SONOGRAPHY IN OBSTETRICS AND GYNECOLOGY: Principles & Practice
Seventh Edition
Arthur C . Fleischer, M D
Professor of Radiology and Radiologic Sciences Professor of Obstetrics and Gy
Chief, Diagnostic Sonography
V anderbilt University Medical Center Nashville, T ennessee
W esley Lee, MD
Division of Fetal Imaging
W illiam Beaumont Hospital
R o y al Oak, Michigan
Clinical Professor of Obstetrics and Gynecology Oakland University William Be
R ochester, Michigan
Eugene C . T o y , MD
V ice Chair of Academic Affairs and Residency Program Director
Department of Obstetrics and Gynecology
T he Methodist Hospital-Houston
Associate Clinical Professor
W eill Cornell College of Medicine
Associate Clinical Professor and Clerkship Director Department of Obstetrics
F r ank A. Manning, M D
Professor
Department of Obstetrics and Gynecology Montefiore Medical Center
Bronx, New York
R oberto J. R omero, MD
Chief, P erinatology Research Branch
EDITORS
E ugene C. Toy, MD, i s Vice- Chair of
F rank A . Manning, MD, is a tenured
E ditors
CONTENTS
Contributors ix Preface xv Acknowledgments xvii
I. GENERAL OBSTETRIC SONOGRAPHY
1. Ultrasound Bioeffects and Safety: What the Practitioner Should Know 2
2. Normal Pelvic Anatomy as Depicted with Transvaginal Sonography 21
3. Transvaginal Sonography of Early Intrauterine Pregnancy 39
4. Transvaginal Sonography of Ectopic Pregnancy 71
5. Fetal Biometry 99
6. Prenatal Diagnosis of Congenital Heart Disease 121
7. Placenta, Cord, and Membranes 155
8. Prenatal Diagnosis of Placenta Accreta 187
9. Fetal Growth Restriction 195
10. Doppler Velocimetry of the Uteroplacental Circulation 223
11. Doppler Interrogation of the Fetal Circulation 257
12. Color Doppler Sonography in Obstetrics 309
13. Sonography in Multiple Gestation 337
II. FETAL ANOMALIES AND DISORDERS
14. Fetal Anomalies: Overview 376
15. Prenatal Diagnosis of Cerebrospinal Anomalies 413
16. Fetal Neck and Chest Anomalies 441
17. Fetal Gastrointestinal Anomalies 461
18. The Fetal Genitourinary System 509
19. Fetal Skeletal Anomalies 523
20. Fetal Syndromes 593
21. Ultrasound Detection of Chromosomal Anomalies 651
III. RISK ASSESSMENT AND THERAPY
22. First Trimester Screening 682
23. Fetal Biophysical Profile Score: Theoretical Considerations and Practical
24. Chorionic Villus Sampling 715
25. Amniocentesis 733
26. Fetal Blood Sampling 775
27. Fetal Therapy: Maternal Fetal Surgery and Percutaneous Ultrasound Guided
IV. M A TERNAL DISORDERS
28. Sonographic Examination of the Uterine Cervix 816
29. Sonography of Trophoblastic Diseases 849
30. Postpartum Ultrasound 859
V . GYNECOLOGIC SONOGRAPHY
31. Sonographic Evaluation of Pelvic Masses with Transabdominal and/or Transv
32. Color Doppler Sonography of Pelvic Masses 897
33. Sonographic Evaluation of Uterine Disorders 933
34. Transvaginal Sonography of Endometrial Disorders 961
35. Sonographic Techniques for Early Detection of Ovarian and Endometrial Ca
36. Acute Pelvic Pain: Transvaginal and Doppler Evaluation 1001
37. Transvaginal Sonography in Gynecologic Infertility 1011
C ontents
viii
38. Sonohysterography and Sonohysterosalpingography 1043
39. Guided Procedures Using Transvaginal, Transperineal, and Transrectal Son
40. Pelvic Floor Ultrasound 1087
41. Breast Sonography 1111
42. Breast Ultrasound 1119
VI. COMPLIMENTARY IMAGING MODALITIES
43. Volume Sonography: Core Concepts for Clinical Practice 1134
44. Obstetrical Applications for 3D Ultrasonography 1171
45. Fetal Cardiac Evaluation Using 3D and 4D Ultrasonography 1205
46. Magnetic Resonance Imaging in Obstetrics 1235
47. Three-Dimensional Volumetric Sonography in Gynecology 1263
48. MRI of the Female Pelvis: Problem Solving Sonographic Uncertainties 1295
Index 1319
CONTRIBUTORS
Jacques S. Abramowicz, MD
R o chelle F. Andreotti, MD
Ahmet A. Baschat, MD
George Bega, MD
Beryl R. Benacerraf, M D
Carol B. Benson, MD
F ionnuala M. Breathnach, MD, MRCOG, MRCPI
Daniel M. Breitkopf, M D
Mieke Cannie, MD, PhD
P eter S. Cartwright, MD
T innakorn Chaiworapongsa, MD
W erther Adrian Clavelli, MD
Christine H. C omstock, MD
David O. C osgrove, MA, MSc, FRCP, FRCR
Marta Crispens, MD
Antonella Cromi, MD, PhD
Laura Cruciani, MD
V alentina De Robertis
Greggory R. DeVore, MD
Michael P. Diamond, MD
Hans Peter Dietz, MD, PhD
P eter M. Doubilet, MD, PhD
David A. F ishman, MD
Arthur C . Fleischer, M D
Maria-Teresa Gervasi, MD
F abio Ghezzi, MD
Luís F. Gonçalves, MD
F r ancesca Gotsch, MD
Christopher Harman, MD
Sonia S. Hassan, MD
J ill Herzog, RDMS
T amarya L. Hoyt, MD
John G. H uff, MD
James C . H uhta, MD
Jacques Jani, MD, PhD, F A CR
Marcia C . Javitt, MD, F A CR
Philippe Jeanty, MD, PhD
Cristiano Jodicke, M D
Howard W. Jones, III, MD
xii
Sun Kwon Kim, MD, PhD
Juan Pedro Kusanovic, M D
Debbie J. Lee, BS
W esley Lee, MD
Jodi P. Lerner, M D
Andréj Lyshchik, MD, PhD
F ergal D. Malone, MD
F r ank A. Manning, M D
Joan M. Mastrobattista, MD
Alexandra Matias, MD PhD
Ana Monteagudo, M D
Juliana Moyses L Abdalla
Ana Luisa Neves, MD
Melinda S. New, MD
Giovanna Ogge’, MD
xiii
P ercy Pacora, MD
Dario Paladini, MD
Anna K. P arsons, MD
Gianluigi Pilu, MD
Dolores Pretorius, MD
Elizabeth E. Puscheck, MD
Mark Redman, MD
Georgios Rembouskos, MD
Silvia Susana Romaris, MD
R oberto J. R omero, MD
A. Cristina Rossi , M D
Gabriella Sglavo, M D
Eyal Sheiner, M D
Gabriele Siesto, M D
xiv
Sandra R. Silva, MD
W illiam E. Svensson, FRCR, FRCSI, LRCPI, LRCSI, LM
Eugene C . T o y , MD
Ilan E. T imor-Tritsch, MD
Diane M. T wickler, M D , F A CR
E di Vaisbuch, MD
Jaime M. V asquez, MD
P aolo Volpe, MD
R onald.J. W apner, M D
Phillip K. W illiams, RDMS
Douglas Wilson, MD
Lami Yeo, MD
PREFACE
A CKNOWLEDGMENTS
GENERAL OBSTETRIC SONOGRAPHY
ULTRASOUND BIOEFFECTS AND SAFETY: WHAT THE PRACTITIONER SHOULD KNOW
J acques S. Abramowicz
E yal Sheiner
INTRODUCTION
B ASIC PHYSICS OF ULTRASOUND
T he Ultrasound Wave
T issue Characteristics
Instrument Outputs
distance. A very important control is receiver gain.
THERMAL EFFECTS
MECHANICAL EFFECTS
THE OUTPUT DISPLAY STANDARD
T able 1-2
RISK ASSESSMENT
HISTORICAL RESEARCH
Animal Research
H uman Research and Epidemiology
Clinical Exposimetry
Nonmedical Ultrasound
Official Positions
RECOMMENDATIONS
FUTURE DIRECTIONS
KEY POINTS
REFERENCES
H ighlighted References
NORMAL PELVIC ANATOMY AS DEPICTED WITH TRANSVAGINAL SONOGRAPHY
SCANNING TECHNIQUE AND INSTRUMENTATION (Figures 2-1 to 2-3)
UTERUS (Figures 2-4 to 2-7)
O V ARIES (Figure 2-8)
O THER PELVIC STRUCTURES (Figures 2-9 and 2-10)
REFERENCES
SUMMARY
Appendix 2-1
AIUM Practice Guidelines for the Performance of Ultrasound Examination of the
I. INTRODUCTION
II. INDICATIONS
III. QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL
IV. SPECIFICATIONS OF THE EXAMINATION
A. General Pelvic Preparation
B. Uterus
C. A dnexa (Ovaries and Fallopian Tubes)
D . Cul-de-Sac
V . DOCUMENTATION
VI. EQUIPMENT SPECIFICATIONS
VII. QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIE
Appendix 2-2
Guidelines for Cleaning and Preparing Endocavitary Ultrasound T r ansducers B
TRANSVAGINAL SONOGRAPHY OF EARLY INTRAUTERINE PREGNANCY
O VERVIEW
CLINICAL INDICATIONS
INSTRUMENTATION AND SCANNING TECHNIQUE
Normal First-Trimester Pregnancy
T able 3-1B
T able 3-1C
T able 3-1A
T able 3-1D
4 to 6 Weeks
7 to 8 Weeks
9 to 11 Weeks
COMPLICATED EARLY INTRAUTERINE PREGNANCY
CAVEATS
O THER APPLICATIONS
SUMMARY
K E Y P O I N T S
Appendix 3-1
Ultrasound Examination of the Female Pelvis in the First
10 Weeks (Embryonic Period) of Pregnancy
INTRODUCTION
SPECIFICATIONS OF THE EXAMINATION
1. Indications
Comment
2. Imaging Parameters
Overall Comment
Comment
3. Equipment Specifications
Comment
4. F etal Safety
TRANSVAGINAL SONOGRAPHY OF ECTOPIC PREGNANCY
A rthur C. Fleischer
M ichael P. Diamond
Peter S. Cartwright
M elinda New
INTRODUCTION
INCIDENCE
P A THOGENESIS
CLINICAL ASPECTS
hCG ASSAY
SONOGRAPHIC EVALUATION
SCANNING TECHNIQUE
SONOGRAPHIC FINDINGS
Uterine
A dnexal
P e r itoneal
RARE TYPES OF ECTOPIC PREGNANCY
O THER ADNEXAL MASSES
TREATMENT IMPLICATIONS
MEDICOLEGAL CONSIDERATIONS
SUMMARY
REFERENCES
FETAL BIOMETRY
E u gene C . Toy
Philippe Jeanty
INTRODUCTION
IMPORTANCE OF A CRITICAL APPROACH
WHY FETAL BIOMETRY?
