isuog basic training · myoma echogenicity. basic trainingeditable text herebasic training •...
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Editable text hereBASIC TRAININGBasic Training
ISUOG Basic TrainingExamining the Uterus: Myometrium
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Learning objectives
At the end of the lecture you will be able to:
• Recognise the typical ultrasound appearances of the
normal myometrium
• Recognise the typical ultrasound appearances of
abnormalities in the myometrium
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Key questions
1. What are the typical ultrasound findings of a normal
myometrium?
2. What are the typical ultrasound findings of common
abnormalities in the myometrium?
3. Know when to refer for a specialist opinion
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Normal myometrium before menopause
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Myometrial pathology: MUSA
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Myometrial pathology: MUSA
• Common
• Rare
- Leiomyoma (fibroids)
- Adenomyosis
- Calcifications
- Enhanced myometrial vascularity
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Most common myometrial pathology - myoma“Benign tumour of the smooth muscle”
Munro et al, Int J Gynaecol Obstet. 2011,113(1):3-13
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Most common myometrial pathology -
myoma
• Echogenicity
• Shadowing
• Vascularity
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Van Den Bosch et al. UOG, 2015, 46: 284–298
Non-uniform
Mixed echogenicity
Non-uniform
Cystic areas
Non-uniform
Echogenic areas
MyomaEchogenicity
Uniform
Hyperechogenic
Uniform
Hypoechogenic
Uniform
Isoechogenic
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Uniform
Hyperechogenic
Uniform
Hypoechogenic
Uniform
Isoechogenic
Non-uniform
Mixed echogenicity
Non-uniform
Cystic areas
Non-uniform
Echogenic areas
Low
threshold for
specialist
referral if
atypical
features
Van Den Bosch et al. UOG, 2015, 46: 284–298
MyomaEchogenicity
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• Shadowing
Most common myometrial pathology - myoma
Van Den Bosch et al, UOG, 2015, 46
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Normal vascularity in the myometrium
Van Den Bosch et al, UOG, 2015, 46
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• Vascularity
Most common myometrial pathology -
myoma
Circumferential Intra-lesional
Van Den Bosch et al, UOG, 2015, 46
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Vascularity in myoma
Van Den Bosch et al, UOG, 2015, 46
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Relatively common myometrial pathology
- adenomyosisAbnormal presence of endometrium tissue within the myometrium
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Relatively common myometrial pathology
- adenomyosis
• Enlarged uterus
– Asymmetrically enlarged
– Globally enlarged
• Fan shaped shadowing
• Myometrial cysts
• Poorly defined endometrial-myometrial
border
Van Den Bosch et al. Ultrasound Obstet Gynecol 2015, 46: 284–298
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Relatively common myometrial pathology
- adenomyosis• Enlarged uterus
Globally enlargedAsymmetrically enlarged
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Relatively common myometrial pathology
- adenomyosis
'Rain in the forest' sign
• Abnormal myometrial echogenicity
Fan shaped shadowing
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Relatively common myometrial pathology
- adenomyosis
• Myometrial cysts • Poorly defined endometrial-
myometrial border
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Relatively rare myometrial pathology
• Myometrial calcifications
• Enhanced myometrial vascularity
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• Myometrial calcifications
Normal myometrium after menopause
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Retained products of conception (RPOC) /
Enhanced myometrial vascularity (EMV)
Timmerman D. UOG, 2003, 21:570-7; Van den Bosch, JUM, 2015, 34:1577-82; Timor-Tritsch IE, AJOG, 2016:214:731 e1-10
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Standardisation of the routine examination of
the myometrium
• Measurement of the uterus
• Symmetry of the myometrium walls
• Echogenicity
• Myometrial lesions ( well / ill defined)
• Number of lesions (location/max diameter)
• Vascularity
• Midsagittal/ transverse/ 3D
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Which patients should I refer for
specialist opinion?
• Those in whom you are uncertain about the
diagnosis (especially if you suspect malignancy)
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Key points
We should use a standardised terminology when we
describe ultrasound images of:
• Adnexal lesions (IOTA)
• The endometrium /uterine cavity (IETA)
• The myometrium (MUSA)
• Deep infiltrating endometriosis (IDEA)
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Key points
When in doubt:
refer for second opinion
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ISUOG Basic Training by ISUOG is licensed under a Creative Commons Attribution-NonCommercial-
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Based on a work at https://www.isuog.org/education/basic-training.html.
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