Color Doppler, 3D & 4D Ultrasound in Gynecology, Infertility & Obstetrics

The second edition of Color Doppler, 3D & 4D Ultrasound in Gynecology, Infertility & Obstetrics, presents new advances in the use of ultrasound in obstetrics and gynaecology. Beginning with an introduction to the Doppler Effect and ultrasound, each chapter has been revised to focus on the clinician’s needs in ultrasound practice. The text guides clinicians through the use and interpretation of ultrasound in a variety of gynaecological conditions and includes sections on how to write ultrasound and obstetric ultrasound reports. In addition, the book includes a manual for sonographers and physicians with clinical presentation-based information to help in the interpretation of Doppler and ultrasound images.

Contents
1. PhysicalPrinciplesoftheDopplerEffectandItsApplicationinMedicine... 1
B Breyer
The Doppler Effect 1
Doppler Indices 3
Instrumentation for Doppler Measurements 4 Two Dimensional Flow Measurement 6 Basic Limitations of Doppler Examinations 7 Contrast Media 8
How to Reduce Problems 10
2. NormalPelvicAnatomyAssessedby2D, 3DandColorDopplerUltrasound... 12
S Kupesic Plavsic, A Kurjak, K Baston
Uterus 12
Postmenopausal State 14
Cervix 14
Uterine Perfusion 14
Uterus in Newborn and Prepuberty 15 Vagina 16
Fallopian Tube 16
Ovaries 16
Newborn 19
Childhood 19
Perimenopausal and Postmenopausal State 19
3. ColorDopplerand3DUltrasoundoftheUterineLesions... 22
S Kupesic Plavsic, A Kurjak, K Baston
Normal Uterus 22
Endometrial Polyps 23
Intrauterine Synechiae (Adhesions) 24 Adenomyosis 25
Endometrial Hyperplasia 25 Endometrial Carcinoma 26 Leiomyoma 29
Leiomyosarcoma 30
4. Adnexal Masses... 33
A Kurjak, S Kupesic Plavsic, U Honemeyer
The Main Basis of Angiogenesis 33
Tumor Neovascularization—Current Concepts 34
Evolution of 2D Conventional and Color Doppler Ultrasound in Imaging of Adnexal Tumor Angiogenesis 36 Three-Dimensional Ultrasound and Power Doppler Imaging of Benign and Malignant Adnexal Masses 38 Further Possibilities in the Evaluation of Tumor Angiogenesis 48
Zagreb Experience 50
Future Challenges 53

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Color Doppler, 3D and 4D Ultrasound in Gynecology, Infertility and Obstetrics
5. OvarianCancerScreeningby3Dand3DPowerDopplerUltrasound... 58
A Kurjak, U Honemyer, S Kupesic Plavsic
Why to Screen for Ovarian Cancer? 58
Difficulties in Ovarian Cancer Screening 59
Attempts to Screen—Some Lessons Learned 60
Screening Tests 60
Target Populations
General Population 64
Ovarian Cancer Screening Trials 65
Ovarian Cancer—The Role of 3D Ultrasound and 3D Power Doppler Imaging 66 Zagreb Ovarian Cancer Screening Trial 68
6. Ovarian Endometriosis... 80
S Kupesic Plavsic, A Kurjak, K Baston
Symptoms 80
Endometriosis in Infertile Patients 80
Ultrasound Diagnosis 81
Combined Studies by Doppler Ultrasound and Ca-125 Values 83 Ovarian Endometrioma Assessed by 3D Ultrasound 85
7. Pelvic Inflammatory Disease... 89
S Kupesic Plavsic, A Kurjak, K Baston
Transvaginal Ultrasound and Color Doppler Assessment of PID 89 Tubo-ovarian Abscess 92
Chronic PID 92
Three-Dimensional Ultrasound 94
8. EndoscopicSurgeryinGynecology... 96
V Sparac, A Kurjak, I Bekavac, S Kupesic Plavsic
Laparoscopy 96
Laparoscopy of Adnexal Lesions 99 Laparoscopic Myomectomy 102 Laparoscopic Hysterectomy 102 Laparoscopy in Gynecologic Oncology 103 Hysteroscopy 104
Diagnostic Hysteroscopy 105
Operative Hysteroscopy 106
9. Color Doppler and Three-Dimensional Ultrasound Imaging in Infertility... 112
S Kupesic Plavsic, A Kurjak, N Zafar
Uterine Causes of Infertility 112 Ovarian Causes of Infertility 120
Polycystic Ovarian Syndrome Tubal Causes of Infertility 129
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10. ColorDopplerand3DPowerDopplerHystero-Contrast-Salpingography... 134
S Kupesic Plavsic, A Kurjak, N Zafar
Historical Development of the Ultrasonic Assessment of the Fallopian Tube 135 Ultrasound Contrast Agents 136
Technique of Hystero-contrast-salpingography 136
Requirements 136
Procedure 137
Gray-scale Hystero-contrast-salpingography 138