Selection of Patients
T ypes of Studies: Cross-Sectional or Longitudinal?
PRINCIPLES OF FETAL BIOMETRY
How Are Normal Values Derived?
T able 5-2
Prediction from Equations
How to Compute the Confidence Limits
ESTIMATION OF GESTATIONAL AGE
Definition
P arameters Proposed for Gestational Age Assessment
Gestational Sac
Crown-Rump Length
Biparietal Diameter
H ead Perimeter or Head Circumference
F emur and Humerus Lengths
Other Parameters
Ossification Center
Selection of an Appropriate Table
HOW TO REPORT THE RESULTS
THE ABDOMINAL PERIMETER
W hen Different Parameters Have Discrepancies in Estimates
O THER AVAILABLE NOMOGRAMS
CLINICAL CORRELATES
Answers
Appendix 5-1 Biometry Tables
T able A5-1
T able A5-2
T able 5-4
T able A5-5
T able A5-7
T able A5-8
PRENATAL DIAGNOSIS OF CONGENITAL HEART DISEASE
J ames Huhta
A na Luisa Neves
INTRODUCTION
CARDIAC ANATOMY AND FETAL CIRCULATION
FETAL HEART SCAN
F etal Heart Screening
T able 6-1
Maternal Autoimmune Disease
T e ratogen Exposure 30
F etal Echocardiogram
Indications for Fetal Echocardiogram
M AT E R N A L I NDIC A TIONS Maternal Metabolic Disorders
Obstetrical Ultrasound Examination Suggesting F etal Heart Disease
Obstetrical Ultrasound Scan Suggesting Extracardiac Disease in the Fetus
Maternal Congenital (or Familial) Heart Disease
P a ternal congenital heart disease
M endelian syndromes
Responsible Personnel for Fetal Echocardiogram
F etal Heart Echocardiographic Technique
Rhythm Abnormalities
Significance and Effectiveness of Prenatal Cardiac Diagnosis
Limitations of Fetal Echocardiography
Safety Issues
CONGENITAL HEART DISEASES
Left Heart Defects
H ypoplastic Left Heart Syndrome
Coarctation of the Aorta
Right Heart Defects
Pulmonary Valve Stenosis
Pulmonary Atresia With Intact Ventricular Septum
Ebstein’s Anomaly of the Tricuspid Valve or Tricuspid Dysplasia
Septal Defects
V entricular Septal Defects
A t rial Septal Defects
A t rioventricular Septal Defect
C onotruncal Defects
T etralogy of Fallot
Other Defects
H eterotaxy Syndromes
Common Arterial Trunk
D-Transposition of the Great Arteries
OUTCOMES OF CONGENITAL HEART DISEASE
HYDROPS FETALIS
Cardiac Failure in the Fetus
Prognosis of Fetal Heart Failure— Markers of Fetal Mortality
T he Cardiovascular Profile Score
P a r t 1 GENERAL OBSTETRIC SONOGRAPHY
T r eatment
EMERGING CONCEPTS
T ei Ind e x
V olume Sonography of the Fetal Heart
CLINICAL CORRELATES
T issue Doppler Imaging in the Fetus
CONCLUSIONS
K E Y P O I N T S
REFERENCES
H ighlighted References
PLACENTA, CORD, AND MEMBRANES
J oan M. Mastrobattista
E u gene C . Toy
INTRODUCTION
DEVELOPMENT OF THE PLACENTA: EMBRYOLOGY
Decidual Change
F e rtilization and Implantation
Placenta and Fetal Membranes
PLACENTAL IDENTIFICATION
Placental Calcification
MACROSCOPIC LESIONS OF THE PLACENTA: NORMAL
Subchorionic Fibrin Deposition
Intervillous Thrombosis
P e r ivillous Fibrin Deposition
Maternal Lakes
Infarcts
MACROSCOPIC LESIONS OF THE PLACENTA: ABNORMAL (TABLE 7-1)
Gestational Trophoblastic Disease
Primary Neoplasm
T able 7-1
Secondary Neoplasms
THE RETROPLACENTAL AREA
C ontractions
Leiomyomas
THE MEMBRANES
Placenta Extrachorialis
T he Umbilical Cord Insertion
V ARIATIONS IN SHAPE
Succenturiate Lobes
Placenta Membranacea
ANTEPARTUM HEMORRHAGE
R etroplacental/Submembranous Hematoma
Abruptio Placentae
Placenta Previa
UMBILICAL CORD
F ormation of the Umbilical Cord
Structure and Function of the Umbilical Cord
SONOGRAPHIC ANATOMY OF THE NORMAL CORD
CORD ABNORMALITIES
A bnormalities of Cord Length
A bnormalities of Cord Position
Single Umbilical Arter y
T rue Cord Cysts
Other
ABNORMAL CONDITIONS ASSOCIATED WITH MEMBRANES, SEPTA, OR SYNECHIAE
MULTIPLE PREGNANCIES
SUMMARY
K E Y P O I N T S
REFERENCES
PRENATAL DIAGNOSIS OF PLACENTA ACCRETA
Christine H. Comstock
RISK FACTORS
INTRODUCTION
P A THOLOGY
Before the beginning of a scan, ask all patients about previous uterine surge
DETECTION IN THE FIRST TRIMESTER
SECOND AND THIRD TRIMESTERS
V ascular Spaces
Clear Zone
Uterine-Bladder Serosa
Diagnosis in the Patient Without Uterine Scarring
Diagnosis of Placenta Percreta
USE OF COLOR DOPPLER
MAGNETIC RESONANCE IMAGING
Answer
KEY POINTS
CLINICAL CORRELATE
REFERENCES
FETAL GROWTH RESTRICTION
Christopher Harman
Ahmet A. Baschat
IMPACT OF FGR
NORMAL FETAL GROWTH
FGR TERMINOLOGY
CAUSES OF FGR
MATERNAL CAUSES V ascular Disease
T hrombophilias
Maternal Hypoxemia
Inadequate Substrate
Drugs
Demographics
FETAL FACTORS
THE SMALL FETUS
PLACENTA-BASED FGR Placental Development
IMPACTS OF PLACENTAL DEFICIENCY
T able 9-4
P A TTERNS OF FGR
Early Severe FGR—Easy to Diagnose, Hard to Manage
Late FGR—Hard to Diagnose, Easy to Manage
ULTRASOUND IN FGR
Biometry
BPD
Head Circumference
Abdominal Circumference
HC/AC Ratio
Skeletal Measurements
F etal Proportions
Estimated Fetal Weight
Measurement Definition of FGR
DETAILED ANATOMIC REVIEW
AMNIOTIC FLUID VOLUME
FETAL HEART RATE MONITORING
T able 9-5
C omputerized Heart Rate Analysis
C ontraction Stress Testing
DOPPLER
Multivessel Surveillance
Normal Progression
FGR Hemodynamics
FETAL BEHAVIOR
Biophysical Profile Scoring
INTEGRATED FETAL TESTING
T able 9-8
WHEN SHOULD THE FGR FETUS BE DELIVERED?
