Independent of the indication for hysterectomy, each operating surgeon will be highly interested in the detailed information on the uterus given by preoperative imaging methods, such as sonographic imaging.
To know what to expect enables the surgeon to define an adequate surgical management and prevents unexpected intraoperative findings. This is one of the most important reasons for preoperative sonographic imaging.
Especially transvaginal sonography (TVS), more so than transabdominal sonography (TAS), gives us the opportunity to closely approach the regions of interest within the minor pelvis. Because of the short distances within the minor pelvis, probes of high frequency with corresponding high resolution can be used to discover even very small uterine alterations.
Developments such as color Doppler and volume scan give additional diagnostic extensions and refinements.
As sonography is an imaging method, this chapter will be primarily image-based appropriate to the saying, “A good image tells more than a thousand words”.
KeywordsUterine findings Sonographic diagnostics
Endometrial-myometrial junction . Anatomically, an inner layer of myometrium surrounding the endometrium differentiated sonographically and by MRI from the other myometrium by lower echogenity (Figs. 5.2 and 5.3). This layer is also part of the endometrial-subendometrial unit “archimetra” , which evolutionary is an old part of the uterus. According to the theory of Leyendecker, the EMJ is of importance for uterine peristalsis by performing contractions and is believed to play a role in fertility and the development of adenomyosis and endometriosis .
- Glass body
3D glass-body rendering. Grey values in a transparent mode and color presentation together give a glass-like image of vascularization (Fig. 5.5). Color Doppler alone without grey values shows the vascularization without any surrounding tissue (Fig. 5.6).
- Inversion mode
Image presentation of surfaces in a technically inverted way. Findings of low or no echogenity present echogenic (Fig. 5.7) whereas echogenic structures present low echogenic.
Image presentation on the basis of a stored volume and a chosen plane of section.Used to render structures in planes not ordinarily visible in real time e.g. the uterus can be shown in a frontal scan in its whole length without its usual flexure, so to say “stretched” (Fig. 5.1).
Tomographic ultrasound imaging. Imaging of a sonographic finding in diverse, simultaneously presented parallel planes of section on the basis of a stored volume (Fig. 5.4)
Volume contrast imaging. Image presentation in a certain selectable slice thickness for better contrast and suppression of artifacts on the basis of a special technique with assemblage of diverse, parallel scans of close vicinity and their following superposition with the effect of better discrimination between structures of different echogenity (Fig. 5.1).
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