Diagnostic Imaging - Ultrasound

Ultrasound Services at RIMA:
•    Hysterosonography
•    Obstetric Ultrasound
•    Ultrasound – Breast
•    Ultrasound-Guided Breast Biopsy
•    Ultrasound – Carotid
•    Ultrasound – General
•    Ultrasound – Pelvis
•    Ultrasound – Prostate
•    Ultrasound – Scrotum
•    Ultrasound – Thyroid
•    Ultrasound – Vascular
•    Ultrasound – Venous (Extremities)

Hysterosonography, also known as sonohysterography or saline infusion sonography, is a special, minimally invasive ultrasound technique. It provides pictures of the inside of a woman’s uterus.

It is a valuable technique for evaluating unexplained vaginal bleeding that may be the result of uterine abnormalities such as:
•    polyps
•    fibroids
•    atrophy
•    adhesions (or scarring)
•    masses
•    congenital defects

Hysterosonography is also used to investigate uterine abnormalities in women who experience infertility or multiple miscarriages.

Obstetric Ultrasound
Obstetrical ultrasound provides pictures of an embryo or fetus within a woman’s uterus.

Obstetrical ultrasound is a useful clinical test to:
•    establish the presence of a living embryo/fetus
•    estimate the age of the pregnancy
•    diagnose congenital abnormalities of the fetus
•    evaluate the position of the fetus
•    evaluate the position of the placenta
•    determine if there are multiple pregnancies
•    determine the amount of amniotic fluid around the baby
•    check for opening or shortening of the cervix or mouth of the womb
•    assess fetal growth
•    assess fetal well-being

Ultrasound – Breast
Ultrasound imaging of the breast produces a picture of the internal structures of the breast. During aultrasound examination the sonographer or physician performing the test may use Doppler techniques to evaluate blood flow or lack of flow in any breast mass. This may in some cases provide additional information as to the cause of the mass.

Breast Ultrasound is most commonly utilized for:
•    Determining the Nature of a Breast Abnormality

The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography.

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.

Doppler ultrasound is used to assess blood supply in breast lesions.

Supplemental Breast Cancer Screening
Mammography is the only screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of glandular tissue and less fat, many cancers can be hard to see on mammography.

Many studies have shown that ultrasound and magnetic resonance imaging (MRI) can help supplement mammography by detecting small breast cancers that may not be visible with mammography. This is usually only considered when the breast tissue is dense. It is hoped that by detecting such cancers, these other screening tests might help to further prevent deaths due to breast cancer beyond what is achieved with mammography alone. When ultrasound is used for screening, many abnormalities are seen which may require biopsy but are not cancer (false positives), and this limits its cost effectiveness.

Today, ultrasound is being investigated for use as a screening tool for women who:
•    have dense breasts
•    have silicone breast implants and very little tissue can be included on the mammogram
•    are pregnant or should not to be exposed to x-rays (which is necessary for a mammogram)
•    are at high risk for breast cancer based on family history, personal history of breast cancer, or prior atypical biopsy result.

Ultrasound-guided Breast Biopsy
When an ultrasound examination cannot characterize the nature of a breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures.

A breast biopsy involves removing some tissue—usually by a procedure involving a needle which can take small pieces of tissue under local anesthesia—from the suspicious area in the breast and examining it under a microscope to determine a diagnosis. Occasionally, a surgical biopsy is needed to make a diagnosis.

Ultrasound-guidance is used to assist physicians in obtaining tissue samples from the breast in three different biopsy procedures: a cyst aspiration, a fine needle aspiration (FNA) biopsy and a core needle (CN) biopsy. Most cysts do not require any procedure. FNA is most often performed to evaluate suspicious axillary lymph nodes (under the arm) in patients with known or suspected breast cancer. Most ultrasound-guided breast biopsies are performed using core or vacuum-assisted needle biopsy techniques.

Ultrasound – Carotid
The carotid ultrasound is most frequently performed to detect narrowing, or stenosis, of the carotid artery, a condition that substantially increases the risk of stroke.

The major goal of carotid ultrasound is to screen patients for blockage or narrowing of their carotid arteries, which if present may increase their risk of having a stroke. Once the diagnosis is made a comprehensive treatment may be initiated.

