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SYMPOSIUM
EQUIPMENTS
Purpose (s)
Indications
Safety
Budgeting
After sales service
Education and training
program
3 4
Probe (s)
1
12/2/2014
MEASURING FACILITIES :
The monitor
ONSCREEN MEASUREMENT
ONSCREEN MEASUREMENT
POSITION
BASIC OF TV SCANNING
2
12/2/2014
Anteversion
Probe insertion & Rotation
The abdominal side of the patient is displayed on the left side of
the image
Retroversion
The back side of the patient is displayed on the right side of the
image
3
12/2/2014
4
12/2/2014
ULTRASONOGRAPHIC EVALUATION OF
Scanning Technique PELVIC BLOOD FLOW
1. Sliding
2. Rotating
3. Rocking
PELVIC BLOOD FLOW
• iliac arteries and veins
4. Panning • extrinsic ovarian vascular system ovarian arteries
• intrinsic ovarian vascular system intraovarian arteries
EXTRINSIC
OVARIAN
VASCULAR SYSTEM
VENOUS
OVARIAN DRAINAGE
HILUS
INTRINSIC OVARIAN
SYSTEM
OVARIAN
HILUS
ARCADE
CENTRAL
MEDULLARY
PART OF THE
STROMA
OVARIAN CORTEX
5
12/2/2014
• 8 - 10th DAY OF THE M.C. DIAMETER 10 mm •RI = 0.50-0.55 - parameter hemodinamik pertumbuhan folikel
• MAX. DIAMETER 19 - 23 mm •RI = 0.42-0.48 – reduksi signifikan resistensi vaskuler pada fase
preovulasi
• GROWTH RATE: 2 - 3 mm/DAY
6
12/2/2014
HDlive view of a corpus luteum. Notice the different positions of the virtual
light that gives different shadows and images. The translucency mode is
showing in the upper right image
7
12/2/2014
FUNGSI NORMAL OVARIUM BERDASARKAN POLA KHAS ARUS DARAH KISTA KORPUS LUTEUM
SIKLIK
HDlive in ovarian stimulation. Left: Basal US scan immediately before starting FSH for ovarian stimulation (day 2 of menstrual cycle).
Center: US control 6 days after FSH estimulation, notice the multifollicular development in a photo-like image. Right: HDlive view of a stimulated ovary in IVF cycle
Ultrasonographic evaluation of a polycystic ovary. Upper left: 2D ultrasound evaluation depicting antral follicles surrounding a
hyperecogenic ovarian medullar zone. Upper right: HDlive view of the same case showing a natural-resembling ovarian appearance.
Bottom row: the same ovary after the elimination of redundant structures, clearly showing the peripheral distribution of the follicles and a
dense medullar zone. Bottom left: translucency view
8
12/2/2014
VASKULARISASI UTERUS
1
0.98
0.96
0.94
0.92
INFERTILE WOMEN
0.9
FERTILE WOMEN
0.88
0.86
0.84
0.82
0.8
5 7 9 11 13 15 17 19 21 23 25 27
ZONA 1 ZONA 3
ZONA 2 ZONA 4
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12/2/2014
SUBENDOMETRIAL
ZONA
PR = 26.7 %
from
P < 0.05
ZONA THE ONLY PERIOD OF
HIPEREKHOGENIC
LUAR GESTATION NOT DETECTED
PR = 36.4 %
DIRECTLY
ZONA
HIPOEKHOGENIC P > 0.05
DALAM
PR = 37.9 %
to
PR = Pregnancy Rate Zaidi et al., Ultrasound Obstet Gynecol 1995
Oocytes FERTILIZATION
0 2 3 4 5 days
10
12/2/2014
FETOSCOPY
2D ULTRASOUND COLOR DOPPLER
Uterochorionic blood flow (color rendering, top)
and intervillous blood flow (transparent rendering, down)
A) at 6 weeks B) 8 weeks
4D HD LIVE ULTRASOUND
3D ULTRASOUND
3D PD ULTRASOUND
VISUALIZZATION OF
VISUALI
VASCULARIZATION IS
SYNCHRONOUS WITH THE
EARLY SOMATIC DEVELOPMENT Usefull tool in differentiation of morphology
Secondary
yolk sac YOLKSAC
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12/2/2014
•The yolk sac appears sonographically as a round, translucent, cyst-like structure, often located near
the periphery of the gestational sac
•Transitory organ, function limited on the first trimester
Kurjak A, et al., J Perinatal Med 1994
CHANGES IN
YOLK SAC
CHANGES IN
APPEARANCE
VASCULAR
(SIZE, SHAPE,
ECHOGENICITY) PATTERN Large yolk sac is associated with chromosomal aberration of autosomal trisomy
Kucuk T, et al. Yolk sac size and shape as predictors of poor pregnancy outcome. J. Perinat. Med. 1999;27:316-320
VOLUME (mm3)
Volume Vascularity VASCULARITY (%)
EARLY CIRCULATION
70 100
90
60
80
DEGREE OF VISUALIZATION
50 70
60
40
50
30
40
20 30
20
Visualisation of
10 circulation:
10
• uteroplacental
0 0
• umbilical
5 6 7 8 9 10 11 12 • embrionic / fetal
GESTATIONAL AGE (WEEKS)
Kurjak A, et a., J Perinatal Med 1994
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12/2/2014
5 weeks:
- gestational sac:
embryo and yolk sac
not yet visible
5-6 weeks:
•Early trophoblast (Intervillous Space)
•Lacunar flow
•Secondary yolk sac
A 20-day-old (2 mm) embryo: a chorionic plate with villi 3D surface rendering of an embryo & YS at 5 weeks
The amnion is attached to the chorion by a connecting stalk
6 weeks :
clear distinction
between embryo ,
yolk sac and amniotic
membrane
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12/2/2014
H M
8-9 weeks:
•CRL 15mm, head and trunk differentiation
•neural tube, intracranial structures, falx cerebri, A 43-day-old (approximately 13 mm) embryo:
3D surface rendering from the fetus at 8 – 9 weeks'
•cerebral bubbles, choroid plexuses fluorescent illumination makes the structures of
gestation
•recognition of extremities the face very distinct.
11-12 weeks:
• CRL 50mm
• BPD 15mm
• cerebral and facial details
• choroid plexus - dominant
intracranial structure
14