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Objective. The aim of this work was to review the technical aspects and clinical applications of three-dimensional ultrasonography in gynecologic imaging. Methods. With the use of a computerized database (MEDLINE), articles on three-dimensional ultrasonography were reviewed. Other pertinent references were obtained from the references cited in these articles. In addition, we reviewed our own clinical experience over the past 7 years. Results. Numerous applications of three-dimensional ultrasonography have been reported, including imaging of the uterus, the endometrial cavity, adnexa, and the pelvic floor and color and power Doppler applications. The accuracy of volume calculations and the networking opportunities with three-dimensional ultrasonography have also been reported. Technical problems and limitations of this technique are summarized. Conclusions. Three-dimensional ultrasonography has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity.

n 2005, the American Institute of Ultrasound in Medicine (AIUM) will celebrate its 50th anniversary. The first 50 years of the AIUM are closely intertwined with the evolution of ultrasound and with the pioneers and developments responsible for propelling ultrasound into its position as one of the leading imaging modalities in North America and around the world. I am delighted that Beryl R. Benacerraf, MD, editor-in-chief of our prestigious Journal of Ultrasound in Medicine, asked me to write this introductory article in honor of the AIUM’s first 5 decades. The AIUM has a number of activities and items planned for these next 2 years. First and foremost will be a series of articles on the history of ultrasound, which will be published in our journal from this June until our June 2005 annual convention in Orlando, Florida. These articles will highlight the history of ultrasound from its earliest days to the present. The articles will be written by key ultrasound pioneers and preeminent scholars of the AIUM and will describe the remarkable progress and changes that have taken place in ultrasound over these 5 decades. Among the topics expected to be addressed are abdominal, breast, cardiology, contrast-enhanced, emergency, intraoperative, musculoskeletal, obstetric/gynecologic, ophthalmologic, pediatric, retroperitoneal, and vascular ultrasound, as well as changes in AIUM administration/governance, bioeffects, instrumentation, medicolegal issues, and neurosonology. Today, the AIUM is known and respected around the world as a unique, dynamic, multidisciplinary organization, blending clinical and basic science in the pursuit of excellence in ultrasound. It is a society of more than 8200 members and represents a true cross section of ultrasound professions, including physicians (sonologists) from almost all diagnostic fields, sonographers, basic scientists, engineers, and ultrasound industry representatives. It is difficult to believe that only a little more than half a century ago, few people had heard of ultrasound, and even fewer could describe how it could be used in medicine. Today, virtually everyone knows about diagnostic ultrasound, and many have had the firsthand experience of undergoing an ultrasound examination. In fact, by some estimation, more than 80 million ultrasound examinations are now performed annually in the United States. In the 1940s and 1950s, when ultrasound was just emerging as a diagnostic technique, display technology was largely limited to Aand M-mode tracings and crude bistable static B-mode images. At that time, the only nonresearch clinical application for ultrasound was for therapy rather than diagnosis. High-power, low-frequency ultrasound was already widely used to provide therapeutic heating of deep tissues.

We studied 54 asymptomatic postmenopausal women to characterize normal contrast-enhanced computed tomography (CT) appearance of endometrium. Endometrium was visualized in 26 out of 54 (48.1%) women, and when seen its mean short-axis thickness was 7.5 mm. The anteroposterior thickness varied directly with uterine angulation (P

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.

To analyze ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) imaging features of primary and secondary ovarian malignant neoplasms to determine if there is any significant difference in their appearance.Analysis of the multi-institutional Radiology Diagnostic Oncology Group data revealed 86 patients with primary ovarian carcinoma and 24 patients with a secondary ovarian neoplasm. Numerous imaging features that had been recorded for the adnexal masses with each imaging modality were reviewed and compared between primary and secondary malignant ovarian neoplasms.Of the imaging features assessed with all three modalities, multilocularity as determined at US (P =.02) or MR imaging (P: =.01) was the only significant feature. At US, 30 (37%) of 81 primary ovarian cancers were multilocular, whereas only three (12%) of 24 metastatic neoplasms were multilocular. At MR imaging, 40 (74%) of 54 primary ovarian cancers were multilocular, whereas only five (36%) of 14 metastatic neoplasms were multilocular. Neither a predominately solid appearance nor bilaterality was significantly different between primary and secondary neoplasms.For malignant ovarian masses, multilocularity at MR imaging or US favors the diagnosis of primary ovarian malignancy rather than secondary neoplasm, but it is difficult to accurately distinguish between primary and secondary ovarian malignancies.

