom to prevent any possible infection from other patients. Ultrasonic jelly is appropriately applied to the probe head prior to the tight-fit placement of the condom, thus avoiding the presence of air that would prevent ultrasound transmission.
A needle guide is attached to a transvaginal probe in transvaginal ultrasound-guided follicular/cyst aspiration for ease and safety (Figs. 1.10A and B).6
zoom view
Figs. 1.10A and B: (A) A needle guide and a transvaginal probe; (B) The transvaginal probe prepared with a condom, the needle guide and a long needle for aspiration
REFERENCES
  1. Baba K, Kinoshita K. Video: physics and equipment of ultrasound imaging. Medical View (Tokyo, Japan), 1991.
  1. American Institute of Ultrasound in Medicine. Recommended ultrasound terminology. AIUM.  1997.
  1. Baba K. Leaps of Obstetrics and Gynecology by Ultrasonography. Osaka, Japan: Nagai Shoten;  1992.
  1. Baba K, Okai T. Basis and principles of three-dimensional ultrasound. In: Baba K, Jurkovic D (Eds). Three-dimensional Ultrasound in Obstetrics and Gynecology. Carnforth, England: Parthenon;  1997. pp. 1–19.
  1. Baba K, Io Y. Ultra-sonografia Tridimensional emGinecologia e Obstetricia. In: Sao Paulo (Eds). Brazil: Roca Ltda;  2003.