T able 9-10
P atterns of Deterioration in FGR Fetuses
ANCILLARY MEASURES T herapeutic Amnioinfusion
Antenatal Steroid Administration
Maternal Oxygenation
Maternal Volume Expansion
Maternal Hyperalimentation
OUTCOME—IMMEDIATE AND LONG TERM
Neonatal Outcomes
Long-Term Outcomes
REFERENCES
H ighlighted References
DOPPLER VELOCIMETRY OF THE UTEROPLACENTAL CIRCULATION
Lami Yeo
Luís F. Gonçalves
Roberto J. Romero
Maria-Teresa Gervasi
Percy Pacora
INTRODUCTION
ANATOMY AND DEVELOPMENT OF THE UTEROPLACENTAL CIRCULATION
INSTRUMENTATION AND EXAMINATION TECHNIQUE
DOPPLER VELOCITY WAVEFORMS OF THE NORMAL UTEROPLACENTAL CIRCULATION
Nonpregnant Uterus
F i r st Trimester
Second and Third Trimesters
Puerperium
T able 10-2
Influence of Sampling Site and Placental Implantation on Doppler Flow Velocit
ABNORMAL DOPPLER VELOCITY WAVEFORMS OF THE UTERINE ARTERY
Elevated Doppler Indices in the Uterine Arteries as a Measure of Impedance to
Computer Models of the Uteroplacental Circulation
Embolization of the Uteroplacental Circulation of Pregnant Ewes
Correlation of Placental Bed Biopsies and Uterine Artery Doppler Velocity Wav
Prediction of Preeclampsia and SGA Fetuses
T able 10-3
T able 10-5
T able 10-6
T able 10-7
T able 10-8
Prediction of Superimposed Preeclampsia in P atients With Chronic Hypertens
Risk of Stillbirth
UTERINE ARTERY DOPPLER IN PREGNANCIES ALREADY COMPLICATED BY PREECLAMPSIA
UTERINE ARTERY DOPPLER IN PREGNANCIES COMPLICATED BY FETAL GROWTH RESTRICTIO
RANDOMIZED CONTROLLED TRIALS
COMBINATION OF UTERINE ARTERY DOPPLER VELOCIMETRY WITH O THER TESTS
Uterine Artery Doppler Velocimetry C ombined With 24-Hour Automated Blood P
Uterine Artery Doppler Velocimetry in Patients W ith Elevated Maternal Serum
Uterine Artery Doppler in Pregnancies With Elevated Free β -hCG
C ombination of MSAFP, Maternal Serum hCG, and Uric Acid Levels
C ombination of Inhibin A and Uterine Artery Doppler
Pregnancy-associated plasma protein A, F r ee
β -hCG, A ctivin A, Inhibin A, and Uterine Artery Doppler
Placental Growth Factor, Soluble Fms-Like Tyrosine Kinase, and Uterine Arte
Homocysteine and Uterine Artery Doppler
PRETERM LABOR
DIABETES MELLITUS
FIRST TRIMESTER UTERINE ARTERY DOPPLER VELOCIMETRY
Association With Miscarriage
Uterine Artery Doppler in the First Trimester as a Screen for Preeclampsia
F irst Trimester Uterine Artery Doppler
Changes in Uterine Artery Doppler From First to Second Trimesters
Uterine Artery Doppler in the First Trimester as a Screen for Fetal Growth Re
Uterine Artery Doppler and First Trimester Biochemical Serum Markers
P APP-A and First Trimester Uterine Artery Doppler
Combination of PAPP-A and Free β -hCG With Second T rimester Uterine Artery
Combination of Placental Protein 13 With First T rimester Uterine Artery Dopp
F irst Trimester PAPP-A, PP-13, and Second T rimester Uterine Artery Doppler
Placental Growth Factor and First Trimester U terine Artery Doppler
EMERGING CONCEPTS
REFERENCES
K E Y P O I N T S
H ighlighted References
DOPPLER INTERROGATION OF THE FETAL CIRCULATION
F r ancesca Gotsch
Laura Cruciani
F abio Ghezzi
Giovanna Ogge’
Lami Yeo
Roberto J. Romero
INTRODUCTION
UMBILICAL ARTERY
Anatomy of the Umbilical Arteries
Physiology of the Umbilical Arteries
Sampling Techniques
Morphology of the Umbilical Artery Waveform and Changes with Gestational Age
T he Physiologic Significance of an Abnormal Umbilical Artery Waveform
T able 11-1
Clinical Correlations of Abnormal Umbilical Artery Doppler Velocimetry
Small for Gestational Age
Congenital/Chromosomal Anomalies
Placental Abruption
P e rsistent Discordant Flow Velocity Waveforms in the 2 Umbilical Arteries
Umbilical Artery Doppler Velocimetry during Labor
UMBILICAL VEIN
Anatomy of the Umbilical Vein
Sampling Techniques
Morphology of the Umbilical Vein Waveform and Changes with Gestational Age
Definition of Umbilical Vein Pulsations
Umbilical Vein Pulsations in Normal Pregnancies
P athophysiology of Umbilical Vein Pulsations
Clinical Correlations of Umbilical Vein Pulsations
U mbilical Vein Pulsations in SGA Fetuses
DOPPLER INTERROGATION OF THE CEREBRAL CIRCULATION
Middle Cerebral Artery
Anatomy of the Middle Cerebral Arter y
Sampling Techniques
Morphology of the Middle Cerebral Artery Waveform and Changes with Gestationa
Indices
Clinical Correlations of an Abnormal Middle Cerebral Artery Doppler Velocimet
T able 11-4
ANTERIOR CEREBRAL ARTERY
Anatomy of the Anterior Cerebral Arter y
Sampling Techniques
Indices
Clinical Correlations of an Abnormal Anterior Cerebral Artery Doppler Velocim
DUCTUS VENOSUS
Anatomy of the Ductus Venosus
Physiology of the Ductus Venosus
Shunting
Sampling Techniques
Morphology of the Ductus Venosus Waveform and Changes with Gestational Age
Doppler Indices
Clinical Correlations of an Abnormal Ductus V enosus Doppler Velocimetry
INFERIOR VENA CAVA
Anatomy of the Inferior Vena Cava
Sampling Techniques
Indices
Morphology of the Inferior Vena Cava Waveform and Changes with Gestational Ag
Clinical Correlations of an Abnormal Inferior V ena Cava Doppler Velocimetry
HEPATIC VEINS
Anatomy of the Hepatic Veins
Sampling Technique
Indices
Morphology of the Hepatic Veins Waveform and Changes with Gestational Age
Clinical Correlations
PULMONARY VEINS
Anatomy of the Pulmonary Veins
Sampling Techniques
T he Physiology of the Pulmonary Veins
Morphology of the Pulmonary Veins Waveform and Changes with Gestational Age
Indices
T he Physiologic Significance of an Abnormal Pulmonary Vein Waveform
A ORTIC ISTHMUS
Anatomy of the Aortic Isthmus
Hemodynamics in the Aortic Isthmus
Sampling Techniques
Morphology of the Aortic Isthmus Waveform and Changes with Gestational Age
Doppler Indices
T he Physiologic Significance of an Abnormal A o rtic Isthmus Waveform
T able 11-7
Clinical Correlations of an Abnormal Aortic Isthmus Doppler Velocimetry
DESCENDING AORTA
Sampling Techniques
Morphology of the Descending Aorta Waveform and Changes With Gestational Age
Indices
Clinical Correlations of an Abnormal Descending A o rta Doppler Velocimetry
T able 11-9
R E N A L A R T E R I E S
Anatomy of the Renal Arteries
Sampling Techniques
Morphology of the Renal Arteries Waveform and Changes with Gestational Age
ADRENAL ARTERY
Anatomy of the Adrenal Arteries
Sampling Techniques
T able 11-10
Physiology of the Adrenal Artery
Morphology of the Adrenal Artery Waveform and Changes with Gestational Age
Indices
Clinical Correlations of an Abnormal Adrenal Artery Doppler Velocimetry
SUPERIOR MESENTERIC ARTERY
Anatomy of the Superior Mesenteric Artery
Sampling Techniques
Indices
Morphology of the Superior Mesenteric Artery W a v e f orm and Changes with G
Clinical Correlations of an Abnormal Superior Mesenteric Artery Doppler Velo
CELIAC ARTERY
Anatomy of the Celiac Artery
Sampling Techniques
Morphology of the Celiac Artery Waveform and Changes with Gestational Age
Indices
Implications
SPLENIC ARTERY
T able 11-11
Anatomy of the Splenic Artery
Sampling Techniques
Indices
Morphology of the Splenic Artery Waveform and Changes with Gestational Age
Clinical Significance
PELVIC AND LOWER EXTREMITIES CIRCULATION: EXTERNAL ILIAC ARTERIES AND FEM
Anatomy
Sampling Techniques
F emoral and External Iliac Artery Flow V elocity Waveforms
Clinical Implications
CORONARY CIRCULATION
Anatomy of the Coronary Circulation
Physiology of the Coronary Circulation
Sampling Techniques
Normal Coronary Arteries Waveform and Changes with Gestational Age
Clinical Implications
FUTURE DIRECTIONS
K E Y P O I N T S
REFERENCES
COLOR DOPPLER SONOGRAPHY IN OBSTETRICS
Dario Paladini
Gabriella Sglavo
P aolo Volpe
B ASIC CONSIDERATIONS
CDUS/PDUS TO DEMONSTRATE NORMAL/ ABNORMAL FETAL CARDIOVASCULAR ANATOMY
F etal Heart
C entral Venous S ystem
T he Aortic Arch
T he Normal Cerebral Circulation
C e r ebral Arteriovenous Malformations
Other Conditions Associated with Arteriovenous Shunt
CDUS/PDUS TO HELP IDENTIFY DISPLACED FETAL ORGANS AND ABNORMAL FETAL MASSE
CDUS/PDUS TO GUIDE PULSED-WAVE DOPPLER SAMPLING OF MATERNAL AND FETAL VESSEL
Uterine Artery in Screening Protocols for Intrauterine Growth Restriction/Pre
Ductus Venosus in the Staging of Vascular C ompromise in Fetuses with IUGR
Middle Cerebral Artery for Noninvasive Diagnosis and Monitoring of Fetal Anem
CDUS/PDUS TO STUDY PLACENTAL MEMBRANES AND UMBILICAL CORD
Placenta and Membranes
Umbilical Cord
CLINICAL CORRELATES
CONCLUSIONS
2. H ow are neuromuscular disorders ruled out?
Middle cerebral artery for fetal anemia
Uterine artery Doppler in screening for preeclamp sia or IUGR
Ductus venosus for IUGR assessment
REFERENCES
KEY POINTS
1. A ctivate color/power Doppler sonography only after
H ighlighted References
SONOGRAPHY IN MULTIPLE GESTATION
Alexandra Matias
Philippe Jeanty
E u gene C . Toy
EMBRYOLOGY
INTRODUCTION
TIMING OF SEPARATION
HETEROTOPIC GESTATION
Differential Diagnosis
MOLAR GESTATION WITH A CONCURRENT PREGNANCY
CHORIONICITY AND PERINATAL PROGNOSIS
THE NAMING OF TWINS
MONOAMNIOTIC TWINS
Definition
Sonographic Features
Differential Diagnosis
Associated Syndromes
CONJOINED TWINS
Definition
Sonographic Features
Classification
T able 13-2
Differential Diagnosis
Associated Syndromes
Prognosis
Management
UNIQUE MONOZYGOTIC MONOCHORIONIC SYNDROMES
Affecting structurally normal babies
Being associated with important perinatal morbid ity and mortality
Diagnosis of Twin-to-Twin Transfusion S yndrome
1 . Discordance in amniotic fluid volume (oligo polyhydramnios sequence)
2. Discordance in fetal size
3. A bnormal Doppler findings
4. F etal echocardiography
5. Signs of hydrops in the recipient twin
6. Other ultrasonographic findings
Ti m i n g
Prognosis
Management
Differential Diagnosis
Associated Complications
Prediction of Twin-to-Twin Transfusion Syndrome
N uchal Translucency
Ductus Venosus Flowmetr y
Growth Discordance in the First Trimester of Pregnancy
Arterio-Arterial Anastomoses
Intertwin Membrane Folding
T win “Embolization” S yndrome
Differential Diagnosis
T win Reversed Arterial Perfusion Syndrome (or Acardiac Twin)
Management
Differential Diagnosis
Associated Syndromes
F etus In Fetu
Synonyms
E tiology
P a thogenesis
Localization
V ascularization
Age at Detection
W eight
Presenting Symptoms in Children
N umber
Z y gosity
Macroscopic Appearance
What Is Included
Differential Diagnosis
Associated Anomalies
E volution
Prognosis
Recurrence Risk
Management
V ANISHING TWIN
Sonographic Features
Associated Syndromes
FETUS PAPYRACEOUS
PRENATAL SCREENING AND DIAGNOSIS: DOES CHORIONICITY MATTER?
