婦產科疾病的超聲診斷2011ENGLISH

1、Ultrasonography on Gynecology and ObstetricsLiu Liping1醫(yī)學pptSangreal-uterusTHE DAWINCI CODE2醫(yī)學ppt Pelvic CavityPosterior : Occupied by rectum, colon, and ileumAnterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vaginaNORMAL ANATOMY3醫(yī)學pptPre-inspection :Moderate bladder filling 4醫(yī)學pptUt

2、erusHollow, pear-shaped organDivided into fundus, body, and cervixUsually anteflexed and antevertedCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in position5醫(yī)學pptUterine s

3、izePrepubertal : 3 cm long by 0.5 to 1.0 cm wideMenarcheal: 8 cm long by 4 cm widePostmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wideNormal size : 23(thick)45(width)78 cm(length)6醫(yī)學pptUterine longitudinal diameter Uterine wide diameter Uterus before and after the Trail 7醫(yī)學pptlength 78cmbefore and a

4、fter the Trail 23cmwidth 45cm8醫(yī)學pptUterine PositionMidline anteversion: most common; degree of anteversion is bladder distention dependentRight or left: normal variant in absence of pelvic massesRetroverted: entire organ displaced posteriorlyRetroflexed: body displaced with respect to cervix9醫(yī)學pptUl

5、trasonography of normal uterusUterine serosa layer: Linear high-echo ;clear, smooth; Myometrium: Homogeneous middle-echo ;Endometria: The middle line of high echo , around the weak echo . It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.10醫(yī)學pptUterine ser

6、osa layer Myometrium Endometria Normal uterustransabdominal ultrasonography11醫(yī)學pptTransvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through the middle of the uterine cavity.MyometriumEndometriaUterine serosa layer12

7、醫(yī)學pptFallopian Tube（輸卵管）Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovariesAmpulla: sidest part of the tube where fertilization occursIsthmus: hardest part; lies just lateral to the uterusLength: 12 cm; supplied by ovarion arteries and veins13醫(yī)學ppt

8、Ovary（卵 巢） Almond shapedAttached to back of the broad ligament by mesovarium; sometimes called suspensory ligament of the ovaryLies in ovarian fossaFossa is bounded by external iliac vessels, ureter, and obturator nerveReceives blood from ovarian arteryBlood drained by ovarian vein into inferior ven

9、a cava on right; on left by ovarian vein into lert renal vein14醫(yī)學pptSonography of the normal ovaryAn ovoid homogeneous echodensity; follicular cysts are often present.The best sonographic marker for the ovary is identification of a follicular cyst, which has the classic appearance of being thin wall

10、ed and anechoic with through-transmission posteriorly.15醫(yī)學pptTransabdominal sagittal image shows the left ovary posterior to the urinary bladder16醫(yī)學pptTransvaginal sagittal image of the ovaryovarian follicle17醫(yī)學pptFollicular wall flow18醫(yī)學pptCommon Diseases of Obstetrics and GynecologyGynecology ：Lei

11、omyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc.Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.19醫(yī)學pptThe uterus Leiomyoma /Hysteromyoma20醫(yī)學pptCharacteristics of LeiomyomasMost common pelvic tumorSmooth muscle cell compositionFibrosis occurs after atrophic of degenerative changes

12、Degeneration occurs when fibroids outstrip their blood supply; calcificationMay be pedunculatedClinical: enlarged uterus, profuse and prolonged bleeding, pain21醫(yī)學pptUterine Locations of leiomyomasSubmucosal Erode into endomertial cavity heavy bleeding; infertilityIntramuralMay enlarge to cause press

13、ure on adjacent organs; infertilitySubserosalMay enlarge to cause pressure on adjacent organs 22醫(yī)學pptSubserous myomaBroad ligamentmyomaCervical myomaintramurous myomaSubmucous myoma23醫(yī)學pptUltrasonic performanceTwo-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the

14、 uterine body ，Rear echo attenuation； With calcification or Cystic change, etc；Signs of oppression；Color Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ；Doppler spectrum：Medium resistance index，RI 0.60.1。24醫(yī)學pptintramurous myoma25醫(yī)學pptSubserous myomaintram

15、urous myoma26醫(yī)學pptSubserous myoma27醫(yī)學pptCervical myoma28醫(yī)學pptAbundant tumor blood flowMUT29醫(yī)學pptRI 0.6130醫(yī)學pptSubmucous myoma with calcification31醫(yī)學pptTeratoma Dermoid Tummors（卵巢良性囊性畸胎瘤/皮樣囊腫)Pathology ：derives from germ cell，the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to

16、 20% are bilateral. About 80% occur in women of childbearing age. 32醫(yī)學pptSize ranges from small to 40 cmUnliateral,round to oval massContains faty,sebaceous material, hair, cartilage, bone, teethClinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsionSonog

17、raphy: Cystic/ complex/solid mass, echogenic components; acoustic shadowing33醫(yī)學pptSpecial Ultrasound Findings:1. A cystic mass: with an echogenic mural nodule2. A paste sign：particulate liptinite3. A fluff of hair sign4. A fat-fluid level sign：with fluid level in the cyst, fat above, fluid below.5.