Objective To evaluate the feasibility and accuracy of fetal gender assignment from three-dimensional ultrasound (3D US) data at 10–24 weeks' gestation. Methods Three-dimensional ultrasound volume data on 47 fetuses were reviewed and divided into groups: 10–14, 15–18, and 19–24 weeks. Fetal genitalia were studied in axial and sagittal planes for gender assignment, using published criteria. The most valuable plane for assignment was noted. Gender assignment was compared with gender at birth. Results Gender assignment was possible in 44 of 47 fetuses; 25 assigned male and 19 female. Between 10 and 14 weeks the mid-sagittal plane alone was diagnostic for all fetuses. Accuracy of assignment between 11 and 14 weeks was 100%. Between 15 and 18 and 19 to 24 weeks, male assignment was 100% accurate. Female assignment was 100% accurate between 15 and 18 weeks. Accuracy decreased to 60% in the 19 to 24 week group, however, in two of the five cases in which gender was wrongly assigned to be male, the assignment was prospectively considered doubtful due to poor resolution of volume data. Excluding these two cases, accuracy for female assignment in the 19–24 week group was 100%. Conclusion Using 3D US, gender assignment was possible in 44 of 47 of fetuses, as early as 11 weeks' gestation. In early gestation, 11–14 weeks, accuracy of male and female gender assignment was 100%. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer.US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A(z)), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference.There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A(z) = 0.96 for both) were more accurate than US (A(z) = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A(z) = 0.76 vs 0.57, P =.04). In the liver, the A(z) values for the three modalities were 0.77-0.94.CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.

To determine the optimal imaging modality for diagnosis and staging of ovarian cancer.Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread.All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%).MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.

A 22-year-old pregnant woman, gravida 4 para 3 (with three normal children) presented at 34 gestational weeks for her first prenatal care visit. Ultrasonographic (US) images showed an enlarged head in a single, live fetus (Fig 1). One month later, the woman was delivered of a 4,870 g (10 lb 7 oz) boy by means of cesarean section. The newborn had a head circumference of 42 cm (normal 5 34.5 cm). Computed tomography (CT) of the newborn’s head was performed on day 2 (Fig 2).

To determine the effects of level of training and other factors on the rate of discrepant interpretation of emergency body computed tomographic (CT) scans by trainees and staff radiologists.Five hundred ninety-eight consecutive emergency CT studies were prospectively interpreted by radiology residents or board-certified body imaging fellows over a 12-month period. Each interpretation was reviewed within 12 hours by an attending body CT radiologist. Major discrepancies between staff radiologists' and trainees' interpretations were defined and those with the potential to affect immediate patient therapy; minor discrepancies were defined ad those without such potential. The effects on discrepancy rates were examined for abnormal versus normal CT findings and trauma versus nontrauma cases.Major and minor discrepancy rates were 1.2% and 6.5%, respectively, between interpretations made by the trainee and the staff radiologist. Overall, fellows demonstrated statistically significantly lower discrepancy rates than did senior of junior residents (5.9%, 13.7%, and 13.3%, respectively). The discrepancy rate was higher when CT findings were abnormal than when they were normal (13.5% vs 2.6%). There were no differences between discrepancy rates for trauma and nontrauma cases.Experience appeared to decrease discrepancy rates. Trainees were more likely to miss findings than to read normal scans as abnormal.

Background: To determine whether intravenous contrast improves the ability of radiologists to establish the cause of acute abdominal pain after nondiagnostic or normal unenhanced CT. Methods: Out of 164 consecutive emergency department patients presenting with less than 48 h of nontraumatic, acute abdominal pain, a confident diagnosis for cause of pain was made prospectively in 71/164 (43%) patients on these unenhanced scans by the monitoring radiologist. In the other 93 patients, our study sample, intravenous contrast-enhanced CT was obtained. At a later date, retrospectively, two experienced abdominal CT radiologists independently evaluated unenhanced CT scans alone for potential causes of pain and diagnostic confidence level on a 1–3 scale. At least 2 weeks later, intravenous enhanced and unenhanced scans were read side-by-side for the same assessment. Results: There was no significant difference in diagnostic confidence levels comparing unenhanced CT alone (2.59) vs. intravenous enhanced and unenhanced CT together (2.64). Chi-square analysis found no significant difference in finding a cause for pain when intravenous contrast was added compared to the initial unenhanced scan alone. Conclusions: Intravenous contrast did not significantly improve the ability of CT to establish a cause of abdominal pain after a negative or nondiagnostic unenhanced CT.

The routine ultrasound examination of the pregnant uterus is presented in this article. The approach is based on published guidelines, dividing the examination into studies of the first trimester and studies of the second and third trimesters. The discussion emphasizes the standard anatomical views and describes the normal sonographic appearances. The methods of obtaining important measurements are described, and tables are provided to analyze these measurements. A systematic approach to obstetric ultrasound is important in ensuring completeness and in maximizing the detection of fetal abnormality.