Differential Diagnosis
INVASIVE TECHNIQUES IN TWINS
Diagnostic Amniocentesis
DISCORDANCE OF FETAL GROWTH: WHAT IS ADAPTATION, PROMOTION, AND GROWTH RE
VELAMENTOUS INSERTION OF THE PLACENTA
CONGENITAL ANOMALIES
MULTIFETAL PREGNANCY REDUCTION
PRETERM DELIVERY: DOES CERVICAL LENGTH MATTER?
KEY POINTS
REFERENCES
FETAL ANOMALIES AND DISORDERS
FETAL ANOMALIES: O VERVIEW
Lami Yeo
Roberto J. Romero
S u n Kwon Kim
Luís F. Gonçalves
INTRODUCTION
FUNDAMENTAL CONCEPTS
Malformation
Deformation
Disruption
T able 14-1
T he Fetus with Multiple Anomalies
P olytopic Field Defect
Dysplasia
Sequence
Syndrome
Association
CLASSIFICATION OF ANOMALIES
Ultrasonographic Markers
INCIDENCE OF CONGENITAL ANOMALIES
T able 14-7
T able 14-8
MORBIDITY, MORTALITY, AND BURDEN OF CONGENITAL ANOMALIES TO SOCIETY
T able 14-10
CAUSES AND RECURRENCE RISK OF CONGENITAL ANOMALIES
ULTRASOUND DIAGNOSIS OF CONGENITAL ANOMALIES
A CCURACY OF PRENATAL ULTRASOUND IN THE DETECTION OF CONGENITAL ANOMALIES S
T able 14-13
Chapter 14 F etal Anomalies: Overview
T able 14-14
T able 14-16
F i r st Trimester Ultrasound
Legal Implications of Accuracy Studies
MANAGEMENT PRINCIPLES IN THE DETECTION OF CONGENITAL ANOMALIES
P erformance of Prenatal Diagnosis
W orkup of an Abnormal Finding
Pregnancy Termination
Site, Mode, and Timing of Delivery
SHOULD EVERY PREGNANT PATIENT HAVE AN ULTRASOUND EXAMINATION?
W h y the Discrepancy Between the Results of the T w o Studies (RADIUS Compar
Detection of Congenital Anomalies
T able 14-19
Correction of Dating Errors
Detection of Multiple Pregnancies
Detection of Growth Disorders
Cost of a Routine Screening Program
IMPACT OF PRENATAL DIAGNOSIS ON
THE BIRTH PREVALENCE AND OUTCOME
OF FETUSES WITH CONGENITAL ANOMALIES
EMERGING CONCEPTS
KEY POINTS
REFERENCES
H ighlighted References
PRENATAL DIAGNOSIS OF CEREBROSPINAL ANOMALIES
Gianluigi Pilu
NORMAL SONOGRAPHIC ANATOMY OF THE FETAL CENTRAL NERVOUS SYSTEM
INTRODUCTION
VENTRICULOMEGALY
NEURAL TUBE DEFECTS
T able 15-1
MIDLINE ANOMALIES
DESTRUCTIVE CEREBRAL LESIONS
DISORDERS OF NERVE CELL PROLIFERATION
T able 15-4
T able 15-6
ANOMALIES OF NEURONAL MIGRATION
V ASCULAR ABNORMALITIES
INTRACRANIAL CYSTS
CONCLUSIONS
H ighlighted References
FETAL NECK AND CHEST ANOMALIES
M ieke Cannie
J acques Jani
FETAL NECK ANOMALIES
Anterocervical Pathologies
Enlargement of the Thyroid Gland or Goiter
Cervical Teratoma
P osterocervical Pathology
Second Trimester Nuchal Fold Thickness
Encephalocele
C ystic Hygroma or Lymphangioma
FETAL CHEST ANOMALIES
P athologies of the Fetal Lungs
Congenital Cystic Adenomatoid Malformation
Sequestration
Bronchogenic Cyst
Congenital High Airway Obstruction
Pleural Effusion
C ongenital Diaphragmatic Hernia
Overview
Diagnosis
Prediction of Postnatal Outcome by Two- and T hree-Dimensional Ultrasonograph
T able 16-1
Prediction of Postnatal Outcome by MRI
F etal Surgery for CDH
EMERGING CONCEPTS
What are other important considerations in this case?
H ighlighted References
FETAL GASTROINTESTINAL ANOMALIES
P aolo Volpe
Dario Paladini
V alentina De Robertis
Cristina Rossi
Georgios Rembouskos
EMBRYOLOGIC DEVELOPMENT OF THE GASTROINTESTINAL SYSTEM
T he Primitive Gut
Physiologic Herniation of the Midgut and Its Subsequent Reduction
Liver, Choledocal System, P ancreas, and Spleen
F etal Thorax
NORMAL ULTRASONOGRAPHIC APPEARANCE OF THE GIT AND SECTIONAL APPROACH: FROM
F etal Head
F etal Abdomen
Emerging Concepts
INTRAABDOMINAL MASSES AND DIFFERENTIAL DIAGNOSIS
Splenic Cyst
E tiology
Differential Diagnosis
Prognosis and Management
Choledochal Cyst
E tiology
Ancillary Ultrasound Signs
Differential Diagnosis
Caroli Disease
T able 17-2
Prognosis and Management
P ancreatic Cyst
Sonographic Appearance
Associated Anomalies
Prognosis and Management
Answer
5. Fetal sex : Female.
STENOSIS AND ATRESIAS
Esophageal Atresia
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
Recurrent Risk
Management
Emerging Concepts and Future Directions
Duodenal Atresia
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
K E Y P O I N T S
K E Y P O I N T S
Management
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
Jejunoileal Stenosis and Atresia
Definition and Incidence
Management
Emerging Concepts
K E Y P O I N T S
Ancillary Ultrasound Signs
Anal Atresia and Other Anorectal Abnormalities
Definition and Incidence
E tiology
Associated Anomalies
Management
K E Y P O I N T S
HYPERECHOGENIC BOWEL
Definition and Incidence
Etiology
Ancillary Ultrasound Signs
Associated Anomalies
Management
Emerging Concepts
Ancillary Ultrasound Signs
K E Y P O I N T S
MECONIUM ILEUS
Definition and Incidence
Etiology
Associated Anomalies
Management
ENTERIC DUPLICATION CYST
Definition and Incidence
Etiology
Ancillary Ultrasound Signs
Differential Diagnosis
Associated Anomalies
Management
K E Y P O I N T S
Associated Anomalies
HEPATIC AND SPLENIC ABNORMALITIES
Hepatic Echogenicities
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Management
Hepatomegaly and Splenomegaly
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Management
KEY POINTS
CLINICAL CORRELATE
C omment
F inal Consideration
GALL BLADDER AGENESIS
Definition and Incidence
Ancillary Ultrasound Signs
Associated Anomalies
Management
UMBILICAL, PORTAL, AND HEPATIC VENOUS SYSTEMS
Umbilical and Portal Venous Systems Malformations
Definition and Anatomy
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
Management
Emerging Concepts and Future Directions
Umbilical Vein Varix
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
Management
P e r sistent Right Umbilical Vein
Definition and Incidence
E tiology
Ancillary Ultrasound Signs
Associated Anomalies
ABDOMINAL WALL DEFECTS
Gastroschisis
Definitions
T able 17-3
KEY POINTS
Incidence
Embryogenetic Mechanism
Risk of Recurrence
Causative Factors
Ancillary Ultrasound Signs
Complications
Associated Anomalies
Management
Exomphalos (Omphalocele)
Definition and Incidence
Embryogenetic Mechanism
Risk of Recurrence
Causative Factors
Ancillary Ultrasound Signs
Complications
Associated Anomalies
T able 17-4
Management
KEY POINTS
REFERENCES
THE FETAL GENITOURINARY SYSTEM
Carol B. Benson
Peter M. Doubilet
RENAL AGENESIS
RENAL ECTOPIA
HYDRONEPHROSIS
URETEROPELVIC JUNCTION OBSTRUCTION
VESICOURETERAL REFLUX
PRIMARY MEGAURETER
BLADDER OUTLET OBSTRUCTION
RENAL DUPLICATION
MULTICYSTIC DYSPLASTIC KIDNEY
HEREDITARY POLYCYSTIC KIDNEY DISEASE
A utosomal Recessive Polycystic Kidney Disease
A utosomal Dominant Polycystic Kidney Disease
RENAL MASSES AND CYSTS
ABNORMALITIES OF THE URINARY BLADDER
Megacystis
Exstrophy
ABNORMALITIES OF THE REPRODUCTIVE SYSTEM AND EXTERNAL GENITALIA
