妇产科疾病的超声诊断课件.ppt

Ultrasonography on Gynecology and Obstetrics,妇产科疾病的超声诊断,1,Ultrasonography on 妇产科疾病的超声诊断1,Sangreal-uterus,THE DA,WINCI CODE,妇产科疾病的超声诊断,2,Sangreal-uterusTHE DAWI,Pelvic CavityPosterior : Occupied by rectum, colon, and ileumAnterior: bladder, ureters, ovaries, fallopian tubes, uterus, and vagina,NORMAL ANATOMY,妇产科疾病的超声诊断,3,Pelvic CavityNORMAL ANATOMY妇,Pre-inspection :,Moderate bladder filling,妇产科疾病的超声诊断,4,Pre-inspection :Moderate bladd,Uterus,Hollow, pear-shaped organDivided into fundus, body, and cervixUsually anteflexed and antevertedCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in position,妇产科疾病的超声诊断,5,UterusHollow, pear-shaped orga,Uterine size,Prepubertal : 3 cm long by 0.5 to 1.0 cm wideMenarcheal: 8 cm long by 4 cm widePostmenopausal: 3.5 to 5.5 cm long by 1 to 2 cm wideNormal size : 23(thick)45(width)78 cm(length),妇产科疾病的超声诊断,6,Uterine sizePrepubertal : 3 cm,Uterine longitudinal diameter,Uterine wide diameter,Uterus before and after the Trail,妇产科疾病的超声诊断,7,Uterine longitudinal diameter,length 78cm,before and after the Trail 23cm,width 45cm,妇产科疾病的超声诊断,8,length 78cmbefore and after t,Uterine Position,Midline anteversion: most common; degree of anteversion is bladder distention dependentRight or left: normal variant in absence of pelvic massesRetroverted: entire organ displaced posteriorlyRetroflexed: body displaced with respect to cervix,妇产科疾病的超声诊断,9,Uterine PositionMidline anteve,Ultrasonography of normal uterus,Uterine serosa layer: Linear high-echo ;clear, smooth; Myometrium: Homogeneous middle-echo ;Endometria: The middle line of high echo , around the weak echo . It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.,妇产科疾病的超声诊断,10,Ultrasonography of normal uter,Uterine serosa layer,Myometrium,Endometria,Normal uterustransabdominal ultrasonography,妇产科疾病的超声诊断,11,Uterine serosa layer Myometriu,Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the image with the endometrial stripe rumming through the middle of the uterine cavity.,Myometrium,Endometria,Uterine serosa layer,妇产科疾病的超声诊断,12,Transvaginal sagittal view of,Fallopian Tube（输卵管）,Infundibulum: funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovariesAmpulla: sidest part of the tube where fertilization occursIsthmus: hardest part; lies just lateral to the uterusLength: 12 cm; supplied by ovarion arteries and veins,妇产科疾病的超声诊断,13,Fallopian Tube（输卵管）Infundibulu,Ovary（卵 巢）,Almond shapedAttached to back of the broad ligament by mesovarium; sometimes called suspensory ligament of the ovaryLies in ovarian fossaFossa is bounded by external iliac vessels, ureter, and obturator nerveReceives blood from ovarian arteryBlood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal vein,妇产科疾病的超声诊断,14,Ovary（卵 巢） Almond shaped妇产科疾病的,Sonography of the normal ovary,An ovoid homogeneous echodensity; follicular cysts are often present.The best sonographic marker for the ovary is identification of a follicular cyst, which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.,妇产科疾病的超声诊断,15,Sonography of the normal ovary,Transabdominal sagittal image shows the left ovary posterior to the urinary bladder,妇产科疾病的超声诊断,16,Transabdominal sagittal image,Transvaginal sagittal image of the ovary,ovarian follicle,妇产科疾病的超声诊断,17,Transvaginal sagittal image of,Follicular wall