Contents
Pulsed Doppler Analysis of Tubal Patency 138 Color Doppler Hystero-contrast-salpingography 139 Review of Literature 140
Three-Dimensional Hysterosonosalpingography 141
11. ColorDopplerand3DUSImaginginNormalandAbnormalEarlyPregnancy... 146
S Kupesic Plavsic, A Kurjak, N Zafar
Ultrasound Studies of the Uterus from Ovulation to Implantation 146 Uterine Findings Following Implantation 147
Placenta 148
Umbilical and Fetal Portion 150
3D Ultrasound Measurement of Nuchal Translucency 159
Doppler Assessment of Ductus Venosus 159
First Trimester Screening for Chromosomopathies: Nasal Bone and Fetal Heart 160 Pathology of Early Pregnancy 161
12. EctopicPregnancy... 168
S Kupesic Plavsic, A Kurjak, N Zafar
The Role of Biochemical Markers in Ectopic Pregnancy 169
The Role of Ultrasound in the Diagnosis of Tubal Ectopic Pregnancy 169 Color Doppler in Early Diagnosis of Tubal Ectopic Pregnancy 171
3D Ultrasound in the Assessment of Tubal Ectopic Pregnancy 174
Other Sites of Implantation 175
Therapy 178
13. The Assessment of Normal Fetal Anatomy... 182
U Honemeyer, A Kurjak, B Ahmed, S Kupesic Plavsic Technological Improvements in Prenatal Diagnosis 182 Visualization of Normal Fetal Anatomy 185 Volumetry—Organ Volume Measurements 194
14. The Assessment of Abnormal Fetal Anatomy... 198
A Kurjak, B Ahmed, U Honemeyer, S Kupesic Plavsic
Head and Neck 198
Fetal Spine 203
Heart 204
Abdomen 205
Skeleton and Extremities 207
Role of Color and Power Doppler Ultrasound 211
15. First Trimester Ultrasonographic Screening and Prenatal Diagnostic Methods... 217
K Gersak
First Trimester Ultrasonographic Screening 217 Prenatal Diagnostic Methods 221
4D US and Prenatal Diagnostic Methods 223
16. GeneticApproachtoFetalAbnormalities... 225
K Gersak
Morphological Characterization of Abnormalities 225 Recognition of the Pattern of Multiple Abnormalities 226 Establishment of Diagnosis 227
Assessment of Prognosis and Recurrent Risk 229
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17. Four-Dimensional Sonography in Perinatal Medicine... 231
A Kurjak, M Stanojevic, B Ahmed, Tikvica Luetic
Fetal Motility and 4D Ultrasound 231
Classification of Movement Patterns 232
Onset of Specific Fetal Behavioral Patterns Assessed by 3D/4D US 233
The First Trimester 233
The Second Trimester 234
The Third Trimester 235
New Scoring System for Fetal Neurobehavior Assessed by 3D and 4D Sonography 236 Multicentric Study 238
18. GestationalTrophoblasticDisease... 243
S Kupesic Plavsic, A Kurjak, K Baston
Hydatidiform Mole 243
Invasive Mole 245
Choriocarcinoma 246
Placental Site Trophoblastic Tumor 247
Zagreb Experience 247
Three-Dimensional Power Doppler (3D PD) 249
19. ClinicalSonographicPearls... 252
S Kupesic Plavsic
Pelvic Ultrasound Pearls 253 Uterus 253
Tubes 254
Cul-de-sac 254
Writing an Ultrasound Report 254
19. 1: Amenorrhea 256
19. 2: Abnormal Genital Tract Bleeding (Reproductive Age) 261
19. 3: Menopause 270
19. 4: Peri- and Postmenopausal Bleeding 274
19. 5: Prolapse and Pelvic Floor Relaxation 280
19. 6: Contraception 285
19. 7: Infertility 290
19. 8: Pelvic Inflammatory Disease 300
19. 9: Pelvic Pain 306
19. 10: Abnormal Pap Smear and Cervical Mass 314
19. 11: Uterine Mass 320
19. 12: Adnexal Mass 327
19. 13: Breast Lumps 342
20. ObstetricUltrasoundPearls... 349
S Kupesic Plavsic
20. 1: First Trimester Ultrasound Examination 349
Nuchal Translucency Measurement (11 to 13 Weeks and 6 Days) 350
20. 2: Second and Third Trimester Ultrasound Examination (Fetal Anatomy Scan) 351
20. 3: Bleeding in Pregnancy 366
Writing an Obstetric Ultrasound Report 366
Index... 373