Ovarian Cysts and Masses
Hydrometrocolpos
Hydrocele
Cryptorchidism
Ambiguous Genitalia
T esticular Feminization
K E Y P O I N T S
FETAL SKELETAL ANOMALIES
Lami Yeo
Roberto J. Romero
F r ancesca Gotsch
E d i Vaisbuch
Gianluigi Pilu
MOLECULAR GENETIC BASIS OF THE CHONDRODYSPLASIAS
ABNORMAL MESENCHYMAL DIFFERENTIATION
Bone Morphogenetic Proteins
Mutation in Transcription Factor Genes
INTRODUCTION
SOX and TBX Genes
ABNORMAL CHONDROCYTES MATURATION
F ibroblast Growth Factor Receptors
H omeotic Genes
P arathyroid Hormone Related Protein Receptor
DEFECTS OF EXTRACELLULAR MATRIX COMPONENTS
C ollagen
Cartilage Oligomeric Matrix Protein
DISORDERS OF PROTEOGLYCAN SULFATATION
BIRTH PREVALENCE AND CONTRIBUTION T O PERINATAL MORTALITY
CLASSIFICATION OF SKELETAL DYSPLASIAS
T able 19-3
T able 19-4
T able 19-4
T able 19-4
T able 19-4
T able 19-4
TERMINOLOGY FREQUENTLY USED IN THE DESCRIPTION OF BONE DYSPLASIAS
BIOMETRY OF THE FETAL SKELETON
IN THE DIAGNOSIS OF BONE DYSPLASIAS
T able 19-6
T able 19-8
R OLE OF ULTRASONOGRAPHY IN THE DETECTION OF SKELETAL DYSPLASIAS
CLINICAL PRESENTATION
APPROACH TO THE DIAGNOSIS OF SKELETAL DYSPLASIAS
Evaluation of Long Bones
T able 19-9
Evaluation of Thoracic Dimensions
Evaluation of Hands and Feet
Evaluation of the Fetal Cranium
Evaluation of the Fetal Face
T able 19-10
T able 19-11
T able 19-12
Evaluation of the Fetal Spine
Ve r t e b r a l B o d i e s
Spinal Curvature
Evaluation of the Internal Organs
Evaluation of the Neonate
INCREASED NUCHAL TRANSLUCENCY AND SKELETAL DYSPLASIAS
OSTEOCHONDRODYSPLASIAS
A CHONDROPLASIA, THANATOPHORIC D Y SPLASIA, AND HYPOCHONDROPLASIA
A chondroplasia
T he most common nonlethal skeletal dysplasia is
T able 19-19
SADDAN (Severe Achondroplasia with Developmental Delay and Acanthosis Nigrica
T hanatophoric Dysplasia
Hypochondroplasia
FIBROCHONDROGENESIS, A TELOSTEOGENESIS
F ibrochondrogenesis
A telosteogenesis
A CHONDROGENESIS
OSTEOGENESIS IMPERFECTA AND HYPOPHOSPHATASIA
Osteogenesis Imperfecta
Hypophosphatasia
DIASTROPHIC DYSPLASIA
KNIEST SYNDROME
D Y SSEGMENTAL DYSPLASIA
CAMPOMELIC DYSPLASIA
SKELETAL DYSPLASIAS CHARACTERIZED BY A HYPOPLASTIC THORAX
Asphyxiating Thoracic Dysplasia (Jeune Syndrome)
Short Rib–Polydactyly Syndromes
Chondroectodermal Dysplasia
T able 19-21
LIMB DEFICIENCY OR CONGENITAL AMPUTATIONS
T able 19-22
SYNDROMES WITH ABSENT LIMBS AND FACIAL ANOMALIES
Limb Reduction Defects Associated With Other Anomalies
PHOCOMELIA
In phocomelia , the e x tremities resemble those of a seal
F ocal Proximal Femoral Deficiency, or Congenital Short Femur
Split Hand and Foot Deformities
CLUB HAND DEFORMITIES
Radial Clubhand
POLYDACTYLY
ARTHROGRYPOSIS
T able 19-26
EMERGING CONCEPTS
KEY POINTS
REFERENCES
H ighlighted References
FETAL SYNDROMES
J uliana Moyses L Abdalla
Sandra R. Silva
Philippe Jeanty
INTRODUCTION
A CHONDROGENESIS
A CHONDROPLASIA
AICARDI SYNDROME
ALAGILLE SYNDROME
AMNIOTIC BAND SYNDROME
ANTLEY-BIXLER SYNDROME
APERT SYNDROME
ARNOLD-CHIARI MALFORMATION
ARTHROGRYPOSIS MULTIPLEX CONGENITA
ASPHYXIATING THORACIC D Y SPLASIA
ASPLENIA-POLYSPLENIA SYNDROMES
BECKWITH-WIEDEMANN SYNDROME
CAMPOMELIC DYSPLASIA
CAUDAL REGRESSION SYNDROME
CORNELIA DE LANGE SYNDROME
FETAL ALCOHOL SYNDROME
FETAL CYTOMEGALOVIRUS INFECTION
FETAL RUBELLA SYNDROME
FETAL TOXOPLASMOSIS SYNDROME
FETAL VARICELLA ZOSTER
FRASER SYNDROME
FRYNS SYNDROME
GOLDENHAR SYNDROME
HEREDITARY LYMPHEDEMA I
HOLT-ORAM SYNDROME
D EFINITION : The Holt-Oram syndrome consists of an upper-limb malformation
HYDROLETHALUS SYNDROME 1
HYPOPLASTIC LEFT HEART SYNDROME
KLIPPEL-FEIL SYNDROME
KLIPPEL-TRENAUNAY-WEBER SYNDROME
LARSEN SYNDROME
LETHAL MULTIPLE PTERYGIUM SYNDROME
MECKEL SYNDROME
MONOSOMY X (TURNER) SYNDROME
NOONAN SYNDROME
P ALLISTER-KILLIAN SYNDROME
PENA-SHOKEIR SYNDROME
PENTALOGY OF CANTRELL
PFEIFFER SYNDROME
PRADER-WILLI SYNDROME
PRUNE BELLY SYNDROME
R OBERTS SYNDROME
PIERRE ROBIN SYNDROME
SEPTOOPTIC DYSPLASIA
TUBEROUS SCLEROSIS
V A CTERL ASSOCIATION
W ALKER-WARBURG SYNDROME
REFERENCES
ULTRASOUND DETECTION OF CHROMOSOMAL ANOMALIES ∗
Philippe Jeanty
W erther Adrian Clavelli
S ilvia Susana Romaris
COMPLEMENTARY INVESTIGATIONS
T r iple Screen
REVIEW OF THE GENETIC CONCEPTS AND TERMINOLOGY
Mitosis
Meiosis
Chromosomal Anomalies
Aneuploidy
Inversion
Isochromosomes
U niparental Disomy
Deletions
Duplications
Ring Chromosome
Reciprocal Translocation
Robertsonian Translocation
Dominant and Recessive Alleles
A utosomal Dominant
A utosomal Recessive
X-Linked Transmission
ULTRASOUND FINDINGS DURING THE FIRST TRIMESTER
Nuchal Edema
T ight Amnion
T w o-Vessel Cord
Y olk Sac Anomalies
Major Structural Anomalies
Shapeless Embryo
SECOND-TRIMESTER FINDINGS
C entral Nervous System
Head and Neck
Cardiovascular Anomalies
Echogenic Focus in the Heart
Chest
T w o-Vessel Cord
C o r d Cysts
Swiss-Cheese Placenta
Gastrointestinal Findings
Duodenal Atresia
Esophageal Atresia or Tracheoesophageal Fistulas
Omphalocele
T o Karyotype or not to Kar yotype?
Bowel Obstructions
Urinary Tract Anomalies
Genital Findings
Skeletal Findings
Limb Shortening
Simian Crease
F indings Related to Anomalies of the Skull and Skull Shape
Eleven Pairs of Ribs
Iliac Wing Angle
Growth Restriction
Definition
Prevalence
E tiology
SCORING SYSTEMS
DIFFERENTIAL DIAGNOSES
TRISOMY 21
Synonyms
P a thogenesis
Differential Diagnosis
Associated Anomalies
Prognosis
Recurrence Risk
Management
TRISOMY 18
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Prognosis
Recurrence Risk
Management
Associated Anomalies
TRISOMY 13
Synonyms
Definition
E tiology
P a thogenesis
Differential Diagnosis
Prognosis
Recurrence Risk
Management
Associated Anomalies
TRISOMY 8
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Differential Diagnosis
Prognosis
Recurrence Risk
Associated Anomalies
TRISOMY 9
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Differential Diagnosis
Prognosis
Recurrence Risk
Management
Associated Anomalies
4p-SYNDROME
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Prognosis
Recurrence risk
Management
Associated Anomalies
TRIPLOIDY
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Differential Diagnosis
Prognosis
Recurrence Risk
Management
Associated Anomalies
MONOSOMY X
Synonyms
Definition
Prevalence
E tiology
P a thogenesis
Differential Diagnosis
Prognosis
Recurrence Risk
Management
Associated Anomalies
REFERENCES
RISK ASSESSMENT AND THERAPY
Chapter 22
FIRST TRIMESTER SCREENING
F ionnuala M. Breathnach
F ergal D. Malone
INTRODUCTION
EVOLUTION OF FIRST TRIMESTER SCREENING
NUCHAL TRANSLUCENCY: TECHNIQUE AND CHALLENGES
T able 22-1
SEPTATED CYSTIC HYGROMA: A DISTINCT ENTITY?
