USG in Gynaecology - Undergraduate Level.pptx

A presentation about the uses of Ultrasound in Gynaecology

1. ULTRASONOGRAPHY IN GYNAECOLOGY

2. Ultrasound is a noninvasive imaging procedure that utilizes high frequency sound waves. Sonography is widely used in gynaecology either with the transabdominal (TAS) or with the transvaginal (TVS) probe. Because of safety, high patient acceptance and relatively low cost, ultrasonography has become a common diagnostic modality in gynaecology.

3. TRANSABDOMINAL SONOGRAPHY(TAS) It is done with a linear or curvilinear array transducer operating at 3-5 MHz. TAS requires full bladder to displace the bowel out of pelvis. Full bladder serves as an acoustic window for the high frequency sound waves. Ultrasound is very accurate in recognizing pelvic mass but cannot stabilize a tissue diagnosis. Tissue resolution of <0.2mm can be obtained with sonography Best used for last masses like fibroid or ovarian tumor .

4. TRANSVAGINAL SONOGRAPHY(TVS) It is done with a probe, which is placed close to the target organ. There is no need of a full bladder. It also avoids the difficulties due to obesity, faced in TAS. TVS operates at a high frequency (5-10 MHz). Therefore, detailed evaluation of the pelvic organs (within 10 cm of the field) is possiblewith TVS. The drawbacks of TVS are mainly due to narrow vagina as in virgins, postmenopausal women, post-radiation vaginal stenosis or woman's refusal.

5. TRANSVAGINAL COLOR DOPPLER SONOGRAPHY(TV-CDS) It provides additional information of blood flow to, from or within an organ (uterus or adnexae ). This flow can be measured by analysis of the waveform using the pulsatility index (PI). Pl = SD/mean.  Neovascularity in an organ with cancer shows abnormal vessels, and multiple arteriovenous shunts. Low impedance flow is expected in such cases.

6. THREE DIMENSIONAL SONOGRAPHY It is more accurate. It can provide details of information as regard to the ovarian volumes, follicular dimensions, complex ovarian masses and uterine malformations.

7. HARMONIC IMAGING Improves tissue visualization and quality by using several frequencies instead of just a single frequency.

8. NORMAL SONOGRAPHIC FINDINGS Uterine stroma : Low level uniform echoes  Endometrium : Linear echogenic stripe  Ovary : Solid and ellipsoid structures  Small amount of fluid is normal finding in POD following ovulation Normal tubes are not visible  Blood is echogenic .

9. USE OF ULTRASOUND IN GYNAECOLOGY

10. TVS is commonly used in assessment of ovarian reserve by counting AF. Count <10 predict poor reserve Infertility workup: Serial measurement of ovarian follicular diameter and endometrial thickness are done using TVS. Mature follicle should measure between 18 and 20 mm in diameter Favorable pre ovulatory endometrium should be between 7 and 11 mm thick To detect correct timing of ovulation by folliculometry Ectopic pregnancy can be detected on TVS as a tubal ring Pelvic mass can be evaluated as regard to its location and consistency Oncology : TV-CDS can assess the vascularity, neovascularization of the mass

11. Endometrial disease : women with unexplained uterine bleeding or postmenopausal bleeding are better studied with TVS. An endometrial thickness of less than 5mm is considered atrophic To locate missing IUD Endoanal USG : Used for assessment of anal sphincter Endorectal USG : Can detect pelvic pathology like endometriosis

12. Interventional sonography Sonographically guided procedures: This technique can be utilized for many diagnostic and terapeutic purposes: Aspiration of cystic masses, e.g. chocolate cyst (p. 286), Follicular aspiration, e.g., ovum retrieval in IVE. Aspiration of tubo-ovarian abscess. Biopsies.  High intensity focused ultrasound (USGgHIFU) ther apy : Cells die due to coagulative necrosis when the target spot temperature rises >55°C. MRI/US guided high-intensity focused ultrasound (HIFU) is based os this principle.

13. Saline infusion sonography (SIS): Infusion of normal saline into the uterine cavity and performing transvaginal (high resolution) sonography is helpfd for the diagnosis of many focal intracavity patholog SIS catheter (17F) is inserted through the cervical os. Normal saline is infused slowly (10-30 mL) when the uterus is imaged with vaginal ultrasound. It is dont within the first 10 days of the cycle

14. Hysterosalpingo-contrast Sonography (HYS-COSY) or Sonohysterosalpingography The procedure is done as similar to SIS. Limitations of Hys-Co-Sy are: Tubal spasm ma cause false positive result for block; Patent tube dos not always suggest normal tubal function; Often the entire fallopian tube cannot be visualised

15. Selective Salpingography (SS) It is the procedure of transcervical tubal catheterization under fluoroscopic guidance. It is done in the follicular phase of the cycle. The catheter is advanced by tactile sensation to the tubal ostium . Contrast dye (water or oil based) is injected thereafter to outline the tubal lumen. A guide wire may be threaded through the catheter to overcome any resistance. This procedure is useful in cases with proximal tubal blockage when seen by hysterosalpingogram (HSG).

16. Three-dimensional Sonography 3D sonography acquires volume of sonographic data. This stored volume of data is reformatted and analyzed in numerous ways. This data could be retrieved, studied and reconstructed in many ways.  Use of 3D imagings : It is used to assess th e volume of leiomyomas , endometrial abnormalities, polyps, cancers, positioning of IUCD within the uterine cavity More details of internal anatomy of any adnexal mass, diagnosis of congenital mullerian anomalies and differentiation of bicornuate and septate uterus is possible. Elastography : Used to measure tissue stiffness in both normal and pathological states.