Uterine ultrasound

Schwartz LB, Rutkowski N, Horan C, Nachtigall LE, Snyder J, Goldstein SR (1998) Use of transvaginal ultrasonography to monitor the effects of tamoxifen on uterine leiomyoma size and ovarian cyst formation. J Ultrasound Med 17 699-703... 

Zhou XD, Ren XL, Zhang J, He GB, Zheng MJ, Tian X, Li L, Zhu T, Zhang M, Wang L, Luo W (2007) Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid utility of contrast-enhanced ultrasonography. European Journal of Radiology 62 289-294. 

The role of imaging in uterine fibroids is not only to characterize the number, type and size of the tumors, but also to screen for other causes of the presenting symptoms. Ultrasound is typically the initial imaging modality used in the work-up of uterine fibroids, but it is subject to operator variability and therefore lacks reproducibility (Fig. 10.2.2). Ultrasound is best suited as a screening test for fibroids and to exclude any obvious pelvic pathology. MRI not only provides the consistency required for postprocedure comparisons [13, 26], but also reliably excludes adenomyosis and all but stage I carcinomas of the endometrium [13]. At our institution the same MR sequences are used pre and post UAE and are described in Table 10.2.1. 

Ahmad I, Ray CE Jr et al (2003) Transvaginal sonographic appearance of thrombosed uterine arteries after uterine artery embolization the white snake sign. J Clin Ultrasound 31 401-406... 

Tranquart F, Brunereau L, Cottier JP et al. (2002) Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids. Ultrasound Obstet Gynecol 19 81-87... 

Marret H, Tranquart F, Sauget S, Alonso AM, Cottier JP, Herbreteau D (2004a) Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas. Ultrasound Obstet Gynecol 23 77-79... 

Hata K, Hata A, Maruyama R, Hirai M (1997) Uterine sarcoma can it be differentiated from uterine leiomyomas with Doppler ultrasonography A preliminary report. Ultrasound Obstet Gynecol 9 101-104... 

Recently, two minimally invasive therapies have been introduced to treat uterine fibroids. High frequency focused ultrasound and transvaginal paracervical clamping of the uterine arteries have been reported in the management of symptomatic uterine fibroids [10]. From our own experience with the use of uterine fibroid embolization, we know that unless complete devascularization of all identified fibroids is obtained after these therapies, the results in terms of recurrence will not be better than after myomectomy and maybe higher than after embolization. 

Hindley J, Gedroyc WM, Regan L, et al. (2004) MRI guidance of focused ultrasound therapy of uterine fibroids early results. Am J Roentgenol 183 1713-1719... 

Fig. 5.6. Transvaginal ultrasound (TVUS) of uterine leiomyoma. TVUS demonstrates a well defined subserosal leiomyoma (arrow) distorting the outer contour of the uterine wall. The leiomyoma shows a heterogenous echotexture and is hypoechoic compared to the adjacent myometrium and endometrium. The endometrium is seen as a hyperechoic stripe...

Sonography has a reported accuracy of approximately 90%-92% [13-15]. SSG, with infusion of saline into the endometrial canal, provides improved delineation of the endometrium and internal uterine morphology. Three-dimensional ultrasound with surface- and transparent-mode reconstructions of the uterus has reported advantages over conventional two-dimensional scanning. In experienced hands, a sensitivity of 93% and a specificity of 100% have been achieved [16]. 

To date, there has been a paucity of reported ultrasound or MRI studies to detect DES-related uterine changes. Most likely, this reflects relatively subtle findings on these examinations. 

GB (1987) Can ultrasound be used to screen uterine malformations Fertil Steril 47 89-93... 

Kupesic S, Kiurjak A (2000) Ultrasound and Doppler assessment of uterine anomalies. In Kupesic S, de Ziegler D (eds) Ultrasound and infertility. Parthenon, Pearl River, NY,pp 147-153... 

Color Doppler ultrasound is the primary imaging modality in patients with suspected ovarian vein thrombosis. Especially in the postpartal period, its performance is often limited due to uterine enlargement, postoperative changes, or obesity. This is why CT or MRI are commonly performed to rule out ovarian vein thrombosis. 

Bunch TD, Panter KE, James LF (1992) Ultrasound studies of the effects of certain poisonous plants on uterine function and fetal development in livestock. J Anim Sci 70 1639-1643... 

Van der Putte SCJ (1986) Normal and abnormal development of the anorectum. J Pediatr Surg 24 434-440 Wagner BJ, Woodward P (1994) Magnetic resonance evaluation of congenital uterine anomalies. Sem Ultrasound CT MR 15 4-17... 

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