gynecology, such as in ovarian or uterine lesions, for a better assessment of vascular patterns that could play a role in diagnosis management. Micro-bubbles represent anentirely new class of materials that are mainly used as intravascular contrast agents for US, though they can also be instilled into the urinary bladder to look for ureteric refluxand into the uterus to check tubal patency. Their effect depends on the compressibilityof gases, which is markedly different from the near-incompressibility of tissue.Exploiting this difference has led to the development of several multi-pulse sequencesthat cancel tissue signals and emphasize those from the micro-bubbles, thus improvingthe contrast-to-tissue signal ratio. Overlay or side-by-side displays allow the agentimage to be viewed along with the grey-scale image to facilitate locating the region of interest
.Ultrasound images depend on echoes being produced by the insonated structures(acoustic backscatter). It is therefore easy to conceptualize that increasing the amount of echo-producing substance in the insonated area will create additional echoes and thus, if properly processed additional information. This may be important when dealing withtiny vessels beyond the resolution of gray-scale ultrasound, color imaging, or power Doppler.In oncology Ultrasound contrast media (UCM) may offer tremendous advantages. Neoangiogenesis (creation of new blood vessels) is common to all malignant tumors,and these new vessels are usually abnormal-irregular in size, branching, anddistribution, with flow in bizarre directions. Ultrasound alone cannot detect these smallvessels but with the addition of UCM, they may be visualized. This has already beendemonstrated in breast cancer and undoubtedly will move into other areas like ovariancancer screening. In obstetrics and gynecology, the use of UCM is limited, but placental perfusion and ovarian tumors are potential areas for this modality
.Following an intravenous (IV) injection, the UCA reaches the organ of interest (such asthe ovary) and time intensity curves can be created to evaluate the degree, speed (slope)and duration of pixel enhancement produced by the UCA (transit time studies).Generally, tumors demonstrate steeper rises and slower washouts secondary toangiogenesis. Furthermore, benign and malignant processes can be differentiated sincein malignancy, absorption should be faster and the UCA should remain in tissues longer and should be excreted faster. Malignant tumors have a larger number of vessels andhigher pixel density when examined with color Doppler. This has already been shownin breast, liver and prostate cancers and undoubtedly will be in the future in other fieldssuch as ovarian cancer screening
The first 3D scanner was produced in 1974, but it was not computerized and proved adisappointment. However, computerized modeling of ultrasound images began in the1980s and the result of that research, combined with 3D scanning technology,ultimately led to the development of improved 3D imaging. This provided clinicianswith a level of imaging detail substantially better than what had been previouslyavailable. And as data acquisition and display continue to improve, 3D imaging will beincreasingly more clinically useful. In gynecology, 3-D offers indisputable advantages – planes not otherwise accessible are available, e.g. the coronal plane in uterine imaging.This may be particularly helpful to assess the uterine contour, both external and withinthe endometrial cavity, for instance for the diagnosis of congenital Müllerian anomaliesor adnexal pathology
Why 3 D US?
Two-dimensional US is a flexible, cost-effective imaging tool that allows users to seeand record a large variety of thin anatomic sections in real time. However, conventionalUS has several disadvantages that 3D US has the potential to rectify. One of its major