flow,妇产科疾病的超声诊断,18,Follicular wall flow妇产科疾病的超声诊断,Common Diseases of Obstetrics and Gynecology,Gynecology ：Leiomyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc.Obstetrics： Natural pregnancy ； Abnormal pregnancy; etc.,妇产科疾病的超声诊断,19,Common Diseases of Obstetrics,The uterus Leiomyoma /Hysteromyoma,妇产科疾病的超声诊断,20,The uterus Leiomyoma /Hystero,Characteristics of Leiomyomas,Most common pelvic tumorSmooth muscle cell compositionFibrosis occurs after atrophic of degenerative changesDegeneration occurs when fibroids outstrip their blood supply; calcificationMay be pedunculatedClinical: enlarged uterus, profuse and prolonged bleeding, pain,妇产科疾病的超声诊断,21,Characteristics of LeiomyomasM,Uterine Locations of leiomyomas,Submucosal Erode into endomertial cavity heavy bleeding; infertilityIntramuralMay enlarge to cause pressure on adjacent organs; infertilitySubserosalMay enlarge to cause pressure on adjacent organs,妇产科疾病的超声诊断,22,Uterine Locations of leiomyoma,Subserous myoma,Broad ligamentmyoma,Cervical myoma,intramurous myoma,Submucous myoma,妇产科疾病的超声诊断,23,Subserous Broad ligamentCervic,Ultrasonic performance,Two-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the uterine body ，Rear echo attenuation； With calcification or Cystic change, etc；Signs of oppression；Color Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ；Doppler spectrum：Medium resistance index，RI 0.60.1。,妇产科疾病的超声诊断,24,Ultrasonic performanceTwo-dime,intramurous myoma,妇产科疾病的超声诊断,25,intramurous myoma妇产科疾病的超声诊断25,Subserous myoma,intramurous myoma,妇产科疾病的超声诊断,26,Subserous myomaintramurous myo,Subserous myoma,妇产科疾病的超声诊断,27,Subserous myoma妇产科疾病的超声诊断27,Cervical myoma,妇产科疾病的超声诊断,28,Cervical myoma妇产科疾病的超声诊断28,Abundant tumor blood flow,M,UT,妇产科疾病的超声诊断,29,Abundant tumor blood flowMUT妇产,RI 0.61,妇产科疾病的超声诊断,30,RI 0.61妇产科疾病的超声诊断30,Submucous myoma with calcification,妇产科疾病的超声诊断,31,Submucous妇产科疾病的超声诊断31,Teratoma Dermoid Tummors（卵巢良性囊性畸胎瘤/皮样囊肿),Pathology ：derives from germ cell，the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to 20% are bilateral. About 80% occur in women of childbearing age.,妇产科疾病的超声诊断,32,Teratoma Dermoid Tummors（卵巢,Size ranges from small to 40 cmUnliateral,round to oval massContains faty,sebaceous material, hair, cartilage, bone, teethClinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsionSonography: Cystic/ complex/solid mass, echogenic components; acoustic shadowing,妇产科疾病的超声诊断,33,Size ranges from small to 40 c,Special Ultrasound Findings:,1. A cystic mass: with an echogenic mural nodule2. A paste sign：particulate liptinite3. A fluff of hair sign4. A fat-fluid level sign：with fluid level in the cyst, fat above, fluid below.5. A complex mass,妇产科疾病的超声诊断,34,Special Ultrasound Findings:1.,cystic teratoma of ovary,A cystic mass,Paste sign,Fluff of hair sign,妇产科疾病的超声诊断,35,cystic teratoma A cystic massP,Paste sign,Fat-fluid level sign,A complex mass,妇产科疾病的超声诊断,36,Paste signFat-fluid level sign,A 8 years old girl, cutting off a three kilograms benign teratoma,妇产科疾病的超声诊断,37,A 8 years old girl, cutting of,The role of Ultrasound in Obstetrics,妇产科疾病的超声诊断,38,The role of Ultrasound in Obst,TRIMESTERS,First trimester = 0 to 12 weeks of gestationSecond trimester = 13 to 26 weeks of gestationThird trimester = 27 to 42 weeks of getsationPostterm pregnancy = 42 weeks of gestation,妇产科疾病的超声诊断,39,TRIMESTERSFirst