Contents. Physical and Technical Principles. 1 Physical and Technical Principles of Color Doppler Sonography

Transcription

1 viii Contents Physical and Technical Principles 1 Physical and Technical Principles of Color Doppler Sonography R. Kubale and G. Hetzel Historical Development... 2 B-Mode Sonography... 2 Physical Principles of Echo Production... 2 Principles of Ultrasound Instrumentation... 3 Analysis of B-Mode Information and Artifacts... 7 Duplex and Color Doppler Sonography... 9 Physical Principles of Motion Detection... 9 Technical Principles and Equipment Settings... 9 Technical Aspects of the Examination and Equipment Settings Analysis of Doppler Information and Artifacts New Technical Processes and Approaches New Developments in Transducer Technology New Techniques of Signal Acquisition and Processing Safety Aspects of Doppler and Color Doppler Sonography H.-D. Rott Mechanisms oftissue Effects Heating Cavitation Risk Assessment ofvarious Ultrasound Techniques Duplex Sonography Color Doppler Power Doppler Color Velocity Imaging (CVI) Transvaginal Scanning Ultrasound Contrast Agents Exposure of Gas-Containing Tissues Measures to Limit Risk Recommendations General Recommendations Pulsed Doppler Appendix: Statements on the Biological Safety of Diagnostic Ultrasound Fields EFSUMB Statement on the Clinical Safety of Diagnostic Ultrasound WFUMB Statement on Thermal Effects in Clinical Applications Infertility Evaluation and Assisted Reproduction 3 Uterine Blood Flow in Fertile and Infertile Women S. Kupesic and A. Kurjak Uterine Blood Supply Changes in Uterine Blood Flow during the Menstrual Cycle Blood Flow Parameters in the Uterine Arteries Blood Flow Parameters in the Radial and Spiral Arteries. 37 Uterine Blood Flow in Infertile Women Uterine Blood Flow and Fertilization Rate Uterine Blood Flow in the Normal Cycle and during Ovarian Stimulation with Confirmed Ovulation Endometrial Imaging Conclusions... 39

2 Contents ix 4 Uterine Causes of Infertility S. Kupesic and A. Kurjak Ultrasound Detection ofuterine Abnormalities Congenital Anomalies Endometrial Polyps Submucous Leiomyomas Adenomyosis Endometritis AshermanSyndrome Ultrasound Detection ofendometrial Causes of Infertility Effect of Endometrial Thickness and Morphology on Fertility Effect of Age on Endometrial Function Endometrial Peristalsis Cervical Factor Changes in Uterine and Ovarian Perfusion with the Onset of Menopause A. Kurjak and S. Kupesic Decline offertility in the Perimenopausal Period Uterine Receptivity Oocyte Quality Ovarian Function Effects of Estradiol and Progesterone on Vascular Resistance Sympathetic Innervation of the Uterus EstrogenEffect ProgesteroneEffect Effect of Age on Ovarian and Uterine Perfusion Authors Study Interpretation of the Results Color Doppler Sonography for the Optimization of Assisted Reproduction D. Grab and K. Sterzik Functional Evaluation ofthe Endometrium Authors Studies Patients and Methods Examination Procedures Results Discussion of the Role of Doppler Examinations Summary Pulsed Doppler and Color Duplex Sonography in the Assessment of Tubal Patency B. Hüneke, A. Kleinkauf-Houcken, C. Lindner, and W. Braendle Applications ofdoppler Sonography in Reproductive Medicine Assessment oftubal Patency Patients and Method Examination Technique Results Discussion of the Value of the Test Procedures Summary Abnormalities of Corpus luteum Function S. Kupesic, A. Kurjak, and T. Zodan Morphology and Biochemistry ofthe Corpus luteum. 77 Conventional Methods in the Diagnosis and Treatment ofluteal Phase Defect Possible Causes of Luteal Phase Defect DiagnosisofLutealPhaseDefect Treatment of Luteal Phase Defect Ultrasound and Doppler Sonography in the Detection ofluteal Phase Defect LUF Syndrome Blood Flow in the Corpus luteum during Early Pregnancy... 81