COMBINED/INTEGRATED/SEQUENTIAL AND CONTINGENT SCREENING APPROACHES
ANCILLARY FIRST TRIMESTER MARKERS FOR ANEUPLOIDY
F etal Nasal Bone in the First Trimester
F i r st Trimester Doppler Assessment of the Ductus Venosus
F i r st Trimester Tricuspid R egurgitation
QUALITY ASSURANCE
SCREENING FOR ANEUPLOIDIES O THER THAN TRISOMY 21
T able 22-3
FIRST TRIMESTER SCREENING FOR ANATOMIC DEFECTS
T able 22-5
T able 22-7
SCREENING IN MULTIPLE GESTATION
T able 22-8
FUTURE DIRECTIONS
CONCLUSIONS
CLINICAL CORRELATES
KEY POINTS
REFERENCES
H ighlighted References
FETAL BIOPHYSICAL PROFILE SCORE: THEORETICAL CONSIDERATIONS AND PRACTICAL AP
F r ank A. Manning
FETAL ADAPTIVE RESPONSES TO ACUTE AND CHRONIC HYPOXEMIA OR ACIDEMIA
FETAL BIOPHYSICAL PROFILE SCORE: METHOD AND MODIFICATION
FETAL BIOPHYSICAL PROFILE SCORING: CLINICAL APPLICATION, PREDICTIVE A CCURA
Clinical Application
P e r inatal Outcome: Mortality and Morbidity
T able 23-2
BIOPHYSICAL PROFILE SCORE AND FETAL CORD BLOOD ACID–BASE AND pH VALUES
FETAL BIOPHYSICAL PROFILE SCORING: OUTCOME IN SELECTED HIGH-RISK SUBGROUPS
BIOPHYSICAL PROFILE SCORE: RELATION TO NEUROLOGIC CONDITIONS OF CHILDHOOD
EMERGING CONCEPTS
CLINICAL CORRELATE
K E Y P O I N T S
REFERENCES
H ighlighted Reference
CHORIONIC VILLUS SAMPLING
Ronald J. Wapner
E u gene C . Toy
CONCEPTS AND INDICATIONS FOR CHORIONIC VILLUS SAMPLING
INTRODUCTION
HISTORY OF CHORIONIC VILLUS SAMPLING
CHORIONIC VILLUS SAMPLING: THE PROCEDURE
Procedure-Related Anatomy (Figure 24-1)
Sampling Techniques
T able 24-2
T r anscervical Sampling
T r ansabdominal Chorionic Villus Sampling
C onfirmation of Adequate Tissue R etrieval
RISKS ASSOCIATED WITH CHORIONIC VILLUS SAMPLING
Bleeding
Infection
Ruptured Membranes
Elevated MSAFP
Rh Isoimmunization
Pregnancy Loss
PREGNANCY LOSS: TRANSCERVICAL VERSUS TRANSABDOMINAL CHORIONIC VILLUS SAMPLI
RISK OF FETAL ABNORMALITIES AFTER CHORIONIC VILLUS SAMPLING
T able 24-3
PERINATAL RISKS AND IMPACT ON
LONG- TERM DEVELOPMENT OF THE INFANT
LABORATORY ASPECTS OF CHORIONIC VILLUS SAMPLING
MATERNAL CELL CONTAMINATION
CONFINED PLACENTAL MOSAICISM
BIOCHEMICAL AND DNA PROCEDURES
CHORIONIC VILLUS SAMPLING IN MULTIPLE GESTATIONS
CHORIONIC VILLUS SAMPLING AND MULTIFETAL PREGNANCY REDUCTION
SUMMARY
KEY POINTS
AMNIOCENTESIS
J uan Pedro Kusanovic
Cristiano Jodicke
Lami Yeo
Roberto J. Romero
L u ís F. Gonçalves
Maria-Teresa Gervasi
Mark Redman
F abio Ghezzi
1. Amniocentesis with a filtration technique:
HISTORICAL ASPECTS
INDICATIONS
Ultrasound
Operative Technique
TECHNICAL ASPECTS OF THE PROCEDURE
Gestational Age
Needle Selection
V olume of Amniotic Fluid
INTRAOPERATIVE COMPLICATIONS
Membrane Tenting
Multiple Needle Insertions
Bloody Taps
F etomaternal Transfusion
Discolored Amniotic Fluid
AMNIOCENTESIS RISKS
Maternal Risks
F etal Risks
Fetal Loss
Infection
F etal Injuries Associated with Amniocentesis
Other Complications
Leakage of Amniotic Fluid
Long-Term Outcome
Isoimmunization
EARLY AMNIOCENTESIS
T able 25-5
MOLECULAR DIAGNOSTIC TECHNIQUES
AMNIOCENTESIS IN MULTIPLE GESTATIONS
AMNIOCENTESIS FOR THE DIAGNOSIS OF MICROBIAL INVASION OF THE AMNIOTIC CAVITY
Definition
T able 25-6
F r equency
Diagnosis of Microbial Invasion of the Amniotic Cavity Using Conventional Cul
T able 25-7
T able 25-8
T able 25-10
Diagnosis of Microbial Invasion of the Amniotic Cavity Using Molecular Microb
Importance of the Diagnosis
Amniotic Fluid Collection
T able 25-11
Chapter 25 Amniocentesis
T ests for Diagnosis of Microbial Invasion of the Amniotic Cavity
Amniotic Fluid Gram Stain
T able 25-12
A cridine Orange Stain
Limulus Amebocyte Lysate Assay
Glucose Concentration in Amniotic Fluid
T able 25-13
White Blood Cell Count in Amniotic Fluid
T able 25-15
Amniotic Fluid Interleukin-6 Concentrations
Matrix Metalloproteinase-8 in Amniotic Fluid
C omparison between Amniotic Fluid Tests
Bedside Rapid Test for Diagnosis of Microbial Invasion of the Amniotic Cavity
T able 25-18
REFERENCES
KEY POINTS
H ighlighted References
Chapter 26 F etal Blood Sampling
FETAL BLOOD SAMPLING
F abio Ghezzi
A n tonella Cromi
F r ancesca Gotsch
Gabriele Siesto
Edi Vaisbuch
Roberto J. Romero
Definitions
2. P e r cutaneous umbilical blood sampling (PUBS):
TECHNIQUES OF FETAL BLOOD SAMPLING
C o r docentesis
Intrahepatic Vein Blood Sampling
Cardiocentesis
Quality Control of the Specimen
Duration of the Procedure
T r aining
Normal Values f or F etal Blood
COMPLICATIONS
Maternal Complications
F etal Losses
T able 26-4
Chapter 26 F etal Blood Sampling
Hemorrhage
C o r d Hematoma
Bradycardia
F etomaternal Hemorrhage
Abruptio Placentae
Preterm Delivery
F etal Resuscitation
T able 26-5
INDICATIONS
C ytogenetic Diagnosis
C ongenital Infections
F etal Anemia
Primary Immunodeficiency Diseases
C oagulopathies
T able 26-6
Platelet Disorders
T hrombocytopenias
T hrombocytopathies
Hemoglobinopathies
T able 26-7
Intrauterine Growth Restriction
T h yroid Disease
FETAL BLOOD SAMPLING IN MULTIPLE GESTATIONS
FETAL THERAPY
EMERGING CONCEPTS
KEY POINTS
FETAL THERAPY: M A TERNAL FETAL SURGERY AND PERCUTANEOUS ULTRASOUND GUIDE
R. Douglas Wilson
Definitions
2. C ongenital anomalies/birth defect terminology:
8. T horacocentesis/vesicocentesis/fetal cyst aspiration:
INTRODUCTION
SECTION I: MATERNAL FETAL SURGERY
T able 27-2
Summary
SECTION II: PERCUTANEOUS ULTRASOUND GUIDED FETAL THERAPY PROCEDURES
F etal Thoracic P athology (pleural effusion; macrocystic CCAM)
Lower Urinary Tract Obstruction (LUTO)
T able 27-4
T able 27-5
T able 27-6
T able 27-7
Monochorionic Twin P athology: T win-to-Twin T r ansfusion Syndrome (TTTS)
Monochorionic Twin Pathology and Selective T ermination for TTTS, TRAP, Dis
F etal Ovarian Cyst
Placental Chorioangioma Management With Ultrasound-Guided Techniques
Multifetal Reduction (MFR) and Selective T ermination
Other Case Reports of Ultrasound-Guided Fetal T herapy Techniques
KEY POINTS
FUTURE CONSIDERATIONS
MATERNAL DISORDERS
SONOGRAPHIC EXAMINATION OF THE UTERINE CERVIX
Sonia S. Hassan
T i nnakorn Chaiworapongsa
E d i Vaisbuch
Maria-Teresa Gervasi
Roberto J. Romero
Definitions
INTRODUCTION
PHYSIOLOGY OF CERVICAL CHANGE IN PREGNANCY
C ervical Ripening
C ervical Dilation
SONOGRAPHIC EVALUATION OF THE UTERINE CERVIX
T e chnique and Pitfalls
T echnique
THE COMMON TERMINAL PATHWAY OF PARTURITION
CERVICAL SONOGRAPHY FOR PREDICTION OF PRETERM BIRTH
C ervical Examination in Asymptomatic Patients
Cervical Length in the Prediction of Preterm Deliver y in Asymptomatic Patien
T able 28-1
T able 28-3
Longitudinal Study of Cervical Ultrasound in Asymptomatic Patients
C ervical Length in Predicting Preterm Delivery in High-Risk Singleton Gestat
Short Cervix and the Risk of Preterm Premature Rupture of Membranes and Subse
C ervical Length in Twin Pregnancies
Sonographic Evaluation of Cervical Length in Triplet Pregnancies
C ervical Examination in Patients Presenting with Preterm Labor
WHY DO PATIENTS HAVE A SHORT CERVIX?
T he Syndromic Nature of a Sonographic Short Cervix
A Sonographic Short Cervix as the Only Clinical Manifestation of Intra-amniot
ADDITIONAL P ARAMETERS TO ASSESS THE RISK OF PRETERM BIRTH DURING TRANSVAGI
C ervical Funneling
Amniotic Fluid “Sludge”
T able 28-9
IS THERE AN EFFECTIVE TREATMENT FOR A SONOGRAPHIC SHORT CERVIX?
