超声在妇科应用进展(英文).ppt

progress on the application of ultrasound in gynecology,endo-luminal ultrasound（腔内超声） Real-Time Tissue Elastography (弹性成像) Contrast enhanced ultrasound（超声造影） Three-dimensional Ultrasonography （3D 三维超声）,uterine cavity ultrasonography,Indications contraindication,acoustic penetration depth is inversely proportional to the probe frequency 。 Resolution is proportional to the probe frequency,Advantages and limitations,High-frequency, high resolution, clear image Small scanning radius,妇科腔内超声适应症和禁忌症,适应症 禁忌症：1）未婚无性生活史；2）阴道出血；3）阴道炎；4）老年性或放射性阴道萎缩；4）先天性阴道闭锁。 相对禁忌症：1）患者不同意阴道超声检查；2）超出阴道探头探查范围的盆腔肿块；3）中、晚期妊娠有阴道出血原因不明者。 -临床技术操作规范超声医学分册,2、 实时组织弹性成像 （Real-Time Tissue Elastography）,Elastography The hardness of organization is close relative to histopathology . Gray scale or color coded imaging,soft,soft,hard,external force,soft,hard,Elastography,1 points：deformation, green； 2 points：largely deformation, Green and blue mosaic； 3 points：Boundary deformationgreen, center part undeformed,blue 4 points：tumor undeformedblue； 5 points：tumor and perienchyma undeformed, tumor and perienchymablue,quantitative analysisqualitative analysis,1 points benign 23points Benign maybe 4 points Pay attention to the differential diagnosis 5 points malignancy maybe,strain ratio-quantitative analysis software,strain ratio (应变率),Strain ratio =B/A=FLR=tumor/fatty tissue (reference value 4.3） Strain ratio =B/A=tumor/reference tissue (reference value 3.08）,clinical application,The early diagnosis of cancer Benign , malignant judgement Diffusion region To confirm the therapeutic effec clinical staging of venous thrombosis Hepatic fibrosis The corresponding clinical field：Thyroid, breast, prostate, skin, liver, pancreas, uterus /ovary, lymph node, vascular, rectum, testis,3、Contrast-Enhanced Ultrasound,The shortage of conventional ultrasound differential diagnosis of benign and malignant diseases Low specificity Low sensitivity A diease has abroad spetrum of sonographic apperance，various dieases have common sonographic apperance,Ovarian cystic mass,The principle of conventional ultrasound,2D：acoustic impedance acoustic attenuation CDFI：Doppler shift,Intravenous Contrast Ultrasound,Difference of microcirculation changes increase the echogenicity of the blood Enhance the difference of tissue perfusion,What is ulrasound contrast agent?,Size sufficiently small (less than red blood cell) Strong signals (more than red blood cell) Pass throughout the body Eliminate via the respiratory system,How microbubbles work?,Rapidly contracting and expanding to the pressure changes of the sound make microbubbles several thousand times more reflective than normal body tissue The non-linear oscillation of microbubbles generate harmonic The acoustic result microbubbles burst,-定性：心脏、腹部、高频和腔内应用领域的实时造影技术 CnTI -Contrast Tuned Imaging -定量：声学时间强度曲线分析 Wash-in/Wash-out -创新：微血管灌注成像 CMI-Contrast Micro-Imaging,Inert gas-filled microbubbles contrast agent,Safety non-toxicity Uniform size ,less than 10m Pass through the capillaries Generate harmonic Good stability,microbubbles,Blood circulation,Pass through the capillaries,the difference of tissue perfusion,Reflect Blood supply of lesions,The detection rate of Micro vessels increased,The echogenic of different tissue were different,Real time contrast enhance ultrasound,CEUS,局灶性不典型增生,Focal nodular hyperplasiaFNH,Time-intensity curves(Ordn et al Radiology 2003;206:405-10),Postoperative Cervical cancer,Borderline serous cystadenoma,Malignant mesothelioma,Deep myometrial invasion in endomentrial cancer,Pelvic recurrence of endometrial cancer,4、 Three-dimensional Ultrasonography,Modern obstetrics and Gynecology category,Three dimensional obstetrics ultrasound Three dimensional gynaecology ultrasound,3D, A new field of vision,Dynamic three-dimensional imaging，4D,Imaging mode： surface mode transparent mode color doppler flow imaging mode multiple plane mode Niche mode,surface mode,transparent mode,color doppler flow imaging mode,multiple plane mode,Niche mode,Two dimensional ultrasound can not get；The image is easy to understand；Make a comprehensive analysis of the interesting zone。 Close to the actual anatomy, easy for clinicians and non medical staff understanding, better communication between ultrasound doctors，clinicians and patient,indication,Congenital uterine anomalies Intrauterine device intrauterine disease ectopic pregnancy Adnexal masses, follicle detection, ovarian volume measurement,Assessment of ovarian response The diagnosis of PCOS Evaluate the uterine morphology and endometrial volume Predict the outcome of IVF-ET Three dimensional ultrasound guided puncture,testing time,AFS(美国生殖协会)，1988y,class ：Uterine hypoplasia / dysplasia,class ： unicornous uterus (rudimentary horn of uterus),class ： didelphic uterus,didelphic uterus,class ： bicornuate uterus,Incomplete bicornuate uterus,complete bicornuate uterus（double cervix）,complete bicornuate uterus（double cervix）,class septate uterus,Incomplete septate uterus Side intrauterine pregnancy,complete septate uterus,class arcuate uterus,class ： diethystilbestrol（DES）exposure,length depth angle,Incomplete septate uterus Comparison of preoperative and postoperative before after 内膜,3DPDA,VOCAL histogram,Three vascular index： VIVascular index FIflow index VFIVessels flow index,74,3D：Application in assisted reproductive technology,1、To observe the situation of endometrial, ovarian, ovarian follicle 。 2、Evaluation of endometrial receptivity。 3、To evaluate the reactivity of ovary。 4、To guide the embryo implantation。,3D Ultrasound angiography of fallopian tube,coded contrast imaging CCI Three dimensional imaging function stereo imagery of tubal morphology and distribution,SonoAVC Automatic measurement volume of follicles and follicle coun,diagnostic criteria of PCOS,diagnostic criteria 1990 NIH 2003 Rotterdam 2006 Androgen Excess Society,Ultrasonic PCO criteria: 1990 NIH The ovarian periphery 10 small follicles, and each diameter 1cm 2003 Rotterdam unilateral or bilateral ovarian follicles more than 12, 19mm in diameter, and or ovarian volume greater than 10ml,78,endometrial receptivity,Endometrial receptivity is one of the main factors affecting embryo implantation Although various endocrine factors may influence