3 x Contents 9 Interventional Ultrasound in Reproductive Medicine S. Kupesic, A. Kurjak, and A. K. Ertan Follicular Aspiration in Assisted Reproduction Transabdominal Follicular Aspiration Transurethral Follicular Aspiration Transvaginal Follicular Aspiration GIFT(Gamete Intrafallopian Transfer) and ZIFT (ZygoteIntrafallopianTransfer) Embryo Transfer Fallopian Tube Catheterization Aspiration ofovarian Cysts Drainage ofcul-de-sac Abscesses Selective Reduction ofmultiple Pregnancies Techniques ofultrasound Tubal Imaging Hysterosonosalpingography Obstetric Ultrasound 10 Doppler Ultrasound Examinations from Folliculogenesis to Early Pregnancy S. Kupesic, A. Kurjak, and W. Schmidt Overview Monitoring Folliculogenesis Development ofthe Corpus luteum Changes in Endometrial Blood Flow Luteal Blood Flow in Normal and Abnormal Pregnancies Trophoblastic Invasion and Development ofthe Placenta Evaluation of Early Placentation and the Embryonic Circulation with Doppler Ultrasound A. Kurjak and S. Kupesic Implantation Development ofthe Intervillous Circulation Classic Theory Objections and Alternative Theories Color Doppler Studies Vascularization ofthe Yolk Sac and Vitelline Duct Changes in Uterine Perfusion after Placentation Uterine Arteries and Spiral Arteries Embryonic and Fetal Circulation Fetal Vessels Summary Color Doppler Sonography in Ectopic Pregnancy H. J. Voigt Importance oftransvaginal Sonography and Serum hcg Transvaginal Color Doppler Sonography Typical Findings in Normal and Ectopic Pregnancy Diagnostic Efficiency Author sstudies Assessment of the Method Summary Physiology of Doppler Flow in Maternal Vessels during Pregnancy T. Golaszewski, J. Deutinger, and G. Bernaschek Conditions ofintrauterine Life Physical Principles Anatomical and Physiological Principles Adaptive Processes during Pregnancy Technique oftransvaginal Pulsed Doppler Flowmetry Authors Studies Uterine Perfusion in a Normal Pregnancy Uterine Perfusion in an Abnormal Pregnancy Uterine Perfusion on Medication or following Uterine Manipulation...120

4 Contents xi Discussion Uterine Perfusion in a Normal Pregnancy Uterine Perfusion in an Abnormal Pregnancy Uterine Perfusion on Medication or after Uterine Manipulation Summary Doppler Flowmetry of Maternal Vessels as a Screening Test? Color Doppler Sonography of the Uterine Arteries in Early Pregnancy to Screen for Preeclampsia and Uteroplacental Insufficiency A. Funk Applications ofcolor Doppler Sonography during Pregnancy Technique oftransvaginal Doppler Sonography Normal Development ofuterine Artery Doppler Spectra NormalValuesinEarlyPregnancy Early Doppler Examination ofuteroplacental Blood Flow in Abnormal Pregnancy Patients Results Discussion Summary Normal Fetomaternal Doppler Indices in the Second and Third Trimesters of Pregnancy A. K. Ertan, H. J. Hendrik, I. Tossounidis, and W. Schmidt Establishing Normal Curves Methodology Defining the Normal Population Plotting Quantile Curves Results Discussion Progression of Doppler Indices during the Course of Pregnancy Venous Doppler Sonography F. Bahlmann Historical Development Physiology Umbilical Vein Ductusvenosus Inferior Vena Cava Hepatic Veins Clinical Applications Intrauterine Growth Retardation Due to Chronic Placental Insufficiency Growth Discordance in Multiple Pregnancy Hydrops fetalis Conclusion Other Diseases Specific Obstetric Problems 17 Color Doppler Sonography in the Diagnosis of Nuchal Cord A. K. Ertan, H. J. Hendrik, and W. Schmidt Importance ofnuchal Cord Color Doppler Study on the Diagnosis ofnuchal Cord.148 Examination Technique Results Importance of Nuchal Cord Diagnosis in the Biophysical (ABCD) Profile Role ofdoppler Sonography in NC Summary...153

