77. HÌNH AÛNH TEÁ BAØO CÔ TRÔN
XUAÁT PHAÙT TÖØ THAÂN TÖÛ CUNG
78. RESEARCH
TILTE : UTERINE ARTERY
EMBOLIZATION
Bs Nguyeãn hoaøi Thu
CO .
MEDIC MEDICAL CENTER- VIETNAM
#100cas (2000) 1800cas (2005)
80 CAS khối u thóat đường âm đạo
83. Sonographic Differential Diagnosis I
: Malignant vs. Benign
Morphologic Characteristics – Scoring System
- Ovarian Malignancy by morphological characteristics
- More detail morphologic evaluation by 3D multiplanar mode
- Sassone (1991)
: systematic morphologic scoring system
- DePriest (1993), Lerner (1994)
: modified morphologic scoring system
tumor size, cyst wall structure, papillary structures
septal structure, solidity, echogenicity
Scoring Categories
84. Physiologic Characteristics
- Kurjak (2000)
:Qualitative analysis of tumor vascularity
- highly sensitive Power Doppler
: angle- & velocity-independent, aliasing free
Sonographic Differential Diagnosis II
: Malignant vs. Benign
The combining measurement of vascular impedence
and morphologic scoring system in three-dimensional
ultrasound thereby improves performance of detection
in ovarian malignancy
Aim
85. • Period: January ~ November 1999
• 62 patients with adnexal mass who were planned to receive
explorative laparotomy or pelviscopic surgery (6 patients were excluded
because their mass were mainly cystic and their vascularity were too low)
• mean age 38.6 with a range between 13 and 79 years
• Voluson 530D (Medison-Kretztechnik),
S-VDW5-8 (volume probe),
• Contrast Agent SHU 508 A
; Doppler siganl was too low to evaluate
Material & Method
86. Data Transfer & Storage
• Removable hard disk (540Mb, Nomai Inc.)
• Zip disk (100 Mb, Iomega Inc.)
• 3.5” floppy disk (1.44 Mb)
3D Volume data
Plain bitmap (TIFF)
DICOM
89. Sassone (1991),
Obstet Gynecol
N = 143
Cuttoff value = 5
Sensitivity = 100%
Specificity = 83%
V A R I A B L E S
INNER WALL
STRUCTURE
WALL THICKNESS SEPTA ECHOGENICITY
smooth thin 3 mm No septa Sonolucent
irregularities 3 mm thick > 3 mm thin 3 mm low echogenicity
papillarities > 3 mm not applicable,
mostly solid
thick > 3 mm Low echogenicity with
echogenic core
mixed echogenicitynot applicable,
mostly solid
high echogenicity
4 3 3 5Max
Morphologic
Scoring System
90. Morphologic Scoring System 2
Score
0 1 2 3
Wall
structure
Smooth or small
irregularities
< 3 mm
-
Solid or
nonapplicabl
e
Papillaritie
s 3 mm
Shadowing Yes No - -
Septa
None or thin
(< 3 mm)
Thick
( 3 mm )
- -
Echogenicit
y
Sonolucent or
low-level echo
or echogenic
core
- -
Mixed or
high
Lerner et al., Am J Obstet Gynecol 1994:170;81-5
91. Benign < 3 mm Malignant 3 mm
Dermoid cyst Mucinous cystadenocarcinoma
Wall thickness
104. Suitable in slow flow
Less noise signal
Angle independent
Depth independent
No aliasing
• Age : 45
• Endometrioid CA of ovary
• RI = 0.36
Advantage of Power Doppler
105. Benign Malignant
Impedence High Low
Vessel location Peripheral Central
Vessel density Low High
Waveform shape Notch (+) Notch (-)
Doppler Characteristics
106. Single vessel arrangement
Straight, regularly
branched vessels
Arborization structure and
diameters
Absence of arterio-venous
shunts
A. Kurjak (1999)
3D Power Doppler Characteristics
Benign Malignant
• Randomly dispersed vessels
• Irregular branching
• Aneurysm like spaces
• Vascular lakes
• Arterio-venous shunts
• Thorn-like diameters
109. Asymmetry grading
– G0 : no asymmetry
– G1 : slight asymmetry
– G2 : marked asymmetry
Vessel distribution grading
– G0 : visible flow in the capsular zone
– G1 : vascularization in a homogenous fashion
– G2 : focal increase in vascularization
– G3 : intense focal increase in vascularization
Bogers HA et al., Urology 1999
Grading Scale System
110. Levovist®
- SHU 580A (Schering AG, Germany)
Suspension of monosaccharide (galactose) particle
- mean diameter : 2 µm
Intravascular
microbubble contrast
Contrast Agent
111. Age : 19
PI = 0.84
RI = 0.55
Histology : Fibroma
Levovist® dosage : 2.5 gm IVS
(300mg/ml)
Pre-enhance
Post-enhance
Contrast Agent
112. Age : 61
Diameter : 5 cm
Cystic and solid
CA-125 : 32 U/mL
Serous cystadenoma - Benign
113. RI = 0.27
Papillary serous
cystadenocarcinoma
Enhanced with Levovist®
- Malignant
114. Age : 27
Jan 1998 - immature teratoma was confirmed by histology
Dec 1999 - CA-125 = 135 U/mL; RI = 0.8; A/B ratio = 3.48
Recurrent Immature Teratoma - Malignant
115.
116. Age : 39
Gastric cancer (Bormann type III) was incidentally
found by gastrofiberscopy.
Ascites (+)
Krukenberg Tumor - Malignant
117.
118. Age : 38
CA-125 : 200 U/mL
RI = 0.41
Tumor size = 6.7 cm
Stalk vessel diameter = 5 mm
Non-hodgkin’s Lymphoma - Malignant
D1=67.57 mm
D2=64.98 mm
