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Medical Ultrasonography
2011, Vol. 13, no. 3, 249-252
Ultrasonography of the uterus and ovaries
Dan Mihu1, Carmen Mihaela Mihu2
1
2
„Dominic Stanca” Obstetrics – Gynecology Clinic
Radiology Clinic, „Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
Abstract
Ultrasonography is the most frequently used imaging investigation in the assessment of the female genital tract. Most often
the uterus and ovaries are evaluated with the help 2D transabdominal or endovaginal ultrasonography.
The interpretation of the ultrasonographic data in order to establish the diagnosis of the main uterine and ovarian pathologies requires information about the examination technique and proper knowledge of the female genital tract ultrasound anatomy.
Key words: ultrasonography, uterus, ovary.
Rezumat
Ultrasonografia este modalitatea de examinare imagistică cel mai des utilizată pentru explorarea aparatului genital feminin. Cel mai frecvent uterul şi ovarele sunt apreciate prin ecografie 2 D realizată pe cale transabdominală sau endovaginală.
Interpretarea datelor furnizate de examinarea ecografică în stabilirea diagnosticului principalelor afecţiuni uterine sau ovariene necesită informaţii privind tehnica de examinare precum şi aprofundarea unor aspecte de ecoanatomie a sferei genitale
feminine.
Cuvinte cheie: ultrasonografie, uter, ovar.
Ultraonography is a noninvasive method of investigation of the uterus and ovaries.
The ultrasound examination may be performed in different stages of a woman’s life, the main ones being those
when she presents a menstrual cycle and the menopause.
Uterine ultrasound allows the physician to establish a diagnosis in the following conditions: malformations, benign or malignant tumors, or intracavitary retentions. The
main ovarian diseases that highly benefit from the use of
ultrasonography for their diagnosis are: functional ovarian cysts, benign and malignant tumors, and tubo-ovarian
abscesses. Ultrasonography also helps in the evaluation
Received Accepted
Med Ultrason
2011, Vol. 13, No 3, 249-252
Corresponding author: Dan Mihu
„Dominic Stanca” Obstetrics and
Gynecology Clinic,
55-57 21 Decembrie 1989 str
Cluj-Napoca, Romania
Phone: 0722837213,
e-mail: [email protected]
of the ovarian ovulatory function, along the other investigations recommended for infertility.
The interpretation of the ultrasonographic findings
requires knowledge of the uterine and ovarian ultrasound
anatomy.
Examination technique
The ultrasound exam of the uterus and ovaries may be
performed either with a transabdominal 3.5 MHz transducer, either with a transvaginal 6.5-7.5 MHz transducer.
There are various types of examinations that may be
realized: standard gray scale, three-dimensional, or Doppler ultrasonography.
Transabdominal ultrasonography is performed with
the patient in dorsal decubitus and with a full urinary
bladder. The lateral decubitus allows sometimes for a
better visualization of the ovaries and parauterine or retrouterine masses. Endovaginal ultrasonography is better
realized on the gynecological table, for an easier manipulation of the transducer, and with an empty bladder.
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Systematic sagittal and transverse images are obtained. These two types of views allow for a three-dimensional integration of the pelvic anatomy and are usually
enough for establishing the diagnosis. Sometimes frontal
views are necessary in order to explore the uterus.
Ultrasonography of the uterus and ovaries
On the transverse view the uterine body has an oval
shape, with a transverse long axis, while the isthmus and
the cervix have a round shape.
Ultrasound anatomy
The uterus
The uterus represents the essential landmark of pelvic
anatomy. The main aspects that can be evaluated through
ultrasonography are:
The position. Usually the uterus has a mid-central
situation within the pelvis. A lateral position is seldom
encountered and it is realized around the axis of the uterine isthmus. The anteverted-anteflexed uterus, with the
uterine body found in the vesico-uterine space, is the
most frequent situation compared with the retrovertedretroflexed uterus, when the uterine body is situated in
the Douglas pouch (fig 1).
The size. The following measurements are obtained
during the ultrasound evaluation of the uterus: the length
– the distance from the fundus to the internal orifice of
the uterus on a sagittal view; the width – the maximum
anterior-posterior distance measured in the mid portion
of the uterine body also on a sagittal view; the thickness
– the maximum distance measured at the level of the
uterine fundus on a transverse view. The mean uterine
measurements of a reproductive age patient are 70/35/50
mm, while the measurements for menopausal patient are
50/20/25 (fig 2, fig 3).
The shape. On a sagittal plane the uterus has a pyriform
shape: the superior two thirds correspond to the uterine
body and the inferior third to the cervix. The uterine isthmus is identified where the uterine body and cervix meet.
Fig 1. Endovaginal ultrasonography – normal appearance of the
uterus.
Fig 2. Transabdominal ultrasonography – uterus – normal aspect, anteverted-anteflexed. Uterine measurements on a sagittal
view (length, width).
Fig 3. Transabdominal ultrasonography – evaluation of uterine
thickness in a transverse view.
Fig 4. Endovaginal ultrasonography – uterine cavity line.
Medical Ultrasonography 2011; 13(3): 249-252
Uterine ultrasonographic structure. The myometrium has a homogeneous structure, with fine, parallel, linear echoes and an echogenicity similar to a muscle. The
hyperechoic area in the middle is the uterine cavity and
can not be measured (fig 4). The cavity line corresponds
Fig 5. Endovaginal ultrasonography – endometrium thickness
(double layer).
Fig 6. Endovaginal ultrasonography – endometrium thickness
(single layer).
Fig 7. Endovaginal ultrasonography – ovarian measurements
on a) sagittal view (length, width); b) transverse view.
to the virtual interface that separates the layers of the endometrium. The endometrium is evaluated on a sagittal
view. When the cavity line is present the endometrium is
measured from the base of its anterior layer to the base
of its posterior layer (double layer). When there is intracavitary retention only one layer of the endometrium is
measured (single layer thickness) (fig 5, fig 6). The thickness and the echogenicity of the endometrium varies with
the different stages of the menstrual cycle.
The Ovaries
The main characteristics of the ovary that can be assessed especially through endovaginal ultrasound are:
The position. Usually the ovaries are found lateral
from the uterus in the ovarian fossa, behind and inside
the external iliac vessels. Sometimes the ovaries are
asymmetrical and mobile and change their position as
the uterus changes its own position with the degree of
urinary bladder repletion.
The shape. The ovary has an oval shape with the long
axis oriented downward and forward. The ovaries have a
fine contour.
The size. The measurements of the ovary are obtained
after determining its long axis. Two distances (the length
and the width) are measured in this view and a third one
(the thickness) is obtained after rotating the transducers with 90°. The mean measurements of the ovary are
30/15/15 mm, and the volume is 1.8-5.7 cm³ (fig 7).
Ovarian ultrasonographic structure. The overall aspect of the ovary is hypoechoic when compared with the
myometrium. Through endovaginal ultrasound two distinct areas can be observed (fig 8):
– an echoic central area (corresponding to the stroma)
– a peripheral area (corresponding to the cortex)
which contains the ovarian follicles in different development stages. The dynamics of ovarian structure may be
Fig 8. Endovaginal ultrasonography – normal appearance of the
ovary.
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evaluated during the spontaneous ovarian cycle or after
stimulation as part of infertility investigation.
Conclusion
The ultrasonographic exam of the uterus and ovaries
does not present any difficulties.
Proper knowledge regarding the examination technique as well as the ultrasound uterine and ovarian anatomy is absolutely necessary for the integration of ultrasonographic data in order to establish the diagnosis of the
most frequently encountered gynecological conditions.
References
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Ultrasonography of the uterus and ovaries
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