5 xii Contents 18 Chronic Placental Insufficiency H. J. Hendrik, A. K. Ertan, and W. Schmidt Definitions Definition and Incidence of Chronic Placental Insufficiency Intrauterine Growth Retardation Diagnosis ofchronic Placental Insufficiency Diagnostic Systems Indications for Doppler Sonography Clinical Management ofchronic Placental Insufficiency Suspected from Doppler Findings Antenatal Fetal Heart Rate Monitoring Pathological Changes in Organ Systems Biophysical Profile Summary Identifying Cases with IUGR Obstetric Management Severely Abnormal Doppler Findings and Perinatal Abnormalities A. K. Ertan, H. J. Hendrik, and W. Schmidt Surveillance ofcompromised Fetuses Absent End-Diastolic Flow (AEDF) and Reverse Flow Technical Aspects in the Diagnosis of Absent End- Diastolic Flow and Reverse Flow Absent End-Diastolic Flow in the Umbilical Artery and/or FetalAorta Reverse Flow in the Umbilical Artery and/or Fetal Aorta. 168 Clinical Results of AEDF or Reverse Flow in the Umbilical Arteryand/orFetalAorta Significance of Severely Abnormal Doppler Findings..170 Summary Fetal Doppler Findings in Late Pregnancy K. Vetter Physiological Findings in Late Pregnancy Aorta:QuantitativeAnalysis Aorta: Qualitative Analysis Cerebral Arteries Renal Arteries Femoral Arteries Changes in Findings at Term and in Postterm Pregnancies TermEffect Circulatory Balance Summary Intrapartum Fetal Heart Rate Changes and Doppler Sonography E. Weiss Pathophysiology and Technical Problems Changes in Uterine Artery Waveforms during Labor OurResults Discussion of Uterine Doppler Changes during Labor Intrapartum Waveform Changes in Umbilical and Intrafetal Vessels Umbilical Cord Doppler during Labor Effect of Intrapartum FHR Decelerations on Quantitative Parameters of Umbilical Blood Flow Direct Effect of Intrapartum Fetal Hypoxia or Hypoxemia on Blood Flow Patterns in the Umbilical Arteries and Vein Intrapartum Blood Flow Patterns in the Fetal Aorta Intrapartum Blood Flow Patterns in Fetal Cerebral Vessels Summary...196

