妇产科疾病的超声诊断课件

1、Ultrasonography on Gynecology and Obstetrics妇产科疾病的超声诊断1Ultrasonography on 妇产科疾病的超声诊断1Sangreal-uterusTHE DAWINCI CODE妇产科疾病的超声诊断2Sangreal-uterusTHE DAWI Pelvic CavityPosterior : Occupied by rectum, colon, and ileumAnterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vaginaNORMAL ANATOMY妇产

2、科疾病的超声诊断3 Pelvic CavityNORMAL ANATOMY妇Pre-inspection :Moderate bladder filling 妇产科疾病的超声诊断4Pre-inspection :Moderate bladdUterusHollow, pear-shaped organDivided into fundus, body, and cervixUsually anteflexed and antevertedCovered with peritoneum except anteriorly below the os where peritoneum is refl

3、ected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in position妇产科疾病的超声诊断5UterusHollow, pear-shaped orgaUterine sizePrepubertal : 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 si

4、ze : 23(thick)45(width)78 cm(length)妇产科疾病的超声诊断6Uterine sizePrepubertal : 3 cmUterine longitudinal diameter Uterine wide diameter Uterus before and after the Trail 妇产科疾病的超声诊断7Uterine longitudinal diameter length 78cmbefore and after the Trail 23cmwidth 45cm妇产科疾病的超声诊断8length 78cmbefore and after tUter

5、ine 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 cervix妇产科疾病的超声诊断9Uterine PositionMidline anteveUltras

6、onography 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.妇产科疾病的超声诊断10Ultrasonog

7、raphy of normal uterUterine serosa layer Myometrium Endometria Normal uterustransabdominal ultrasonography妇产科疾病的超声诊断11Uterine serosa layer MyometriuTransvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through the middl

8、e of the uterine cavity.MyometriumEndometriaUterine serosa layer妇产科疾病的超声诊断12Transvaginal sagittal view of Fallopian Tube（输卵管）Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovariesAmpulla: sidest part of the tube where fertilization occursIsthmus: hard

9、est part; lies just lateral to the uterusLength: 12 cm; supplied by ovarion arteries and veins妇产科疾病的超声诊断13Fallopian Tube（输卵管）InfundibuluOvary（卵 巢） Almond shapedAttached to back of the broad ligament by mesovarium; sometimes called suspensory ligament of the ovaryLies in ovarian fossaFossa is bounded

10、 by external iliac vessels, ureter, and obturator nerveReceives blood from ovarian arteryBlood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal vein妇产科疾病的超声诊断14Ovary（卵 巢） Almond shaped妇产科疾病的Sonography of the normal ovaryAn ovoid homogeneous echodensit

11、y; 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 walled and anechoic with through-transmission posteriorly.妇产科疾病的超声诊断15Sonography of the normal ovaryTransabdominal sagittal image sho

12、ws the left ovary posterior to the urinary bladder妇产科疾病的超声诊断16Transabdominal sagittal image Transvaginal sagittal image of the ovaryovarian follicle妇产科疾病的超声诊断17Transvaginal sagittal image ofFollicular wall flow妇产科疾病的超声诊断18Follicular wall flow妇产科疾病的超声诊断Common Diseases of Obstetrics and GynecologyGyne

13、cology ：Leiomyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc.Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.妇产科疾病的超声诊断19Common Diseases of Obstetrics The uterus Leiomyoma /Hysteromyoma妇产科疾病的超声诊断20The uterus Leiomyoma /HysteroCharacteristics of LeiomyomasMost common pelvic tumorSmoo

14、th muscle cell compositionFibrosis occurs after atrophic of degenerative changesDegeneration occurs when fibroids outstrip their blood supply; calcificationMay be pedunculatedClinical: enlarged uterus, profuse and prolonged bleeding, pain妇产科疾病的超声诊断21Characteristics of LeiomyomasMUterine Locations of

15、 leiomyomasSubmucosal Erode into endomertial cavity heavy bleeding; infertilityIntramuralMay enlarge to cause pressure on adjacent organs; infertilitySubserosalMay enlarge to cause pressure on adjacent organs 妇产科疾病的超声诊断22Uterine Locations of leiomyomaSubserous myomaBroad ligamentmyomaCervical myomai