C ervical Cerclage in Patients with a Sonographic Short Cervix
Randomized Clinical Trials of Cervical Cerclage before the Cervical Ultrasoun
Cervical Cerclage after Cer vical Ultrasound Assessment
T able 28-11
Progesterone Use in Patients with a Sonographic Short Cervix
SHORT SONOGRAPHIC CERVICAL LENGTH: A POWERFUL PREDICTOR OF PRETERM DELIVERY
THREE-DIMENSIONAL ULTRASOUND IMAGING OF THE CERVIX
NONINVASIVE ASSESSMENT OF COLLAGEN CONTENT
FUTURE CHALLENGES
KEY POINTS
SONOGRAPHY OF TROPHOBLASTIC DISEASES
A rthur C. Fleischer
H oward W. Jones III
E u gene C . Toy
CLASSIFICATION SCHEMES
H istopathologic
INTRODUCTION
T able 29-1
Clinical Aspects
MOLAR PREGNANCIES
P athogenesis
Clinical Aspects
Sonographic Features
Sonographic Differential Diagnosis
INVASIVE MOLE, CHORIOCARCINOMA, AND PSTT
P athogenesis and Clinical Aspects
SUMMARY
CLINICAL CORRELATE
KEY POINTS
REFERENCES
POSTPARTUM ULTRASOUND
E u gene C . Toy
THE GYNECOLOGIC ORGANS
Normal Anatomy
T he Uterus
INTRODUCTION
T he Broad Ligament
V ulva, Vagina, and Pararectal Space
T he Ovaries
T he Cul-de-sac
P athology
P ostpartum Hemorrhage
P ostpartum Infection
Cesarean Deliver y
T able 30-1
THE GENITOURINARY SYSTEM
THE HEPATOBILIARY SYSTEM
KEY POINTS
V ASCULAR RISKS AND COMPLICATIONS
SUMMARY
H ighlighted References
GYNECOLOGIC SONOGRAPHY
SONOGRAPHIC EVALUATION OF PELVIC MASSES WITH TRANSABDOMINAL AND/OR TRANSVAGINAL SONOGRAPHY
Definitions
INTRODUCTION
SONOGRAPHIC PARAMETERS
T he Presence or Absence of a Pelvic Mass
Size and Location
Internal Consistency
Detection of Associated Lesions
Sonographic Guidance for Aspiration or Biopsy
TRANSVAGINAL SONOGRAPHY OF PELVIC MASSES
SONOGRAPHIC DIFFERENTIAL DIAGNOSIS OF PELVIC MASSES
T able 31-1
C ystic Masses
Physiologic Ovarian Cysts
H ydrosalpinx/Tubo-ovarian Abscesses
Endometriosis (Endometriomas)
C ystadenomas
Other Less Common Cystic Masses
C omplex Masses
Dermoid Cysts
Ectopic Pregnancy
C ystadenoma/Cystadenocarcinoma
To r s e d O v a r y
Solid Pelvic Masses
U terine Leiomyomata
Ovarian Masses
Other Solid Masses
Benign versus Malignant Determination Based on Sonographic Morphology
P e r sistent Versus Regressing Masses
SUMMARY
REFERENCES
H ighlighted References
COLOR DOPPLER SONOGRAPHY OF PELVIC MASSES
INTRODUCTION
NORMAL O V ARIAN ANATOMY AND FLOW
MORPHOLOGY OF ADNEXAL MASSES
PRINCIPLES OF COLOR DOPPLER SONOGRAPHY
COLOR DOPPLER SONOGRAPHY OF ADNEXAL MASSES
General Principles
A dnexal Torsion
T he Postmenopausal Ovary
EARLY VERSUS LATE STAGES OF OVARIAN CARCINOMA
T able 32-1
THE ROLE OF COLOR DOPPLER SONOGRAPHY IN CLINICAL MANAGEMENT
NEW DEVELOPMENTS
T able 32-4
SUMMARY/EMERGING CONCEPTS
CLINICAL CORRELATE
KEY POINTS
REFERENCES
Part 5 GYNECOLOGIC SONOGRAPHY
SONOGRAPHIC EVALUATION OF UTERINE DISORDERS
A rthur C. Fleischer
Rochelle F. Andreotti
SCANNING TECHNIQUE
SONOGRAPHIC FEATURES OF THE NORMAL UTERUS
CONGENITAL MALFORMATIONS AND RELATED DISORDERS
F usion Anomalies—Bicornuate versus Septated Uterus
Hydrometrocolpos and Hematometrocolpos
T -Shaped Uterus
INFLAMMATORY DISORDERS
UTERINE LEIOMYOMATA
Clinical Aspects
Sonographic Features
Sonographic Mimics of Fibroids
ADENOMYOSIS
CERVICAL MASSES
CARCINOMA OF THE OVIDUCT
ENDOMETRIAL DISORDERS
POSTHYSTERECTOMY EVALUATION
INTRAUTERINE CONTRACEPTIVE DEVICE LOCALIZATION
UTERINE ARTERY (FIBROID) EMBOLIZATION
TRANSRECTAL AND TRANSPERINEAL SONOGRAPHIC GUIDANCE FOR INTRAOPERATIVE PROCED
SUMMARY/EMERGING CONCEPTS
KEY POINTS
REFERENCES
TRANSVAGINAL SONOGRAPHY OF ENDOMETRIAL DISORDERS
Definitions
INTRODUCTION
CLINICAL ASPECTS
INSTRUMENTATION AND SCANNING TECHNIQUE
NORMAL (FIGURES 34-1, 34-2, AND 34-3)
POSTMENOPAUSAL BLEEDING
(FIGURES 34-4, 34-5, 34-6, 34-7, AND 34-8)
D Y SFUNCTIONAL UTERINE BLEEDING (FIGURE 34-5)
SERIAL MONITORING (FIGURES 34-4, 34-5, AND 34-6)
CANCER (FIGURE 34-8)
COLOR DOPPLER SONOGRAPHY (FIGURE 34-13)
MISCELLANEOUS CONDITIONS (FIGURES 34-6 AND 34-7)
SUMMARY
CLINICAL CORRELATE
H ighlighted References
SONOGRAPHIC TECHNIQUES
FOR EARLY DETECTION OF OVARIAN AND ENDOMETRIAL CANCERS
A rthur C. Fleischer
Debbie J. Lee
A n d réj Lyshchik
H oward W. Jones, III
Marta Crispens
Phillip K. Williams
David A. Fishman
Definitions
O VERVIEW
INTRODUCTION
SONOGRAPHY’S ROLE IN MULTIMODAL SCREENING FOR ENDOMETRIAL AND O V ARIAN CANC
T able 35-1
FUNDAMENTAL CONCEPTS OF SCREENING AND EARLY DETECTION OF OVARIAN AND ENDOMET
RISK F A CTORS AND LABORATORY TESTS
TRANSVAGINAL SONOGRAPHY
COLOR DOPPLER SONOGRAPHY
SONOGRAPHIC ASSESSMENT OF V ASCULARITY WITH 2D- AND 3D-CDS
CONTRAST-ENHANCED TRANSVAGINAL SONOGRAPHY OF OVARIAN MASSES
ENDOMETRIAL CANCER
SUMMARY/EMERGING CONCEPTS
CLINICAL CORRELATE
KEY POINTS
REFERENCES
H ighlighted References
A CUTE PELVIC PAIN: TRANSVAGINAL AND DOPPLER EVALUATION
Rochelle F. Andreotti
INTRODUCTION
GYNECOLOGIC CAUSES OF ACUTE PELVIC PAIN
A dnexal Torsion
Ovarian Functional Cyst
P elvic Inflammatory Disease
NONGYNECOLOGICAL CAUSES OF ACUTE PELVIC PAIN
KEY POINTS
REFERENCES
TRANSVAGINAL SONOGRAPHY IN GYNECOLOGIC INFERTILITY
E l izabeth E. Puscheck
M ichael P. Diamond
A rthur C. Fleischer
J aime M. Vasquez
A nna K. Parsons
J ill Herzog
Definitions
INTRODUCTION
INSTRUMENTATION
CLINICAL ASPECTS AND INDICATIONS
Spontaneous Cycles
ENDOMETRIAL ASSESSMENT
B ASELINE SONOGRAPHY FOR INFERTILITY
Ovarian Reserve Assessment
Applications of Color Doppler Sonography
Infertility Assessment with Sonohysterography (Figure 37-6)
T ubal Patency Assessment
SONOGRAPHIC EVALUATION OF TUBAL P A TENCY (SONOSALPINGOGRAPHY)
T e chnique
Normal and Abnormal Anatomy
C omparison With Hysterosalpingography
Sonosalpingography Findings
Sonographic Assessment of the Intrauterine Lumen
THE ROLE OF TVS IN INFERTILITY TREATMENTS
FOLLICULAR MONITORING
F ollicular Monitoring by Type of Ovulation Induction
IN VITRO FERTILIZATION
O VULATION INDUCTION FOR IVF
GUIDED FOLLICULAR ASPIRATION
GUIDED EMBRYO TRANSFER AND TUBAL CANNULATION
R ecovery after Ovulation Induction/IVF and Complications
SUMMARY
KEY POINTS
REFERENCES
Appendix 37-1
Ultrasound Examination of the Female Pelvis for Infertility and Reproductive
P ART I: EQUIPMENT AND DOCUMENTATION GUIDELINES
Equipment
Care of the Equipment
Documentation
P A R T II: GUIDELINES FOR PERFORMANCE OF THE ULTRASOUND EXAMINATION OF
General Pelvic Preparation
Uterus
A dnexa (Ovaries and Fallopian Tubes)
Cul-de-Sac
Limited Examination
Ultrasound-Guided Procedures
Qualifications and Responsibilities of the Physician
SONOHYSTEROGRAPHY AND SONOHYSTEROSALPINGOGRAPHY
Daniel M. Breitkopf
SONOHYSTEROGRAPHY
H istoric Development Using Transabdominal T e chnique
Limitations of Transvaginal Sonography
T r ansvaginal Sonohysterography
Indications for Sonohysterography
C o ntraindications to Sonohysterography
Equipment
T e chnique
Directed Biopsies
Use of 3D Imaging in Sonohysterography
EVALUATION OF TUBAL PATENCY
BY SONOHYSTEROSALPINGOGRAPHY T r aditional Hysterosalpingography
Sonographic Hysterosalpingography
Enhanced Saline
Stabilized Bubble Contrast Agents
T hree-Dimensional SonoHSG
SonoHSG and Transcervical Sterilization
P ossible Complications of Uterine Infusion
A V OIDING COMPLICATIONS/IMAGING TIPS AND TRICKS
SONOHYSTEROGRAPHIC IMAGING OF SPECIFIC CONDITIONS
Normal (Figure 38-9)
P o l yps (Figures 38-10 through 38-13)
T amoxifen Changes (Figures 38-14 and 38-15)
Leiomyomas (Figures 38-16 and 38-17)
S ynechiae (Figure 38-19)
Uterine Anomalies (Figures 38-20 and 38-21)
C esarean Scars (Figures 38-22 and 38-23)
Endometrial Carcinoma and Hyperplasia (Figures 38-24 through 38-26)
FUTURE DIRECTIONS
REFERENCES
CLINICAL CORRELATE
W hat Should Be the Next Steps in the Management of This Patient?