6 Contents xiii 22 Color Doppler Ultrasound in Fetal Echocardiography A. Lindinger Congenital Heart Disease Incidence and Risk Factors General Introductory Remarks on Color Doppler Sonography ofthe Fetal Heart Indications for Color Doppler Sonography Advantages andlimitations Special Features of Fetal Echocardiography Ultrasound Examination ofthe Fetal Heart NormalFindings Color Doppler in the Diagnosis of Congenital Heart Disease Management of Suspected Congenital Heart Disease Use of Color Doppler in Echocardiography U. Gembruch Importance ofcolor Doppler Echocardiography in Prenatal Diagnosis Examination ofthe Normal Heart Equipment Settings Examination Technique Cardiac Valve Regurgitation Functional Physiological Tricuspid Regurgitation Pathological Tricuspid Regurgitation Tricuspid and Mitral Valve Regurgitation Semiquantification of AV Valve Regurgitation Anomalies ofvisceroatrial Blood Flow Anomalies ofatrioventricular Blood Flow Anomalies ofventriculoarterial Blood Flow Anomalies ofblood Flow through the Cardiac Septa Color Doppler Sonography in Fetal Arrhythmias Summary Structure of the Human Placenta and Pathomorphological Changes in Placental Insufficiency K. R. Reitnauer Structure ofthe Human Placenta Weight and Dimensions Early Development of the Human Placenta Structure of the Villous Tree Microstructure of the Terminal Villus Maturation of the Placenta Vascular Architecture of the Villous Tree Regulation of Villous Blood Flow Concept of the Placentone Morphology and Physiological Transformation of the Maternal Basal-Plate Vessels Placental Insufficiency Definition and Etiology of Placental Insufficiency Placental Compensatory Mechanisms Classification of Placental Insufficiency by its Progression Morphological Counterparts of Latent or Overt Placental Insufficiency Morphological and Morphometric Studies of the Placenta with Doppler Abnormalities of the Fetal Umbilical Arteries* T. Hitschold Clinical Aspects ofplacental Insufficiency Pathophysiological Aspects ofplacental Insufficiency.249 Pathomorphological Aspects ofplacental Insufficiency Validation ofdoppler Findings by Placental Histology Resistance Index of the Umbilical Arteries End-Diastolic Blood Flow Velocities in the Umbilical Arteries Clinical and Diagnostic Value of Doppler Sonography of the Umbilical Arteries...254

7 xiv Contents Gynecological Ultrasound 26 Sonographic and Doppler Sonographic Examination of Uterine Anomalies S. Kupesic and A. Kurjak Classification of Uterine Anomalies Diagnosis and Complications ofseptate Uterus Ultrasound in the Diagnosis and Treatment ofseptate Uterus Authors Results Patients and Methods Results New Thoughts on Old Problems Doppler Examination of the Normal Endometrium and Benign Endometrial Changes S. Kupesic and A. Kurjak Changes in the Normal Endometrium during the Menstrual Cycle Changes in Endometrial Blood Flow during the Menstrual Cycle Submucous Leiomyomas Endometrial Polyps Endometrial Hyperplasia Adenomyosis Endometritis Incomplete Abortion Decidua Transvaginal Color Doppler and Pulsed Doppler Diagnosis of Benign Changes in the Uterine Myometrium A. Kurjak and S. Kupesic Examination Technique, Anatomy, and Physiology Leiomyomas (Fibroids) Vascularization of Leiomyomas Management ofuterine Leiomyomas and the Importance ofcolor Doppler Sonography Medical Treatment with GnRH Agonists Surgical Treatment Vascular Diseases in the Lesser Pelvis (Varicose Veins or Arteriovenous Malformations) Use of Color Doppler in the Evaluation of Suspicious Endometrial Findings M. Holländer, C. Villena-Heinsen, A. K. Ertan, and W. Schmidt Incidence ofendometrial Carcinoma Diagnostic Investigation ofsuspicious Endometrial Findings Color Doppler Sonography Examination ofthe Uterine Artery Experience at the Department ofobstetrics and Gynecology, Homburg University Hospital, Saar Patients and Methods Visualization and Morphology of the Vessels Resistance Indices of Endometrial Vessels Effect of Menopausal Status and Hormone Use Effect of Histopathological Parameters, with Reference toprognosticfactors Subendometrial and Myometrial Vessels Summary...286