18、A complex mass34醫(yī)學pptcystic teratoma of ovaryA cystic massPaste signFluff of hair sign35醫(yī)學pptPaste signFat-fluid level signA complex mass36醫(yī)學pptA 8 years old girl, cutting off a three kilograms benign teratoma37醫(yī)學pptThe role of Ultrasound in Obstetrics38醫(yī)學pptTRIMESTERSFirst trimester = 0 to 12 weeks

19、 of gestationSecond trimester = 13 to 26 weeks of gestationThird trimester = 27 to 42 weeks of getsationPostterm pregnancy = 42 weeks of gestation39醫(yī)學pptIndications for First-Trimester SonographyConfirm presence of intrauterine pregnancyEvaluate for suspected ectopic pregnancyDefine cause of vaginal

20、 bleedingDetermine gestational ageConfirm suspected multiple gestationsAid in invasive proceduresEvaluate pelvic massesDetect uterine abnormalities40醫(yī)學pptNatural pregnancy41醫(yī)學pptNonage pregnancy (First-Trimester) Definition ：Pregnancy before 12 weekend.42醫(yī)學ppt5 weeks pregnant Gestational sac； 6-7 we

21、eks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac; 9 weeks Embryonic, placenta.The Normal First Trimester43醫(yī)學pptSonographic Features of a Normal Gestational SacShape: round of ovalPosition: fundal or middle portion of uterus; a center position relative to endometriumContour:

22、 smoothWall: echogenic; 3 mm of more in thickness44醫(yī)學pptInternal landmarks: yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mmGrowth: 1 mm per day (range: 0.7 mm to 1.5 mm per day)45醫(yī)學ppt4-5 weeks pregnant In the gestational sac we ca

23、n see a embryo point, the earliest embryo. 46醫(yī)學ppt7 weeks pregnant Fetus was about 4 mm，we can see apparent heart throb, and small limb bud .47醫(yī)學ppt8 weeks pregnant Three-dimensional ultrasound show its beginning of the shape of a human.48醫(yī)學pptUmbilical bordEmbryonic headEmbryonic abdomen49醫(yī)學pptYolk

24、 sacEmbronic headAmniotic sac50醫(yī)學ppt9 weeks pregnant Known as a fetal，Development of the various parts of the fetus, tends to improve.51醫(yī)學ppt12 weeks pregnantThe spine is identifiable , as the two bead-like high echo. Ears, limbs, bones can be shown and measurement. 52醫(yī)學pptUltrasound of the Second a

25、nd Third Trimesters53醫(yī)學pptIndications for Second- and Third-Trimester Estimate gestational age for patients with uncertain datesEvaluate uterine size and clinical date discrepanciesEvaluate fetal growthEstimate fetal weightDetermine fetal presentationEvaluate fetal life54醫(yī)學ppt provide adjunct to amn

26、iocentesis, percutaneous umbilical blood sampling procedure, or cerclage placementEvaluate uterine abnormalityEvaluate abnoumal maternal serum alpha-fetoprotein valuesEvaluate abnormal amniotic fluidEvaluate placenta Etc.55醫(yī)學pptThe Second- and Third-Trimester( Metaphase and terminal prengancy)Mid-pr

27、egnancy:13-27 weeks pregnancy.Late-pregnancy:More than 28 weeks of pregnancy.56醫(yī)學pptScanning TechniquesSurvey uterus Observe cardiac activityDetermine position and number of the fetus and placentaAssess amniotic fluidLook for uterine of placental masses and fetal anomalies57醫(yī)學pptCheck contents1、Feta

28、l head ：BPD biparietal diameter;2、Fetal abdomen: AC abdomen circumference;3、Fetal limb： FL femur length ;4、Others：Placenta, Fetal heart rate, Amniotic fluid, etc.58醫(yī)學ppt1 、 Fetal headMeasuring the Biparietal Diameter(BPD)Obitain biparietal diameter of the fetal head at the transverse level of the mi

29、dbrain: falx, cavum septi pellucidi, and thalamic nucleiMake sure the head is symmetric and ovalMeasure from outer to inner margins of the skullIn the third trimester, the BPD is not as accurate in predicting fetal age 59醫(yī)學ppt Fetal head, after 12 weekend pregnant60醫(yī)學ppt Fetal side profile, we can o

30、bserve its forehead, nose ,lip, and chin, etc.61醫(yī)學ppt2、Fetal abdomenThe hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ductsThe gastrointestinal system: the esophagus, stomach, small and large intestines(colon)62醫(yī)學pptThe urinary system: kidneys, a

31、drenal glands, ureters, bladder.The fetal abdomen circumference（AC) is the most widely measured 63醫(yī)學pptMeasuring the Abdominal Circumference(AC)The AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverThe outer margin of the abdo

32、minal wall should be measuredThe abdominal wall measurement is the least accurate64醫(yī)學pptThe fetal livergallbladderstomachport venousspinegallbladderstomach65醫(yī)學ppt3、Fetal limbsThe upper limbs: the ulna the radius the humerusThe lower limbs: the femur/the thigh bone the fibula the tibia The femur is t

33、he most widely measured long bone （FL femur length ）66醫(yī)學pptFemur measurementHyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condylesThe mormal femur has a straight laeral border and a curved medial borderFemur length may be used with the same accuracy as BPD to predict