H ighlighted References
GUIDED PROCEDURES USING TRANSVAGINAL, TRANSPERINEAL, AND TRANSRECTAL SONOG
Jodi P. Lerner
A na Monteagudo
Ilan E. Timor-Tritsch
A rthur C. Fleischer
Definitions
INTRODUCTION
GENERAL CONCEPTS
B A CKGROUND
TRANSVAGINAL PUNCTURE PROCEDURES
T r ansvaginal Puncture/Catheterization Procedures in Assisted R eproduction
Oocyte Retrieval
TECHNIQUE
Intrauterine Transfer of Fertilized Oocytes
T ubal Catheterization and/or Embryo Transfer
Puncture of Ovarian Cysts
Multifetal Pregnancy Reduction
T r eatment of Ectopic Pregnancy
T ubal Pregnancy (Salpingocentesis)
Cornual Pregnancy
Cervical Pregnancy
C esarean Section Scar Pregnancy
P elvic Drainage Procedures
Culdocentesis
C oelocentesis
GUIDANCE WITH TRANSRECTAL AND TRANSPERINEAL SONOGRAPHY
SUMMARY
PELVIC FLOOR ULTRASOUND
H a ns Peter Dietz
METHODOLOGY AND INSTRUMENTATION
T w o-Dimensional Imaging
INTRODUCTION
T hree-Dimensional/Four-Dimensional Imaging
Display Modes
F o ur-Dimensional Imaging
FUNCTIONAL ASSESSMENT
V alsalva
P elvic Floor Muscle Contraction
Rest
First Valsalva
Optimal Valsalva
ANTERIOR COMPARTMENT
Bladder Neck Mobility
F unneling and Stress Incontinence
U rethral Mobility
C olor Doppler Imaging of Stress Incontinence
C ystocele
Urethral and Paraurethral Pathology
Detrusor Wall Thickness
Other Bladder Pathology
CENTRAL COMPARTMENT Uterine Descent
V ault Prolapse
POSTERIOR COMPARTMENT
R ectocele
POSTOPERATIVE FINDINGS
Anterior Colporrhaphy/Vaginal Paravaginal Repair
Burch/Marshall-Marchetti-Krantz (MMK) Colposuspension
F ascial/Synthetic Traditional Slings
Injectables
Suburethral Slings
Modern Mesh Implants
THE LEVATOR HIATUS AND MUSCLE
EMERGING CONCEPTS
KEY POINTS
REFERENCES
B ASIC BREAST SONOGRAPHY
J ohn G. Huff
T amarya L. Hoyt
INTRODUCTION
INDICATIONS
Diagnostic
Screening
Intervention
INSTRUMENTATION
SCAN TECHNIQUE AND REPORTING
NORMAL ANATOMY
P A THOLOGIC FINDINGS
F ibrocystic Condition
Solid Masses
Other Findings
Implants
AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE GUIDELINES
SUMMARY
KEY POINTS
REFERENCES
ADVANCED BREAST ULTRASOUND
David O. Cosgrove
W illiam E. Svensson
INTRODUCTION
NORMAL FINDINGS
P A THOLOGIC FEATURES
CYSTS
BENIGN BREAST CHANGE (ANDI)
FIBROADENOMAS
CARCINOMAS
CALCIFICATIONS
PROSTHETIC IMPLANTS
TRAUMA AND INFLAMMATION
THE MALE BREAST
THE CLINICAL ROLE OF ULTRASOUND
NEW DEVELOPMENTS
KEY POINTS
REFERENCES
COMPLEMENTARY IMAGING MODALITIES
V OLUME SONOGRAPHY: CORE CONCEPTS FOR CLINICAL PRACTICE
George Bega
INTRODUCTION
RATIONALE FOR VOLUME SONOGRAPHY
V OLUME ACQUISITION
Gray-Scale Scanning and Acquisition Guidelines
3D/4D Color/Power Doppler Sonography, B-Flow, and STIC Acquisition Guideline
A cquiring Volumes with B-Flow
Spatio-temporal Image Correlation
T able 43-2
V OLUME DISPLAY AND NAVIGATION
POST-PROCESSING: QUALITATIVE TOOLS
POST-PROCESSING: QUANTITATIVE TOOLS
Extraction of Standard Anatomical Planes and Quantification of Their Relation
V olume Quantification of Organ Systems
Blood Flow Quantification and Tissue P erfusion Studies
DOCUMENTATION, STORAGE, AND NETWORKING
ARTIFACTS, PITFALLS, AND LIMITATIONS
TRAINING AND RESEARCH
EMERGING CONCEPTS
A cquisition
V isualization
Qualitative and Quantitative Post-processing
Documentation
CLINICAL CORRELATE
What are the most important 2D/3D/4D ultra sound considerations in imaging th
KEY POINTS
REFERENCES
H ighlighted References
OBSTETRICAL APPLICATIONS FOR 3D ULTRASONOGRAPHY
We s l e y L e e
Dolores Pretorius
IMPORTANT CONCEPTS FOR VOLUME SONOGRAPHY
Use 2D Ultrasonography for an Initial Diagnostic Impression
Match the 3DUS Technique With a Specific Clinical Question That Is Being Aske
Do Not Underestimate the Diagnostic V alue of 3D Multiplanar Imaging
Good Two-Dimensional Imaging Is Likely to Translate to Satisfactory Three-Di
EARLY PREGNANCY EVALUATION USING 3DUS
Early Fetal Anatomic Evaluation
Genetic Risk Assessment
N uchal Translucency
N asal Bone Assessment
F rontomaxillary Facial Angle
F etal Iliac Angle
Embryonic Volume
SELECTED 3DUS APPLICATIONS FOR LATER PREGNANCY
F ace
T able 44-1
Eyes
Ears
M etopic Sutures
Cleft Lip and Palate
J a w Abnormalities
Brain
Spina Bifida
Skeletal Dysplasias
TISSUE VASCULARIZATION ASSESSMENT T issue Perfusion Using 3D Vascular Flow In
1. VI vascularization index (standardized range 0 to 100)
2. FI flow index (standardized range 0 to 100)
3. VFI vascularization flow index (VI *FI)/100
FETAL GROWTH AND WEIGHT ESTIMATION
O THER CONSIDERATIONS Safety Issues
P arental Bonding
M edicolegal Issues
Ultrasound for Entertainment
EMERGING CONCEPTS
CONCLUSIONS
KEY POINTS
H ighlighted References
FETAL CARDIAC EVALUATION USING 3D AND 4D ULTRASONOGRAPHY
Greggory R. DeVore
B ASIC IMAGING PRINCIPLES OF THREE DIMENSIONAL ULTRASONOGRAPHY Mechanical Ar
THREE-DIMENSIONAL STATIC VOLUME SWEEP
B ASIC IMAGING PRINCIPLES OF FOUR DIMENSIONAL ULTRASONOGRAPHY
Mechanical Volume Transducer
Spatiotemporal Image Correlation
4D Volume Display
Matrix Array Transducer
CLINICAL APPLICATIONS FOR 3D AND 4D FETAL ECHOCARDIOGRAPHY WHEN PERFORMING A
T omographic Ultrasound Imaging 109
A utomated Multiplanar Imaging
Spin Technique
CLINICAL APPLICATIONS OF 3D AND 4D FETAL ECHOCARDIOGRAPHY WHEN PERFORMING T
T omographic Ultrasound Imaging
T ransverse Sweep: 4-Chamber View and Aortic Outflow Tract (Planes 1 and 2)
Sagittal Sweep: The Long-Axis View of the Right V entricular Outflow Tract (P
Sagittal Sweep: Short-Axis View at the Level of the Great Vessels, Ductal Arc
Multiplanar View
Sagittal Sweep: Caval Long-Axis View (Plane 7)
THREE-DIMENSIONAL RENDERING OF CARDIAC ANATOMY
Mechanical Array Transducer
Matrix Array Transducer
P A THOLOGY
KEY POINTS
Chapter 45 F etal Cardiac Evaluation Using 3D and 4D Ultrasonography
What approaches could the examiner use to fur ther elucidate cardiac anatomy?
1. T hree-dimensional multiplanar imaging
REFERENCES
H ighlighted References
Chapter 46 Magnetic Resonance Imaging in Obstetrics
MAGNETIC RESONANCE IMAGING IN OBSTETRICS
Diane M. Twickler
SAFETY
TECHNIQUE
FETAL CENTRAL NERVOUS SYSTEM
FETAL THORAX
FETAL ABDOMEN
FETAL SURGERY CONSIDERATIONS
PLACENTA
MR VOLUMETRY
MR FETAL SURVEY
MATERNAL CONSIDERATIONS
MR Pelvimetry
Maternal Complications of Pregnancy
P elvic Floor
C ervix
EMERGING CONCEPTS
CLINICAL CORRELATE
Important MR considerations:
KEY POINTS
THREE-DIMENSIONAL VOLUMETRIC SONOGRAPHY IN GYNECOLOGY
Beryl R. Benacerraf
A rthur C. Fleischer
INTRODUCTION
TECHNIQUE (FIGURES 47-1 THROUGH 47-7)
CORONAL VIEW OF THE PELVIS
T he Uterus (see Figures 47-1 and 47-2)
Uterine Anomalies (Figures 47-8 through 47-20)
Uterine Polyps and Fibroids (Figures 47-21 through 47-29)
T he Uterus and IUD Location (Figures 47-29 through 47-37)
USING THE CORONAL VIEW OF THE UTERUS
THE CORONAL VIEW IN THE ADNEXA (FIGURES 47-38 THROUGH 47-40)
SONOHYSTEROGRAPHY WITH 3D (SEE FIGURES 47-21 THROUGH 47-23)
IMAGING OF THE PELVIC FLOOR WITH 3D
SURFACE RENDERING WITHIN A VOLUME (SEE FIGURES 47-21, 47-22, 47-24,
AND 47-25, 47-41 THROUGH 48)
INVERSION ULTRASOUND (FIGURES 47-49 THROUGH 47-51)
V OLUME MEASUREMENT
DOPPLER SONOGRAPHY IN 3D
(SEE FIGURES 47-6, 47-26, AND 47-27; FIGURES 47-51, AND 47-52)
ARTIFACTS (FIGURE 47-53)
T OMOGRAPHIC ULTRASOUND IMAGING (FIGURE 47-54)
EMERGING FRONTIERS
KEY POINTS
REFERENCES
MRI OF THE FEMALE PELVIS: PROBLEM SOLVING SONOGRAPHIC UNCERTAINTIES
Marcia C . Javitt
A rthur C. Fleischer
MRI TECHNIQUE
BENIGN CONDITIONS OF THE UTERUS Müllerian Anomalies
Leiomyomas
A denomyosis
BENIGN CONDITIONS OF THE OVARIES AND ADNEXA
Endometriosis
Dermoid Cysts
Ovarian Fibromas
F allopian Tube Abnormalities
TUMOR STAGING
C ervical Cancer
Endometrial Cancer
Ovarian Cancer
R ecurrent Gynecologic Malignancy
ENDOMETRIAL DISORDERS
EVALUATION OF DISTORTED PELVIC ANATOMY
UROGYNECOLOGY
NEW ADVANCES H igh Field Systems
P arallel Imaging
New MRI Contrast Materials
Diffusion-Weighted MR Imaging
MR Spectroscopy
SUMMARY
KEY POINTS
INDEX
