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INTRODUCTION

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Definitions

  1. Coronal: images obtained in the "elevational" plane.

  2. Curved (convex) array transducer: transducer elements arranged in curved fashion.

  3. Linear array: transducer elements linearly arranged.

  4. Phased array transducer: aims beam by selective activation of transducer elements.

  5. Sagittal: images obtained in the long axis of the body.

  6. Sector transducer: provides a pie-shaped field of view.

  7. Transverse: images obtained in the short axis of the body.

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Transvaginal sonography (TVS) affords improved resolution of the uterus and ovaries over that which can be obtained with the conventional transabdominal sonography (TAS) approach. Although TVS allows a closer proximity of the transducer/probe to the pelvic organs and more detailed depiction, it may be more, rather than less, difficult for the sonographer to become oriented to the images when compared with conventional TAS because of the limited field of view and unusual scanning planes depicted with TVS. As one develops a systematic approach to the examination of the uterus and adnexal structures with TVS, however, the examination becomes much easier to perform. Appendix 2-1 lists the American Institute of Ultrasound in Medicine (AIUM) guidelines for a complete pelvic sonogram.

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In this chapter, the sonographic appearances of the uterus, ovary, and other adnexal and pelvic structures will be described, with particular emphasis on how they are best depicted in a real-time TVS examination.

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SCANNING TECHNIQUE AND INSTRUMENTATION

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The 3 scanning maneuvers that are used in TVS include:

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  1. Vaginal insertion of the probe with side-to-side movement within the upper vagina for sagittal imaging (Figures 2-1,2-2, and 2-3).

  2. Transverse orientation of the probe for imaging in various degrees of semiaxial to semicoronal planes.

  3. Variation in depth of probe insertion for optimal imaging of the fundus to the cervix by gradual withdrawal of the probe into the lower vagina for imaging of the cervix.

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Figure 2-1 A-C.

Scan planes (A) and representative transabdominal pelvic sonograms (B and C). Transabdominal Sonograms (TAS) in long (B) and short (C) axis with accompanying typical sonograms showing uterus and right ovary in sagittal plane and right ovary and uterus in transverse plane (between cursors). By convention, the left of the image depicts the cephalic or superior of the patient whereas the right of the patient is depicted on the left of the image of the transverse scans.

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Figure 2-2 A-C.

Major scanning planes for transabdominal sonography (TAS) and transvaginal sonography (TVS). A: Normal adult, parous uterus in long and short axis as depicted with transabdominal sonography (TAS) through a fully distended urinary bladder. B: Transvaginal sonography (TVS) of an anteflexed uterus in long axis. ...

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