Specially developed high-resolution real-time ultrasound transducers (12.5 and 20 MHz) on the tip of endoluminal catheters were inserted into the endometrial canal to evaluate the usefulness of this approach. Uterine abnormalities, most confirmed by biopsy, surgery, or both, were detected in 12 patients, including submucosal myomas, nabothian cysts, endometrial polyps, synechiae, and endometrial and cervical carcinoma. In one case the catheter was directed under hysteroscopic guidance into a fallopian tube, demonstrating its potential usefulness in this region. In 4 of the 12 cases in which a hysterectomy was performed, an in vitro ultrasound examination of the organ was performed, which confirmed the initial in vivo ultrasound impressions. Anatomic cross-sectional slices of the uterus resulted in excellent correlation with the ultrasound findings. These preliminary results suggest that this new sonographic procedure will become an important diagnostic tool, supplementing abdominal and endovaginal ultrasound approaches.

A prospective study was performed to determine whether thoracic CT yielded useful information regarding the status of axillary lymph nodes (LNs) in patients with breast cancer. Thirty-five consecutive patients with clinically suspected stage II or III breast carcinomas were scanned preoperatively from the supraclavicular regions to the lung bases. Axillary LNs measuring greater than or equal to 1 cm were considered abnormal. The lymph nodes were classified according to their relationship to the pectoralis muscle. Extracapsular lymph node extension was diagnosed when there was irregularity and spiculation of the lymph node margin with surrounding fatty infiltration. Correlation with axillary dissection was obtained in 20 patients, giving a positive predictive value for axillary metastases of 89% with 50% sensitivity, 75% specificity, and 20% negative predictive value. CT was also able to detect the level of axillary involvement accurately when the lymph nodes were enlarged and to evaluate extracapsular LN extension. Although superior to physical examination, CT was not an accurate predictor of axillary LN involvement, primarily because of its low negative predictive value.

After Wilhelm Conrad Roentgen's discovery of the X-ray in 1895, it was initially thought that gallstones could not be visualized. Surgeons relied solely on the clinical examination to detect biliary disease. Today, no evaluation of the gallbladder would be complete without the performance of an imaging study. Radiology has gone through several eras in the imaging of gallstones. The plain film era, 1895-1924, was characterized by techniques that improved soft-tissue detail, allowing better detection of radiopaque stones. The contrast media era, 1924-1960, was initiated by the invention of IV cholecystography. In 1925, oral cholecystography was developed. During the era of expanding technology, 1960-1979, percutaneous transhepatic cholangiography, scintigraphy, and sonography came into use. The therapeutic era began in the 1980s.

In 28 fetuses studied during a 4 1/2-year period, the initial femur was below 2 standard deviations (SDs) of the mean when compared with the biparietal diameter. These fetuses were considered at risk for skeletal dysplasias and were followed up. Studies were performed at a mean gestational age of 26.7 weeks (range, 15.3-41.0 weeks). Group 1 had a femur length 1-4 mm below the 2-SDs line (range, -2.0 to -4.0 SDs); no other abnormalities were detected. Interval examination of 12 femurs showed that 10 either remained shortened to the same degree or had a growth spurt. At birth, all subjects were healthy except one with mild growth retardation and one with a chromosomal abnormality. Of the two subjects that failed to continue normal growth, one was healthy and the other was a heterozygous achondroplastic dwarf. Group 2 had greater femoral shortness; all measurements were more than 5 mm below the 2-SD line (range, -4.3 to -31.0 SDs). All had fetal abnormalities and significant skeletal dysplasias. The authors conclude that the number of millimeters below the 2-SDs line is an accurate, easy criterion for evaluation of femoral length.

A prospective comparison of contrast-enhanced computed tomography (CT) and duplex sonography (DS) was performed to examine the Kimray-Greenfield filter in the inferior vena cava (IVC) in the immediate postoperative period. Fourteen patients were studied for five complications: IVC thrombosis, malpositioning, pericaval hematoma, filter angulation, and prong perforation. Our results found CT to be more efficacious because it was a) able to evaluate more patients with fewer technically inadequate scans and b) more definitive in all categories. However, when visualized, DS was as accurate as CT in the evaluation of thrombosis.

Color Doppler imaging has been used to evaluate a variety of abnormalities in the iliofemoral region. This pictorial essay demonstrates how use of color Doppler techniques aids in the diagnoses of iliofemoral pseudoaneurysms, fluid collections, aneurysms, arteriovenous fistulas and malformations, venous thrombosis, vascular grafts, and soft-tissue masses including tumors and benign lymphadenopathy.