Imaging In Gynae Flashcards
How does an ultrasound work? (5)
- Ultrasound waves and frequency
- Piezo-Elictric crystals
- Grows and shrinks depending on the voltage run through it
- Running an alternating current through it causes it to vibrate at a high speed and to produce an ultrasound wave
- Sound is then reflected back to the PE crystals converting sound into electrical energy and then to photo energy
Doppler Waveform/effect - (siren e.g.) (5)
- Doppler effect-the shift between emitted and observed frequency of sound
- Velocity and Angle
- Pulsed Doppler pulsed echo system
- defines the rate which data is collected
Blood vessels have blood flowing + pressure = that is picked up
in an artery can pick up directions and sound waves are being reflected by RBC’s = pick it up = doppler waveform
- Light moving away—red
- Light moving towards– blue
- Blood cells – scatter—RBC
Imaging in Normal menstrual cycle (3)
Endo
ovarian
changes during menstrual cycle
Endometrial pattern
Endometrial thickness comparison pre and post ovulation (Follicular and luteal) - there is a steady increase pre and then plateu of endo thickness + volume post ovul
After period
shortly after menstruation the endometrium appears as a thin white line
the follicles are small w/ < 8 mm in size and multipl
Mid follicular phase
the endometrium becomes thicker and manifests a “triple-layer” appearance
there is a dominant follicle ahead of the other follicles
Periovulatory phase
the day before ovulation the endometrium still has a “triple-layer” appearance but there is a thick white line surrounding it; this probably reflects some
progesterone production from the dominant follicle
Follicle is about 17-23 mm in size
luteal phase
endometrium is thick and homogenously hyperechoic (white)
Corpus luteum cystic or solid collapsed or full appearance with irregular edge and shadows w/ the the cyst = Raised dopplers are classical – roughly day 21
Resistance Index
A-B/Mean Difference of the highest and lowest value divided by the mean in one cardiac cycle
Pulsatility Index - gynae
A/B ratio indicates peripheral resistance
RI absent or reversal - foetal
Increase peripheral resistance causes diminution and then loss of blood
flow
3D AND 4D (4)
- Coronal plane
- Volume for review
- TUI Like MRI
- SONOAVC
1D - still image
2D - still image in motion
3D - static but from all angles
4D - all angles in motion
Gynaecology pathology looked at (3)
- Uterus
- Adnexa mainly fallopian tubes
- Ovaries
What in the uterus is looked at? (4)
- Polyp - small soft growth in the lining
- Fibroids
- Uterine malformation
- Location of pregnancy
What is Slime inducing sonography (SIS) + Hycosy Catheter used for? (3)
picking up polyps - twist it and take it off
1) put catheter in uterus
2) put h2o in cavity = expansion of uterus
3) if polyp present - will be seen very easily
so seen by routine scans or SIS (hycosy checks the tubes)
What may be a presentation of a polyp - preg + non preg? (4)
preg:
miscarriages
non-preg:
spotting
bleeding
or asymp for both
Polyp classification (3)
Type 0– fibroid polyp - completely in the cavity
Type 1 – Less than 50% within the myometrium (half the cavity)
Type 2 – more than 50% within the myometrium (<half the cavity)
Uterine Malformations (4)
two halves of foetus that comes together to join - middle bit dissolves = uterus forms body + cervix
- Arcuate uterus - in the past called thsi ( heart shaped)
- bicornuate uterus - if they remain separate
- uterine septum - if they join + middle doesn’t dissolve
- Unicornuate uterus
Early pregnancy Assessment - TVS (when there is a complication) (4)
Gestational sac and CRL - ectopic in uterine tubes
Visible cardiac activity
‘Bagel Sign’ (no foetus in it, just placenta + sac)
Inhomogeneous Mass ‘Blob Sign’ ( same thing - looks like a blob)
Cervical Ectopic Pregnancy (2)
5/6 (83%) successfully treated with methotrexate
-single dose
-multiple dose
-intra-amniotic
*1 case then successfully treated with intra-amniotic KC
LSCS Scar Ectopic Pregnancy (2)
ectopic in the c section scar
- Series of 18 ectopics within
- 71% (5/7) treated successfully with local Methotrexate ± KCl
Cornual Ectopic Pregnancy (3)
starts in fallopian tube + in teh muscle of teh uterus
*20 interstitial pregnancies
*17 treated with single dose Methotrexate
*94 % success (16/17)
What is a heterotopic pregnancy?
one in uterus
+
one in fallopian tube
1/10000 - very rare - slightly more common because of IVF
when do you use Surgical Management in pregnancy? (6)
- Pain
- Haemodynamically unstable
- High hCG
- Viable ectopic pregnancy
- Large ectopic mass
- Haemoperitoneum
Transvaginal Ultrasound (2)
- Double thickness measurement of both endometrial surfaces at the thickest point in the mid-sagittal view - shouldn’t happen post-menopause because of oestrogen
- If fluid present: layers individually measured and summated
endo thickness + cancer
A meta-analysis of 85 published studies that included 5892 women showed that an endometrial thickness of greater than 5 mm identified 96% of endometrial cancer.
When should Sonohysterography be used?
Should used when an endometrial echo is not well visualized or is not thin and distinct
Ovarian pathology (5)
- Endometriosis (bleeding elsewhere due to endometriosis @ other locations and cyst forms - endo. cyst) - chocolate cyst
- Dermoid cyst (has hair, bone, teeth etc - most common benign cyst in reproductive age)
- Polycyctic ovaries (not cyst - it is multiple follicles)
- Cystadenoma (cyst with fluid - benign)
- Mucinous cyst (cyst with unclear fluid)
Clinical applications of ultrasounds (+ART) (6)
- Assessment of Uterus and ovaries
- Assessment of uterine cavity
- Tubal patency – hycosy
- Follicle growth
- Egg retrieval
- Embryo transfer
