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Role of Magnetic Resonance Imaging in the Evaluation of Gynecologic Disorders

Summary of Key Points Magnetic resonance imaging (MRI) is a problem-solving tool and has greater accuracy and specificity for characterization of gynecologic masses than sonography or computed tomography (CT), but should generally be performed after pelvic sonography. High resolutionT2-weighted sequences are the mainstay images for evaluation of nonobstetric gynecologic disorders. T1-weighted imaging must be performed with and without fat suppression if characterization of fat or blood…

Ultrasound and Magnetic Resonance Imaging in Urogynecology

Summary of Key Points Endoanal sonography has an important role in the assessment of the anal sphincter in patients with fecal incontinence. Sonography and magnetic resonance imaging (MRI) of the pelvic floor can be useful in evaluation of women with pelvic floor disorders and in assessment of mesh implants. There is no strong evidence for routine use of pelvic floor sonography in assessment of women with…

Gynecologic Sonography in the Pediatric and Adolescent Patient

Summary of Key Points Reproductive tract anomalies may present at different stages of life. Most abnormalities of the external genitalia are obvious at birth, whereas obstructive and nonobstructive lesions of the reproductive tract may be evident at birth or present later during childhood, at puberty, in adolescence, or during adulthood. Sonography is used to determine the presence of a uterus and gonadal location in patients with…

Ectopic Pregnancy

Summary of Key Points The incidence of ectopic pregnancy (EP) in the United States is increasing as a result of an increase in the number of patients with risk factors as well as an increase in diagnosis due to earlier presentation and detection. Mortality rate from EP is decreasing because of improved diagnostic techniques and heightened awareness among clinicians and patients. The most common predisposing risk…

Sonographic Imaging in Infertility and Assisted Reproduction

Summary of Key Points Transvaginal sonography (TVS) provides valuable information as part of the initial evaluation of an infertile patient. EVS has an essential role in monitoring endometrial thickness and morphology as well as follicular development during hormonal stimulation. EVS or transabdominal sonography provides guidance for oocyte retrieval. Postretrieval complications such as ovarian hyperstimulation, hemorrhage, and infection are optimally imaged with sonography. Infertility can be defined…

Ultrasound Evaluation of the Fallopian Tube

Summary of Key Points Normal fallopian tubes are difficult to visualize with ultrasound unless surrounded by small amounts of free peritoneal fluid. Classic sonographic signs that help distinguish a dilated fallopian tube from other cystic adnexal masses include waist, incomplete septation, cogwheel, and beads on a string signs. Acute pyosalpinx is diagnosed on ultrasound examination by the finding of a dilated, tubular adnexal structure filled with…

Ultrasound Evaluation of the Ovaries

Summary of Key Points A simple cyst less than 3 cm in the ovary of a premenopausal patient is best termed a follicle and is a normal finding. A simple cyst less than 1 cm in the ovary of a postmenopausal patient is considered inconsequential. Most ovarian masses are benign and have a typical sonographic appearance that allows accurate diagnosis. Many simple and hemorrhagic cysts do not need…

Evaluation of Pelvic Pain in the Reproductive Age Patient

Summary of Key Points Pelvic pain in the reproductive age patient often presents a diagnostic challenge as there are many causes, including both gynecologic and nongynecologic disorders with overlap in clinical symptoms. Pregnancy status must always be determined to exclude a pregnancy-related complication, particularly ectopic pregnancy. Pelvic sonography is the well-established first-line imaging method of choice and may require both a transabdominal and transvaginal approach to…

Ultrasound Evaluation of the Uterus

Summary of Key Points Sonography is the imaging modality of choice for evaluation of the myometrium, with magnetic resonance imaging (MRI) reserved as a problem-solving technique. Many müllerian duct anomalies can be accurately diagnosed with sonography, and three-dimensional (3D) imaging of the fundal contour is diagnostic in differentiating the bicornuate uterus (>1 cm fundal cleft between the two horns) and the septate uterus. Adenomyosis presents most commonly…