It may also be performed if a patient has high blood pressure or a carotid bruit (pronounced brU-E)—an abnormal sound in the neck that is heard with the stethoscope. Other risk factors calling for a carotid ultrasound are:
•    advanced age
•    diabetes
•    elevated blood cholesterol
•    a family history of stroke or heart disease

A carotid ultrasound is also performed to:
•    locate a hematoma, a collection of clotted blood that may slow and eventually stop blood flow.
•    detect dissection of the carotid artery, a split between layers of the artery wall that may lead to obstruction of blood flow or a weakening of the wall of the artery.
•    check the state of the carotid artery after surgery to restore normal blood flow.
•    verify the position of a metal stent placed to maintain carotid blood flow.
Doppler ultrasound images can help the physician to see and evaluate:
•    blockages to blood flow (such as clots)
•    narrowing of vessels (which may be caused by plaque)
tumors and congenital malformation

Ultrasound – Pelvis
A pelvic ultrasound provides pictures of the structures and organs in the lower abdomen or pelvis.

There are three types of pelvic ultrasound:
•    abdominal (transabdominal)
•    vaginal (transvaginal, endovaginal) for women
•    rectal (transrectal) for men

A Doppler ultrasound exam may be part of a pelvic ultrasound examination.
In women, a pelvic or abdominal ultrasound is most often performed to evaluate the:
•    bladder
•    ovaries
•    uterus
•    cervix
•    fallopian tubes

Pelvic ultrasound exams are also used to monitor the health and development of an embryo or fetus during pregnancy.

Ultrasound examinations can help diagnose symptoms experienced by women such as:
•    pelvic pain
•    abnormal bleeding
•    other menstrual problems
and help identify:
•    palpable masses such as ovarian cysts and uterine fibroids
•    ovarian or uterine cancers

A transvaginal ultrasound is usually performed to view the endometrium or the lining of the uterus, including its thickness and thickness, and ovaries. Transvaginal ultrasound also affords a good way to evaluate the muscular walls of the uterus, called the myometrium. Sonohysterography allows for a more in-depth investigation of the uterine cavity. These exams are typically performed to detect:
•    uterine anomalies
•    scars
•    endometrial polyps
•    fibroids
•    cancer, especially in patients with abnormal uterine bleeding

Some physicians also use hysterosonography for patients with infertility.

In men, a pelvic or abdominal ultrasound is used to evaluate the:
•    bladder
•    seminal vesicles
•    prostate

The transrectal ultrasound, a special study usually done to view the prostate gland, involves inserting a specialized transducer to a probe and inserting it into a man’s rectum.
In men and women, a pelvic ultrasound exam can help identify:
•    kidney stones
•    tumors
•    other disorders in the urinary bladder

Pelvic ultrasound is also used to guide procedures such as needle biopsies, in which needles are used to extract a sample of cells from organs for laboratory testing.

Doppler ultrasound images can help the physician to see and evaluate:
•    blockages to blood flow (such as clots)
•    narrowing of vessels (which may be caused by plaque)
•    tumors and congenital malformation

Ultrasound – Prostate
Ultrasound – Scrotum
Ultrasound imaging of the scrotum is the primary imaging method used to evaluate disorders of the testicles.

This study is typically used to:
•    determine whether a mass in the scrotum felt by the patient or doctor is cystic or solid.
•    diagnose results of trauma to the scrotal area.
•    diagnose causes of testicular pain or swelling such as inflammation or torsion.
•    evaluate the cause of infertility such as varicocele.
•    look for the location of undescended testis.

Ultrasound is also a valuable tool for evaluating the epididymis (a tube that collects sperm made by the testicles) and the prostate.

A sudden onset of pain in the scrotum may be very serious. The most common cause of scrotal pain is epididymitis, an inflammation of the epididymis. It is treatable with antibiotics. Left untreated, this condition can lead to an abscess or loss of blood flow to the testicles.

Ultrasound can detect an absent or undescended testicle as well. In rare cases a testicle may fail to develop. More often, patients have an undescended testicle. It is estimated that approximately three percent of full-term baby boys have undescended testicles. It’s important to diagnose an undescended testicle because it has a very high probability of developing cancer if left untreated.