16、ntramurous myomaSubmucous myoma妇产科疾病的超声诊断23Subserous Broad ligamentCervicUltrasonic performanceTwo-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the uterine body ，Rear echo attenuation； With calcification or Cystic change, etc；Signs of oppression；Color Doppler：Tu

17、mor around with the blood flow signal in the shape of ring or semi-circular ring ；Doppler spectrum：Medium resistance index，RI 0.60.1。妇产科疾病的超声诊断24Ultrasonic performanceTwo-dimeintramurous myoma妇产科疾病的超声诊断25intramurous myoma妇产科疾病的超声诊断25Subserous myomaintramurous myoma妇产科疾病的超声诊断26Subserous myomaintramur

18、ous myoSubserous myoma妇产科疾病的超声诊断27Subserous myoma妇产科疾病的超声诊断27Cervical myoma妇产科疾病的超声诊断28Cervical myoma妇产科疾病的超声诊断28Abundant tumor blood flowMUT妇产科疾病的超声诊断29Abundant tumor blood flowMUT妇产RI 0.61妇产科疾病的超声诊断30RI 0.61妇产科疾病的超声诊断30Submucous myoma with calcification妇产科疾病的超声诊断31Submucous妇产科疾病的超声诊断31Teratoma Der

19、moid Tummors（卵巢良性囊性畸胎瘤/皮样囊肿)Pathology ：derives from germ cell，the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to 20% are bilateral. About 80% occur in women of childbearing age. 妇产科疾病的超声诊断32Teratoma Dermoid Tummors（卵巢Size ranges from small to 40 cmUnliateral,round to oval ma

20、ssContains faty,sebaceous material, hair, cartilage, bone, teethClinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsionSonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowing妇产科疾病的超声诊断33Size ranges from small to 40 cSpecial Ultras

21、ound 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. A complex mass妇产科疾病的超声诊断34Special Ultrasound Findings:1.cystic teratoma of ovaryA cystic massPas

22、te signFluff of hair sign妇产科疾病的超声诊断35cystic teratoma A cystic massPPaste signFat-fluid level signA complex mass妇产科疾病的超声诊断36Paste signFat-fluid level signA 8 years old girl, cutting off a three kilograms benign teratoma妇产科疾病的超声诊断37A 8 years old girl, cutting ofThe role of Ultrasound in Obstetrics妇产科疾

23、病的超声诊断38The role of Ultrasound in ObstTRIMESTERSFirst trimester = 0 to 12 weeks of gestationSecond trimester = 13 to 26 weeks of gestationThird trimester = 27 to 42 weeks of getsationPostterm pregnancy = 42 weeks of gestation妇产科疾病的超声诊断39TRIMESTERSFirst trimester Indications for First-Trimester Sonog

24、raphyConfirm presence of intrauterine pregnancyEvaluate for suspected ectopic pregnancyDefine cause of vaginal bleedingDetermine gestational ageConfirm suspected multiple gestationsAid in invasive proceduresEvaluate pelvic massesDetect uterine abnormalities妇产科疾病的超声诊断40Indications for First-TrimesteN

25、atural pregnancy妇产科疾病的超声诊断41Natural pregnancy妇产科疾病的超声诊断41Nonage pregnancy (First-Trimester) Definition ：Pregnancy before 12 weekend.妇产科疾病的超声诊断42Nonage pregnancy (First-Trime5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac; 9 weeks Emb

26、ryonic, placenta.The Normal First Trimester妇产科疾病的超声诊断435 weeks pregnant The Normal FSonographic Features of a Normal Gestational SacShape: round of ovalPosition: fundal or middle portion of uterus; a center position relative to endometriumContour: smoothWall: echogenic; 3 mm of more in thickness妇产科疾

27、病的超声诊断44Sonographic Features of a NormInternal 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)妇产科疾病的超声诊断45Internal landmarks: yalk sac p4-5 weeks pregnant In the gest

