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The Fetal Brain

Summary of Key Points Protocol-based ultrasound carefully performed by a knowledgeable and experienced examiner following established guidelines is very sensitive in evaluating the central nervous system (CNS). Ventriculomegaly can be due to many underlying conditions, including obstruction, destruction, and dysmorphism, or a combination. In cases of brain abnormalities in which additional morphologic or functional information is needed beyond that available with ultrasound, magnetic resonance imaging can…

The Fetal Face and Neck

Summary Key Points Ear and eye anomalies often accompany abnormalities of the skull and face. Abnormalities of fetal head size and shape may be associated with various syndromes and chromosomal anomalies. Hypoplastic or absent nasal bone may be seen in fetuses with trisomy 21. Cleft lip may be associated with cleft palate, and detailed description of the cleft is important to accurately counsel parents, predict postnatal…

Multifetal Pregnancy

Summary of Key Points Multifetal pregnancies have higher rates of perinatal morbidity and mortality than singletons. Chorionicity is the major determining feature for the inherent unique complications faced by multiple gestations. Fetal growth differences and congenital malformations are increased in all types of multiple gestations. In monochorionic twins with a single demise, there is a high risk of severe cerebral and other injuries in the survivor.…

Chromosomal Abnormalities

Summary of Key Points Screening for aneuploidy using the nuchal translucency (NT) measurement should be performed by a credentialed provider participating in an ongoing quality-monitoring program. In chromosomally normal fetuses with an increased NT, normal anatomy and no identifiable genetic syndromes, there does not appear to be a higher risk of developmental delay than in the general population. A “marker” identified during a second-trimester sonogram should…

The First Trimester

Summary of Key Points First-trimester development follows a predictable pattern on first-trimester ultrasound. Some ultrasound findings are definitive for early pregnancy failure, whereas others are suggestive and require follow-up. Ultrasound is vital in the diagnosis of ectopic pregnancy in typical and atypical locations. Gestational trophoblastic disease is composed of four entities, and ultrasound is helpful in their diagnosis and management. The first trimester of pregnancy is…

Bioeffects and Safety of Ultrasound in Obstetrics

Summary of Key Points Obstetric ultrasound should only be performed with a clear indication, with calibrated machines, and by proficient professionals. Know the specific machine being used (what causes increase in output power). Keep the examination as short as possible and use the lowest possible output power but compatible with arriving at the correct diagnosis (as low as reasonably achievable [ALARA] principle). Keep track of the…

Overview of Obstetric Imaging

Summary of Key Points Ultrasound allows for accurate prediction of gestational age. The appropriate training and skills are necessary for safely performing and accurately interpreting obstetric ultrasound There are many options for screening pregnant women, most of which include ultrasound. Routine obstetric ultrasound has specific recommended views that allow for depiction of many, but not all, fetal anomalies. Three-dimensional ultrasound, fetal Doppler examinations, and fetal magnetic…

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…