trimester,Indications for First-Trimester Sonography,Confirm presence of intrauterine pregnancyEvaluate for suspected ectopic pregnancyDefine cause of vaginal bleedingDetermine gestational ageConfirm suspected multiple gestationsAid in invasive proceduresEvaluate pelvic massesDetect uterine abnormalities,妇产科疾病的超声诊断,40,Indications for First-Trimeste,Natural pregnancy,妇产科疾病的超声诊断,41,Natural pregnancy妇产科疾病的超声诊断41,Nonage pregnancy (First-Trimester),Definition ：Pregnancy before 12 weekend.,妇产科疾病的超声诊断,42,Nonage pregnancy (First-Trime,5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac; 9 weeks Embryonic, placenta.,The Normal First Trimester,妇产科疾病的超声诊断,43,5 weeks pregnant The Normal F,Sonographic Features of a Normal Gestational Sac,Shape: round of ovalPosition: fundal or middle portion of uterus; a center position relative to endometriumContour: smoothWall: echogenic; 3 mm of more in thickness,妇产科疾病的超声诊断,44,Sonographic Features of a Norm,Internal landmarks: yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mmGrowth: 1 mm per day (range: 0.7 mm to 1.5 mm per day),妇产科疾病的超声诊断,45,Internal landmarks: yalk sac p,4-5 weeks pregnant In the gestational sac we can see a embryo point, the earliest embryo.,妇产科疾病的超声诊断,46,4-5 weeks pregnant妇产科疾病的超声诊断46,7 weeks pregnant Fetus was about 4 mm，we can see apparent heart throb, and small limb bud .,妇产科疾病的超声诊断,47,7 weeks pregnant妇产科疾病的超声诊断47,8 weeks pregnant Three-dimensional ultrasound show its beginning of the shape of a human.,妇产科疾病的超声诊断,48,8 weeks pregnant妇产科疾病的超声诊断48,Umbilical bord,Embryonic head,Embryonic abdomen,妇产科疾病的超声诊断,49,Umbilical bordEmbryonic headEm,Yolk sac,Embronic head,Amniotic sac,妇产科疾病的超声诊断,50,Yolk sacEmbronic headAmniotic,9 weeks pregnant Known as a fetal，Development of the various parts of the fetus, tends to improve.,妇产科疾病的超声诊断,51,9 weeks pregnant妇产科疾病的超声诊断51,12 weeks pregnantThe spine is identifiable , as the two bead-like high echo. Ears, limbs, bones can be shown and measurement.,妇产科疾病的超声诊断,52,12 weeks pregnant妇产科疾病的超声诊断52,Ultrasound of the Second and Third Trimesters,妇产科疾病的超声诊断,53,Ultrasound of the Second and T,Indications for Second- and Third-Trimester,Estimate gestational age for patients with uncertain datesEvaluate uterine size and clinical date discrepanciesEvaluate fetal growthEstimate fetal weightDetermine fetal presentationEvaluate fetal life,妇产科疾病的超声诊断,54,Indications for Second- and T,provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placementEvaluate uterine abnormalityEvaluate abnoumal maternal serum alpha-fetoprotein valuesEvaluate abnormal amniotic fluidEvaluate placenta Etc.,妇产科疾病的超声诊断,55,provide adjunct to amniocente,The Second- and Third-Trimester( Metaphase and terminal prengancy),Mid-pregnancy:13-27 weeks pregnancy.Late-pregnancy:More than 28 weeks of pregnancy.,妇产科疾病的超声诊断,56,The Second- and Third-Trimest,Scanning Techniques,Survey uterus Observe cardiac activityDetermine position and number of the fetus and placentaAssess amniotic fluidLook for uterine of placental masses and fetal anomalies,妇产科疾病的超声诊断,57,Scanning TechniquesSurvey uter,Check contents,1、Fetal head ：BPD biparietal diameter;2、Fetal abdomen: AC abdomen circumference;3、Fetal limb： FL femur length ;4、Others：Placenta, Fetal heart rate, Amniotic fluid, etc.,妇产科疾病的超声诊断,58,Check contents妇产科疾病的超声诊断58,1 