Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 549
A
B
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E
FIG. 15.20 Endometrial Polyps. (A) Sagittal TVS shows a slightly echogenic polyp within
the endometrium. (B) Sagittal TVS shows a single vessel feeding an echogenic mass within
the endometrium. A small amount of luid is seen around the polyp, allowing the endometrium
(calipers) to be measured separately. (C) Sagittal image during sonohysterography (SHG)
shows an echogenic polyp outlined by luid. (D) Transverse image during SHG shows multiple
echogenic polyps; two of these are round and polypoid (large arrows) and two are more sessile
(small arrows). (E) Image during SHG shows a balloon catheter (B) and a small polyp at the level
of the internal os (arrow). (F) Sagittal image from SHG in a 60-year-old with postmenopausal
bleeding and an irregular polyp. This study was followed by a negative endometrial biopsy. This
illustrates the importance of imaging and histologic correlation; a biopsy under direct visualization
was needed for the removal of this lesion. (G) Transverse TVS shows a thin hyperechoic
line (arrows), in this case along a part of each side of the endometrium, illustrating the hyperechoic
line sign of a polyp. No distinct mass was seen and there was no vascular pedicle
detected on Doppler imaging. See also Videos 15.6 and 15.7.
F
Sonographic indings in endometrial cancer include a thickened
endometrium, poor deinition of the endometrial/myometrial
interface, and an indistinct endometrium in an enlarged uterus.
he thickened endometrium may be well deined, uniformly
echogenic, and indistinguishable from hyperplasia and polyps.
Cancer is more likely when the endometrium has a heterogeneous
echotexture with irregular or poorly deined margins (Fig. 15.21,
Videos 15.8 and 15.9). When invasion is clearly identiied into
the myometrium, then malignancy is almost certainly present.
Cystic changes within the endometrium are more frequently seen
in endometrial atrophy, hyperplasia, and polyps, but can also be
seen with carcinoma. Endometrial carcinoma may also obstruct
the endometrial canal, resulting in hematometra. Although certain
sonographic appearances tend to favor a benign or malignant
etiology, there are overlapping features, and endometrial biopsy
is usually required for a deinitive diagnosis.
he role of color and spectral Doppler ultrasound in the
diagnosis of endometrial carcinoma is still controversial. Blood
low may be diicult to detect in the normal endometrium. In
endometrial cancer, abnormal-appearing vessels may be seen
(Fig. 15.21E). Initial studies using TVS color and spectral Doppler
ultrasound suggested that endometrial carcinoma could be
diferentiated from a normal or benign postmenopausal endometrium
by the presence of low-resistance low in the uterine
arteries in women with endometrial cancer, compared with
high-resistance low in women with normal or benign endometria.
157,158 Subsequent reports, however, have shown no signiicant
diference in uterine blood low between benign and malignant
endometrial processes. 159-161 Low-resistance low in the uterine
artery has also been reported in association with uterine ibroids. 158
Some reports have shown low-resistance low in the subendometrial
and endometrial arteries in malignant endometrial
lesions, 38,162 whereas others have found no statistically signiicant
diference. 160,161,163 Sladkevicius and colleagues 161 found that
endometrial thickness is a better method for discriminating
between normal and pathologic or benign and malignant
endometrium than Doppler ultrasound of the uterine, subendometrial,
or intraendometrial arteries. 161
Sonography can be used in the preoperative evaluation of a
patient with known endometrial carcinoma to determine