highlights in U.S

1. Highlights in US
Highlights in U.S

2. • Pelvic pathology .
• Infertility .
• Fertilization .
Role of the Doppler

3. Techniques
• Transvaginal Ultrasound ( more
important )
• Abdominal Ultrasound .
• Both these techniques are collaborated
with Doppler .

4. Doppler ultrasound : A form of ultrasound that can
detect and measure blood flow .
Doppler ultrasound depends on the Doppler effect , a
change in the frequency of a wave resulting here from
the motion of a reflector , the red blood cell .
1. Continuous wave Doppler
2. Spectral Doppler ( duplex ) .
3. Spectral & color Doppler ( triplex ).
4. Power Doppler
Types of Doppler

6. • Zoom to the area of interest .
• Adjust the focus .
• Apply color Doppler .
• Narrow the color box .
• Adjust the gain .
• Apply the pulsed wave .
• Adjust the gate to cover vessel .
• Adjust the angle .
• Adjust the velocity scale .
• Adjust the baseline & filter .
Tips and tricks for optimization of
Doppler imaging

9. • No aliasing .
• Angle independent .
• Increased sensitivity to detect low-velocity flow
Distinguish pre-occlusive from occlusive lesions
Superior depiction of plaque surface
morphology .
• Useful in imaging tortuous vessels .
Advantages of power Doppler

10. Normal vascularization of uterus

11. Pelvic pathology
Uterine Lesions

12. Blood supply of Myoma
Peripheral vessels
Interlesional blood flow
Circumferential
Blood flow

14. Compined myoma + adenoymiosis by PW

15. Uterine AV malformations
Tortuous , tubular cystic structures .
• No mass effect .
• Within the intermediate layer of
myometrium
• Color Doppler ( highly vascular ,
extensive color aliasing .
• Pulsed Doppler (high velocity
waveform )
• ( BHCG to exclude pregnancy )

16. • Color Doppler shows sub endometrial
blood flow and the blood flow in
thickened and polypoidal endometrium
shows low resistance patterns .
• Saline infusion sonography is useful in
detecting polyps and intercavitary
masses . Preoperative assessment with
ultrasound results matches the result of
a CT or MRI assessment .
Endometrial cancers

18. Endometrial
polyp and fluid in
endometrial
cavity
(saline infusion
sonogram)

19. • Color Doppler is useful for diagnosing
endometrial cancer .
• The blood flow in thickened endometrium
shows low resistance ( RI less than 0.3 ).
• EC diagnosis is confirmed by CT , MRI.
Endometrial Cancers

21. Classification of ovarian mass by
International Ovarian Tumor
Analysis ( IOTA )
Adenxial mass

22. B1:unilocular cyst
B2:presence of solid
components (max.
diameter 7 mm)
B3:presence of
acoustic shadow
B4:smooth multi ocular
tumor(max. diameter
100 mm )
B5:no blood flow
M1: irregular solid
tumor
M2: presence of ascites
M3: at least for four
papillary
structures(more than 3
mm)
M4 : irregular
multilocullar solid
tumor ( more than 10
cm )
M5 : very strong blood
flow ( score 4)

23. • IOTA ( International Ovarian Tumor
Analysis group ) consensus statement .
• Scoring
 No blood flow Score 1 .
 Minimal blood flow Score 2 .
 Moderate blood flow Score 3 .
 Highly vascular Score 4 .
• Score of 3 or more Highly
suggestive of malignancy .
Color Doppler

27. Endometrioma
Dermiod cyst

28. • Most common in reproductive age , 20%
occurs in pregnancy .
• Right side more common , (sigmoid
colon protects) left side .
• Symptom and sign( very important to
help us in diagnosis ) .
• OT start by lymphatic obstruction then
venous end by arterial obstruction .
• Ovary is enlargenlarged , edematous .
• Ovarian volume more than 15 cm .
Ovarian Torsion

31. • High resistance (RI 0.6 : 1)
 Cystadenomas , hemorrhagic cysts , dermoid
tumors , endometrioma .
• Intermediate resistance ( RI 0.4 : 0.6 )
 Dermoid tumors , endometriomas .
• Low resistance ( RI 0: 0.4)
 Ovarian cancer , inflammatory masses ,
endometriomas , dermoids , corpus Iuteum.
Resistance Pattern in Ovarian Masses

32. • Complex , hypoechogenic , septated mass .
• Acoustic enhancement .
• Absent color doppler blood flow in mass .
• Ill – defined margins .
• Loss of anatomical landmarks as disease
becomes chronic .
Tubovarian Abscess

35. Ultrasound imaging in ovarian cancer

38. • Normal cycles, the uterine artery PI was
3.16 two days before ovulation and
decreased to 2.22 on the day before
ovulation.
• Decreased uterine perfusion can be a
significant obstacle to implantation in
infertile patients . Very high vascular
resistance in the uterine arteries reflects
poor endometrial receptivity and
suggests that assisted reproductive
techniques will be unsuccessful .
Role of Doppler in Infertility

40. Assessment of uterine artery blood flow by
transvaginal color Doppler scanning on the day
of hCG administration in patients undergoing
IVF could predict pregnancy and implantation
rates.
HCG should be administered when the uterine
artery PI is less than 3 in order to achieve a high
implantation rate .
Role in Assisted Fertilization

41. Thank you
Dr . Sanaa farghal