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Peripheral Vessels

Summary of Key Points Key aspects of vascular Doppler imaging include knowledge of anatomy and waveform morphology, scanning technique, and attention to detail. Spectral Doppler velocity criteria can characterize stenosis detected by gray-scale and color Doppler. Doppler evaluation of peripheral artery disease can provide diagnostic information and enable surgical planning and evaluation of bypass grafts. Extremity aneurysm and pseudoaneurysm have typical Doppler findings similar to other…

The Extracranial Cerebral Vessels

Summary of Key Points The combination of gray-scale, color-flow Doppler, and Doppler spectral analysis is highly accurate in determining plaque characterization and degree of carotid stenosis. Accurate diagnosis of carotid stenosis is critical for patients who would benefit from surgical and interventional treatment. Clinicians can accurately follow changes in noncritical carotid stenosis or plaque using ultrasound. The assessment of the vertebral arteries is an integral component…

Musculoskeletal Interventions

Summary of Key Points Choose transducer geometry and entry site to visualize the needle as a specular reflector. Orient transducer to maximize tendon echogenicity (anisotropy). Injected corticosteroid/anesthetic suspension often displays a contrast effect, which can help localize injected mixture. Patients with diabetes should be cautioned that they may develop a transient hyperglycemia that may last up to 5 days following therapeutic injection. Most small joints and…

The Shoulder

Summary of Key Points In the diagnosis of full-thickness rotator cuff tears, ultrasound is of comparable accuracy to magnetic resonance imaging, although it may be less accurate in the diagnosis of partial-thickness tears. The key to scanning the shoulder is meticulous technique using a protocol that systematically evaluates the entirety of the shoulder. Understanding of optimal patient positioning, probe orientation, and shoulder anatomy is critical to…

Overview of Musculoskeletal Ultrasound Techniques and Applications

Summary of Key Points A wide variety of inflammatory, degenerative, traumatic, and neoplastic conditions can be imaged accurately and cost-effectively with ultrasound. Understanding optimal imaging techniques and recognizing and avoiding common artifacts is essential to musculoskeletal ultrasound. Ultrasound can provide higher-resolution imaging of nerves and tendons compared with standard clinical magnetic resonance imaging examinations. Dynamic imaging may be performed with ultrasound, which can assist in the…

The Scrotum

Summary of Key Points Diagnostic ultrasound is an accurate means of evaluating most scrotal processes and can supplement the physical examination. Solid intratesticular lesions have a high likelihood of malignancy, whereas cystic extratesticular intrascrotal lesions are almost certainly benign. Doppler sonography is the most useful and most rapid technique to assess the patient with acute scrotal pain. Ultrasound can establish the diagnosis of testicular ischemia and…

The Breast

Summary of Key Points Breast ultrasound plays a key role in supplemental breast cancer screening, diagnostic imaging, and interventional breast procedures. All images should be annotated with the following: the side (left or right), clock face position, distance from the nipple in centimeters, and transducer orientation. All lesions should be scanned and measured in two orthogonal planes to assess the size, surface, internal characteristics, and shape.…

The Parathyroid Glands

Summary of Key Points In the vast majority of cases, primary hyperparathyroidism is caused by hyperfunction of a single parathyroid gland due to adenoma, much less commonly due to multiple gland involvement. Surgical removal of the abnormal gland is the only definitive treatment for primary hyperparathyroidism, and selective, minimally invasive surgical techniques are most commonly used for first-time surgery. The role of parathyroid imaging is not…

The Thyroid Gland

Summary of Key Points Ultrasound is the best imaging modality to study the thyroid gland for both diffuse and nodular disease. The overwhelming majority of thyroid nodules are benign. Thyroid cancer is rare and accounts for less than 1% of all malignant neoplasms. Approximately 80% of nodular thyroid disease is caused by hyperplasia. When hyperplasia leads to an overall increase in size or volume of the…

Organ Transplantation

Summary of Key Points To perform an ultrasound assessment of a transplanted organ, the sonographer should be aware of the surgical technique used including the type and location of vascular and nonvascular anastomoses. Gray-scale parenchymal changes often reflect the vascular status of the allograft (e.g., echogenic intraluminal material within a dilated biliary tree of a transplanted liver may result from sloughing of the biliary epithelium as…