、 Fetal head,Measuring the Biparietal Diameter(BPD)Obitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nucleiMake sure the head is symmetric and ovalMeasure from outer to inner margins of the skullIn the third trimester, the BPD is not as accurate in predicting fetal age,妇产科疾病的超声诊断,59,1 、 Fetal headMeasuring the Bi,Fetal head, after 12 weekend pregnant,妇产科疾病的超声诊断,60,Fetal head, after 12 we,Fetal side profile, we can observe its forehead, nose ,lip, and chin, etc.,妇产科疾病的超声诊断,61,Fetal side profile, we,2、Fetal abdomen,The hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ductsThe gastrointestinal system: the esophagus, stomach, small and large intestines(colon),妇产科疾病的超声诊断,62,2、Fetal abdomenThe hepatobilia,The urinary system: kidneys, adrenal glands, ureters, bladder.The fetal abdomen circumference（AC) is the most widely measured,妇产科疾病的超声诊断,63,The urinary system: kidneys,Measuring the Abdominal Circumference(AC),The AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverThe outer margin of the abdominal wall should be measuredThe abdominal wall measurement is the least accurate,妇产科疾病的超声诊断,64,Measuring the Abdominal Circum,The fetal liver,gallbladder,stomach,port venous,spine,gallbladder,stomach,妇产科疾病的超声诊断,65,The fetal livergallbladderstom,3、Fetal limbs,The upper limbs: the ulna the radius the humerusThe lower limbs: the femur/the thigh bone the fibula the tibia The femur is the most widely measured long bone （FL femur length ）,妇产科疾病的超声诊断,66,3、Fetal limbsThe upper limbs:,Femur measurement,Hyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condylesThe mormal femur has a straight laeral border and a curved medial borderFemur length may be used with the same accuracy as BPD to predict gestational ageFemur length may indicate skeletal dysplasias or intrauterine growth restriction,妇产科疾病的超声诊断,67,Femur measurementHyperechonic,Long section of the upper limbs,The radius,The ulna,The humerus,妇产科疾病的超声诊断,68,Long section of the upper limb,Femur/thigh bone,Fibula /perone,Tibia/shin bone,Long section of the lower limbs,妇产科疾病的超声诊断,69,Femur/thigh boneFibula /perone,4、 The placenta（胎盘）,The major fole of the placenta is to permit the exchange of oxygenated maternal blood(rich in oxgen and nutrients) with deoxygenated fetal blood.The thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in fetuses greater than 23 weeks. The size of the placenta rarely exceeds 50 mm in the normal fetus.,妇产科疾病的超声诊断,70,4、 The placenta（胎盘）The major f,Anterior placenta at 21 weeks of gastation,The placenta,Umbilical bord,Amniotic fluid,The fetal,妇产科疾病的超声诊断,71,Anterior placenta at 21 weeks,posterior placenta at 29 weeks of gestation,calcification,妇产科疾病的超声诊断,72,posterior placenta at 29 week,Anterior placenta at 39 weeks of gastation,妇产科疾病的超声诊断,73,Anterior placenta at 39 weeks,Calm little face,Eating toe,Eating fingers,妇产科疾病的超声诊断,74,Calm little faceEating toe Eat,Crying,Poutting,妇产科疾病的超声诊断,75,CryingPoutting妇产科疾病的超声诊断75,Fetal with umbilical cord around the neck,Fetal with cleft lip,妇产科疾病的超声诊断,76,Fetal with umbilical cord arou,smailing,妇产科疾病的超声诊断,77,smailing妇产科疾病的超声诊断77,Bao bao,Bei bei 100 days old!,妇产科疾病的超声诊断,78,Bao bao,Bei bei 100 days old!妇,Bao bao,Bei bei 1 years birthday!,妇产科疾病的超声诊断,79,Bao bao,Bei bei 1 years birth,THANKS ALL!,妇产科疾病的超声诊断,80,THANKS ALL!妇产科疾病的超声诊断80,