Abnormal Uterine Bleeding : The Role of Ultrasound

Summary of Key Points Abnormal uterine bleeding is most commonly due to dysfunctional anovulatory bleeding in premenopausal women and endometrial atrophy in postmenopausal women. Approximately 90% of endometrial cancer occurs after age 50, with the most common symptom being abnormal vaginal bleeding. Transvaginal sonography (EVS) is the initial step in the workup of postmenopausal bleeding; however, if the endometrium is not adequately visualized EVS must be…

Normal Anatomy of the Female Pelvis and Transvaginal Sonography

Summary of Key Points Transabdominal sonography (TAS) and transvaginal sonography (TVS) are often complementary, providing different diagnostic information. TAS provides a wider field of view and better visualization of superficial structures and large pelvic masses but has limited resolution. The transvaginal approach allows the probe to be placed closer to the “target organs,” providing higher resolution imaging, but has a limited field of view. Because of…

Role of Sonography in Fetal Procedures

Summary of Key Points Sonography has transformed the field of fetal therapy and serves as the widely available, necessary diagnostic and intraoperative guidance tool. The potential benefits of open maternal-fetal surgery must be weighed against the potential maternal and fetal risks, which have the potential of complicating the index pregnancy and subsequent pregnancies. Minimally invasive fetal surgery is associated with much lower maternal risks and is…

Role of Magnetic Resonance Imaging in Obstetrics

Summary of Key Points Magnetic resonance imaging (MRI) does not use ionizing radiation, and no known biologic risks are associated with this imaging modality. MRI is an important tool for the evaluation of maternal complications in pregnancy, including the evaluation of atypical advanced ectopic pregnancies, suspected appendicitis, pelvic masses, hepatic and genitourinary diseases, and placenta accreta. In the fetus, MRI is a useful adjunct to the…

Role of Doppler Sonography in Obstetrics

Summary of Key Points Absent or reverse flow during diastole in the umbilical artery represents an advanced stage of placental compromise and is associated with more than 70% of placental arterial obliteration. In the presence of fetal hypoxemia, central redistribution of blood flow occurs, resulting in an increased blood flow to the brain, heart, and adrenals and a reduction in flow to the peripheral and placental…

Antepartum Fetal Surveillance and the Role of Ultrasound

Summary of Key Points The goal of antepartum testing is to prevent fetal death. Antepartum testing is most commonly performed in pregnancies identified as high risk due to maternal conditions or following the identification of fetuses at risk for intrauterine compromise so that intervention and timely delivery can prevent progression to stillbirth. Antepartum surveillance may also be used to confirm the well-being of the normal fetus…

Amniotic Fluid Volume in Fetal Health and Disease

Summary of Key Points The pathways influencing amniotic fluid volume (AFV) are dynamic and complex and are not completely understood. The balance of maintaining the overall AFV occurs at three key areas: fetal urine production and fetal swallowing, the intramembranous pathway, and the osmotic fluid gradient created between the mother and the fetus. There are several published curves that attempt to define a normal AFV. Abnormal…

Ultrasound Evaluation of the Placenta, Membranes, and Umbilical Cord

Summary of Key Points Assessment of the relationship between the placenta and the internal cervical os is an essential component of sonography in the second and third trimesters. Placenta previa is identified in 1% to 5% of second-trimester sonograms but is present at birth in only 3/1000 births. Transvaginal sonography is considered safe regardless of placental location, even in the presence of bleeding. Conditions associated with…

Ultrasound Evaluation of the Gravid Cervix

Summary of Key Points Transvaginal ultrasound (TVU) for cervical assessment is one of the best techniques for predicting preterm birth (PTB). A cervical length (CL) of less than 25 mm between 16 and 24 weeks' gestation is the most reliable threshold for an increased risk of PTB. The shorter the cervix and the earlier in gestation the shortening occurs, the higher the risk of PTB. TVU is…

Evaluation of Hydrops Fetalis

Summary Key Points Diagnosis of hydrops fetalis requires two or more of the following sonographic abnormalities: scalp and body wall edema (defined as skin thickness >5 mm), ascites, pleural effusion, pericardial effusion, polyhydramnios, and placental thickening (≥4 cm in the second trimester and ≥6 cm in the third trimester). Immune hydrops refers to cases in which the underlying condition is due to fetal anemia developing from maternal red blood…