Ultrasound-Guided Biopsy of Chest, Abdomen, and Pelvis

Summary of Key Points Ultrasound is a key method of guidance for biopsy and fluid drainage because of its real-time needle visualization and the ability to image and intervene in multiple anatomic locations and planes. Effective periprocedural antithrombotic management requires an understanding of specific antithrombotic agents as well as the balance of the potential risk of hemorrhage from a given procedure versus the risk of a…

The Adnexa

Summary of Key Points The normal sonographic appearance of the ovaries changes with the menstrual cycle because of the influence of gonadotropins. These changes cease to occur as late menopause is reached and developing follicles are no longer present. Nonneoplastic lesions of the ovary and adnexa are usually simple cysts or cysts that contain blood products and are often physiologic. These include hemorrhagic physiologic cysts and…

The Uterus

Summary of Key Points Transvaginal ultrasound is usually needed for optimal assessment of the uterus. Uterine enlargement in a nonpregnant patient is most commonly caused by fibroids or adenomyosis. Adenomyosis should be considered when there is an enlarged globular shape of the uterus; heterogeneity or asymmetrical thickening of the myometrium; indistinct interface between the endometrium and myometrium; or cysts, echogenic striations, or echogenic nodules in the…

The Peritoneum

Summary of Key Points Ultrasound has a role in peritoneal imaging. Success is dependent on operator awareness and thorough technique. Inclusion of transvaginal scan in women will greatly improve accuracy. Ultrasound is excellent for detecting and characterizing peritoneal fluid. Ultrasound is very useful for detecting and characterizing neoplastic and inflammatory peritoneal disease. Ultrasound is often the modality of choice to guide paracentesis and biopsy of peritoneal…

Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall

Summary of Key Points Dynamic ultrasound is the key examination for assessing the groin or anterior abdominal wall pain. Dynamic components of the examination include Valsalva and compression maneuvers and scanning in both supine and upright positions. Dynamic sonography enables clinicians to determine hernia type, size, contents, reducibility, and tenderness. Evaluation of groin pain in athletes is frequently more complex than in nonathletes because of associated…

The Retroperitoneum

Summary of Key Points If an abdominal aortic aneurysm progresses to rupture, survival is very unlikely. If discovered before rupture, survival is highly likely. Most aneurysms are fusiform, which makes them readily diagnosable with ultrasound. Clinicians must also be aware of related entities that are more difficult to diagnose with ultrasound, including eccentric aneurysms, pseudoaneurysms, and penetrating ulcers. Ultrasound is not an appropriate method for the…

The Adrenal Glands

Summary Key Points The adrenal glands are responsible for maintaining homeostasis and regulating hormonal production and secretion within the body. The adrenal cortex is comprised of the zona glomerulosa, fasciculata, and reticularis, which are responsible for aldosterone, glucocorticoid, and androgen regulation, respectively. The adrenal medulla regulates catecholamines. Sonographic visualization of the right adrenal gland is best through a transverse oblique and coronal view, using the liver…

The Prostate and Transrectal Ultrasound

Summary of Key Points Prostate cancer is a significant health problem and its management is changing rapidly. Currently, transrectal ultrasound (TRUS) with biopsy is the primary modality to diagnose prostate cancer. New modalities including multiparametric magnetic resonance imaging and biomarkers are being introduced for prostate cancer assessment. Understanding of prostate cancer has evolved with recognition of aggressive and indolent forms, which are managed differently. Screening for…

The Kidney and Urinary Tract

Summary of Key Points Renal ultrasound is the screening modality of choice for the initial evaluation of renal insufficiency. Relevant imaging markers include parenchymal echogenicity, renal length, and collecting system dilatation. The primary role for ultrasound in the evaluation of renal masses is to differentiate between cystic and solid lesions, although an appropriate differential diagnosis may be given based on clinical history and cyst complexity. Echogenic…

The Gastrointestinal Tract

Summary of Key Points High-resolution ultrasound allows for excellent depiction of the bowel, including the normal multilayered appearance of the bowel wall and many pathologic features. Ultrasound is a safe, objective, and accurate method for measuring the severity of inflammatory activity in inflammatory bowel disease, an essential requirement considering the young population most often affected by this chronic and often debilitating disease. Contrast-enhanced ultrasound is an…