28、ational sac we can see a embryo point, the earliest embryo. 妇产科疾病的超声诊断464-5 weeks pregnant妇产科疾病的超声诊断467 weeks pregnant Fetus was about 4 mm，we can see apparent heart throb, and small limb bud .妇产科疾病的超声诊断477 weeks pregnant妇产科疾病的超声诊断478 weeks pregnant Three-dimensional ultrasound show its beginning of

29、 the shape of a human.妇产科疾病的超声诊断488 weeks pregnant妇产科疾病的超声诊断48Umbilical bordEmbryonic headEmbryonic abdomen妇产科疾病的超声诊断49Umbilical bordEmbryonic headEmYolk sacEmbronic headAmniotic sac妇产科疾病的超声诊断50Yolk sacEmbronic headAmniotic 9 weeks pregnant Known as a fetal，Development of the various parts of the fe

30、tus, tends to improve.妇产科疾病的超声诊断519 weeks pregnant妇产科疾病的超声诊断5112 weeks pregnantThe spine is identifiable , as the two bead-like high echo. Ears, limbs, bones can be shown and measurement. 妇产科疾病的超声诊断5212 weeks pregnant妇产科疾病的超声诊断52Ultrasound of the Second and Third Trimesters妇产科疾病的超声诊断53Ultrasound of

31、the Second and TIndications 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 life妇产科疾病的超声诊断54Indications for Second- and

32、T provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placementEvaluate uterine abnormalityEvaluate abnoumal maternal serum alpha-fetoprotein valuesEvaluate abnormal amniotic fluidEvaluate placenta Etc.妇产科疾病的超声诊断55 provide adjunct to amniocenteThe Second- a

33、nd Third-Trimester( Metaphase and terminal prengancy)Mid-pregnancy:13-27 weeks pregnancy.Late-pregnancy:More than 28 weeks of pregnancy.妇产科疾病的超声诊断56The Second- and Third-TrimestScanning TechniquesSurvey uterus Observe cardiac activityDetermine position and number of the fetus and placentaAssess amni

34、otic fluidLook for uterine of placental masses and fetal anomalies妇产科疾病的超声诊断57Scanning TechniquesSurvey uterCheck contents1、Fetal 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.妇产科疾病的超声诊断

35、58Check contents妇产科疾病的超声诊断581 、 Fetal headMeasuring the Biparietal Diameter(BPD)Obitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nucleiMake sure the head is symmetric and ovalMeasure from outer to inner margins of the sk

36、ullIn the third trimester, the BPD is not as accurate in predicting fetal age 妇产科疾病的超声诊断591 、 Fetal headMeasuring the Bi Fetal head, after 12 weekend pregnant妇产科疾病的超声诊断60 Fetal head, after 12 we Fetal side profile, we can observe its forehead, nose ,lip, and chin, etc.妇产科疾病的超声诊断61 Fetal side profile

37、, we 2、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)妇产科疾病的超声诊断622、Fetal abdomenThe hepatobiliaThe urinary system: kidneys, adrenal glands

38、, ureters, bladder.The fetal abdomen circumference（AC) is the most widely measured 妇产科疾病的超声诊断63The urinary system: kidneys,Measuring 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 oute

39、r margin of the abdominal wall should be measuredThe abdominal wall measurement is the least accurate妇产科疾病的超声诊断64Measuring the Abdominal CircumThe fetal livergallbladderstomachport venousspinegallbladderstomach妇产科疾病的超声诊断65The fetal livergallbladderstom3、Fetal limbsThe upper limbs: the ulna the radiu

40、s the humerusThe lower limbs: the femur/the thigh bone the fibula the tibia The femur is the most widely measured long bone （FL femur length ）妇产科疾病的超声诊断663、Fetal limbsThe upper limbs: Femur measurementHyperechonic linear structure represents the ossified portion of the femoual diaphysis and correspo

41、nds 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 gestational ageFemur length may indicate skeletal dysplasias or intrauterine growth restriction妇产科疾病的超声诊断67Femur measurementHyperechonic Long section of the upper lim