Ultrasound can identify testicular torsion, the twisting of the spermatic cord that contains the vessels that supply blood to the scrotum. Caused by abnormally loose attachments of tissues that are formed during fetal development, torsion commonly appears during adolescence and is very painful. Torsion requires immediate surgery to avoid permanent damage to the testes.
Ultrasound also can be used to locate and evaluate masses (lumps or tumors) in the scrotum. The majority of scrotal masses are located outside of the testes. Most masses found outside the testicles are benign or non-cancerous; most inside the testicles are malignant or cancerous. Collections of fluid and abnormalities of the blood vessels may appear as masses and need to be assessed by ultrasound.

Ultrasound – Thyroid
An ultrasound of the thyroid produces a picture of the thyroid gland. The thyroid gland is located in front of the neck just below the Adam’s apple and is shaped like a butterfly, with two lobes on either side of the neck connected by a narrow band of tissue. It is one of nine endocrine glands located throughout the body that make and send hormones into the bloodstream.

An ultrasound of the thyroid is typically used to help diagnose:
•    a lump in the thyroid
•    a thyroid that is not functioning properly

Because ultrasound provides real-time images, it also can be used to guide procedures such as needle biopsies, in which needles are used to extract sample cells from an abnormal area for laboratory testing. Ultrasound may also be used to guide the insertion of a catheter or drainage device and helps assure accurate placement.

Ultrasound – Vascular
Sonography is a useful way of evaluating the body’s circulatory system. Vascular ultrasound is performed to:
•    help monitor the blood flow to organs and tissues throughout the body.
•    locate and identify blockages (stenosis) and abnormalities like plaque or emboli and help plan for their effective treatment.
•    detect blood clots (deep venous thrombosis (DVT) in the legs or arms.
•    determine whether a patient is a good candidate for a procedure such as angioplasty.
•    evaluate the success of procedures that graft or bypass blood vessels.
•    determine if there is an enlarged artery (aneurysm).
•    determine the source and severity of varicose veins.

Doppler ultrasound images can help the physician to see and evaluate:
•    blockages to blood flow (such as clots)
•    narrowing of vessels (which may be caused by plaque)
tumors and congenital malformation

Ultrasound – Venous (Extremities)
A Doppler ultrasound study may be part of a vascular  ultrasound examination.

Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel, including the body’s major arteries and veins in the abdomen, arms, legs and neck.

There are three types of Doppler ultrasound:
•    Color Doppler uses a computer to convert Doppler measurements into an array of colors to visualize the speed and direction of blood flow through a blood vessel.
•    Power Doppler is a newer technique that is more sensitive than color Doppler and capable of providing greater detail of blood flow, especially when blood flow is little or minimal. Power Doppler, however, does not help the radiologist determine the direction of blood flow, which may be important in some situations.
•    Spectral Doppler. Instead of displaying Doppler measurements visually, Spectral Doppler displays blood flow measurements graphically, in terms of the distance traveled per unit of time.

The most common reason for a venous ultrasound exam is to search for blood clots, especially in the veins of the leg. This condition is often referred to as deep vein thrombosis or DVT. These clots may break off and pass into the lungs, where they can cause a dangerous condition called pulmonary embolism. If found in time, there are treatments that can prevent this from happening.

A venous ultrasound study is also performed to:
•    determine the cause of long-standing leg swelling. In people with a common condition called varicose veins, the valves that keep blood flowing back to the heart in the right direction may be damaged, and venous ultrasound can help the surgeon decide how best to deal with this condition.
aid in the placement of a needle or catheter in a large interior vein. Sonography can help locate the exact site of the vein and avoid complications, such as bleeding or air in the chest cavity.
•    map out the veins in the leg or arm so that segments may be removed and used to bypass a narrowed or blocked blood vessel. An example is using pieces of vein from the leg to surgically bypass narrowed coronary arteries.
•    examine a blood vessel graft used for dialysis if it is not working as expected; for example, the graft may be narrowed or blocked.

Doppler ultrasound images can help the physician to see and evaluate:
•    blockages to blood flow (such as clots)
•    narrowing of vessels (which may be caused by plaque)
•    tumors and congenital malformation