8 Contents xv 30 Malignant Uterine Tumors A. Kurjak and S. Kupesic Endometrial Carcinoma Incidence RiskFactors TargetGroupforScreening Screening: Dream or Reality? Authors Experience ReviewoftheLiterature Uterine Sarcoma Authors Experience Cervical Carcinoma Conclusion Blood Flow Changes in Cervical Carcinoma Treated by Primary Chemotherapy C. Villena-Heinsen, A. K. Ertan, M. Holländer, and W. Schmidt Treatment ofcervical Carcinoma Assessing Treatment Response with Pulsed Color Doppler Sonography Authors Studies Discussion Summary Color Doppler Imaging of Benign Adnexal Masses A Spectrum of Findings A. Kurjak, S. Kupesic, and A. K. Ertan Appearance ofnormal Ovaries by B-Mode and Color Doppler Ultrasound Specific Adnexal Masses Cystic and Cystic-Solid Ovarian Masses Solid Ovarian Masses Conclusions Malignant Adnexal Tumors A. Kurjak, S. Kupesic, and A. K. Ertan Color Doppler Sonography ofadnexal Malignancies Review ofthe Literature Neoangiogenesis Detecting Blood Vessels and Defining their Location Vascular Patterns Pulsed Doppler Waveforms Vascular Impedance Blood Flow Velocities Stages of Malignant Tumors False-Positive Results Conclusions Three-Dimensional Power Doppler Sonography in Evaluating the Angiogenesis of Ovarian Tumors A. Kurjak, S. Kupesic, and B. Breyer Contribution oftransvaginal Color Doppler Sonography Three-Dimensional Imaging Three-Dimensional Imaging of Vascular Patterns Types of Image Acquisition and Equipment for Three- Dimensional Ultrasound Display Modes for Three-Dimensional Vascular Images Ultrasound Technology in Tumor Diagnosis Problems in the Interpretation of 3D Power Doppler Data Brief Review of the Mathematical Basis of New Technologies Current Methods for Evaluating Vascular Geometry and Function...322

9 xvi Contents Technique for Evaluating Vascular Geometry Example of 3D Power-Mode Imaging of Benign and Malignant Gynecological Tumors Advances in Tumor Therapy Summary Future Outlook Ovarian Cancer Screening A. Kurjak, W. Schmidt, A. K. Ertan, and S. Kupesic Incidence and Five-Year Survival Rates ofovarian Cancer Requirements ofa Screening Program Definition Screening Methods ScreeningParameters Possible Screening Tests Bimanual Pelvic Examination Cul-de-sac Washings and Radiological Studies TumorMarker Ultrasound Who Should be Screened? Age Distribution FamilyHistory Conclusion OtherRiskFactors General Aspects of the Ultrasound Investigation of Blood Flow in Breast Tumors C. Villena-Heinsen, M. Holländer, and W. Schmidt Historical Development Specific Parameters in the Doppler Examination of Breast Tumors Blood Flow Detection Number of Tumor Vessels Resistance Index Absolute Velocities Number and Intensity of Color Pixels and Color Areas Doppler Waveform Comparison of Mirror Image Areas Conceptual Misunderstandings in the Interpretation ofdoppler Measurements Color Doppler Sonography in the Diagnosis of Breast Cancer H. Madjar Evolution ofbreast Cancer Diagnosis Continuous-Wave Doppler Pulsed Doppler Techniques Color Doppler Equipment Settings Examination Technique BloodFlowAnalysis StudyResults Discussion Conclusions Usefulness of the Minimum Resistance Index in the Benign Malignant Discrimination of Breast Tumors C. Villena-Heinsen, M. Friedrich, J. König, and W. Schmidt Flow Resistance in Malignant Breast Tumors Authors Studies Patients and Methods Results and Discussion Summary...363

10 Contents xvii 39 Effect of Menopausal Status and Hormone Replacement on Therapy Resistance Indices and Blood Flow Velocities in Breast Tumors C. Villena-Heinsen, I. Tossounidis, and W. Schmidt Menopausal Status and Benign Malignant Tumor Discrimination Authors Studies Patients and Methods Results Discussion Summary Benign Malignant Tumor Discrimination and Prognostic Evaluation of Breast Tumors with Color Doppler Sonography C. Villena-Heinsen, A. K. Ertan, D. Mink, and W. Schmidt Applications ofcolor Doppler Sonography in Breast Cancer Authors Studies Methods Results Discussion Conclusion Index...379