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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5772_Библиотеки_им_академика_М_И_Перельмана.pdf
x
Contents
9 Interventional Ultrasound in Reproductive Medicine
S. Kupesic, A. Kurjak, and A. K. Ertan
Follicular Aspiration in Assisted Reproduction ....... 83
Transabdominal Follicular Aspiration ................ 83
Transurethral Follicular Aspiration ................... 84
Transvaginal Follicular Aspiration ................... 84
GIFT (Gamete Intrafallopian Transfer) and ZIFT
(Zygote Intrafallopian Transfer) ..................... 85
Embryo Transfer ................................. 85
Fallopian Tube Catheterization .................... 85
Aspiration of Ovarian Cysts ........................ 86
Drainage of Cul-de-Sac Abscesses .................. 86
Selective Reduction of Multiple Pregnancies ......... 86
Techniques of Ultrasound Tubal Imaging ............ 87
Hysterosonosalpingography ........................ 88
Obstetric Ultrasound
10 Doppler Ultrasound Examinations from Folliculogenesis to Early Pregnancy
S. Kupesic, A. Kurjak, and W. Schmidt
Overview ....................................... 96
Monitoring Folliculogenesis ....................... 96
Development of the Corpus luteum ................. 97
Changes in Endometrial Blood Flow ................ 98
Luteal Blood Flow in Normal and Abnormal
Pregnancies .....................................100
Trophoblastic Invasion and Development of the
Placenta ........................................101
11 Evaluation of Early Placentation and the Embr yonic Circulation with Doppler Ultrasound
A. Kurjak and S. Kupesic
Implantation ....................................103
Development of the Intervillous Circulation .........103
Classic Theory ....................................103
Objections and Alternative Theories ..................104
Color Doppler Studies .............................104
Vascularization of the Yolk Sac and Vitelline Duct ....106
Changes in Uterine Perfusion after Placentation .....107
Uterine Arteries and Spiral Arteries ..................107
Embryonic and Fetal Circulation ...................107
Fetal Vessels .....................................108
Summary ........................................109
12 Color Doppler Sonography in Ectopic Pregnancy
H. J. Voigt
Importance of Transvaginal Sonography and Serum
hCG ............................................111
Transvaginal Color Doppler Sonography ............112
Typical Findings in Normal and Ectopic Pregnancy .....112
Diagnostic Efficiency ..............................112
Author’s Studies ..................................112
Assessment of the Method .........................115
Summary .......................................115
13 Physiology of Doppler Flow in Maternal Vessels during Pregnancy
T. Golaszewski, J. Deutinger, and G. Bernaschek
Conditions of Intrauterine Life .....................116
Physical Principles ...............................116
Anatomical and Physiological Principles ............116
Adaptive Processes during Pregnancy ................117
Technique of Transvaginal Pulsed Doppler
Flowmetry ......................................117
Authors’ Studies .................................118
Uterine Perfusion in a Normal Pregnancy .............118
Uterine Perfusion in an Abnormal Pregnancy ..........119
Uterine Perfusion on Medication or following Uterine
Manipulation ....................................120
Contents
xi
Discussion ......................................121
Uterine Perfusion in a Normal Pregnancy .............121
Uterine Perfusion in an Abnormal Pregnancy ..........121
Uterine Perfusion on Medication or after Uterine
Manipulation ....................................122
Summary .......................................122
Doppler Flowmetry of Maternal Vessels as a Screening
Test? ...........................................122
14 Color Doppler Sonography of the Uterine Arteries in Early Pregnancy to Screen for Preeclampsia
and Uteroplacental Insufficiency
A. Funk
Applications of Color Doppler Sonography during
Pregnancy ......................................124
Technique of Transvaginal Doppler Sonography ......124
Normal Development of Uterine Artery Doppler
Spectra .........................................125
Normal Values in Early Pregnancy ...................125
Early Doppler Examination of Uteroplacental Blood
Flow in Abnormal Pregnancy ......................126
Patients .........................................126
Results ..........................................127
Discussion .......................................127
Summary .......................................128
15 Normal Fetomaternal Doppler Indices in the Second and Third Trimesters of Pregnancy
A. K. Ertan, H. J. Hendrik, I. Tossounidis, and W. Schmidt
Establishing Normal Curves .......................129
Methodology ....................................129
Defining the Normal Population .....................129
Plotting Quantile Curves ...........................129
Results .........................................130
Discussion ......................................133
Progression of Doppler Indices during the Course of
Pregnancy .......................................133
16 Venous Doppler Sonography
F. Bahlmann
Historical Development ...........................135
Physiology ......................................135
Umbilical Vein ...................................135
Ductus venosus ...................................136
Inferior Vena Cava ................................139
Hepatic Veins ....................................139
Clinical Applications .............................140
Intrauterine Growth Retardation Due to Chronic
Placental Insufficiency .............................140
Growth Discordance in Multiple Pregnancy ...........141
Hydrops fetalis ...................................141
Conclusion ......................................143
Other Diseases ...................................143
Specific Obstetric Problems
17 Color Doppler Sonography in the Diagnosis of Nuchal Cord
A. K. Ertan, H. J. Hendrik, and W. Schmidt
Importance of Nuchal Cord ........................148
Color Doppler Study on the Diagnosis of Nuchal Cord . 148
Examination Technique ............................148
Results ..........................................149
Importance of Nuchal Cord Diagnosis in the Biophysical
(ABCD) Profile ....................................150
Role of Doppler Sonography in NC ..................151
Summary .......................................153
xii
Contents
18 Chronic Placental Insufficiency
H. J. Hendrik, A. K. Ertan, and W. Schmidt
Definitions ......................................155
Definition and Incidence of Chronic Placental
Insufficiency .....................................155
Intrauterine Growth Retardation ....................156
Diagnosis of Chronic Placental Insufficiency .........158
Diagnostic Systems ...............................158
Indications for Doppler Sonography ..................159
Clinical Management of Chronic Placental
Insufficiency Suspected from Doppler Findings ......160
Antenatal Fetal Heart Rate Monitoring ...............160
Pathological Changes in Organ Systems ...............160
Biophysical Profile ................................161
Summary .......................................162
Identifying Cases with IUGR ........................162
Obstetric Management ............................163
19 Severely Abnormal Doppler Findings and Perinatal Abnormalities
A. K. Ertan, H. J. Hendrik, and W. Schmidt
Surveillance of Compromised Fetuses ...............166
Absent End-Diastolic Flow (AEDF) and Reverse Flow . . 166
Technical Aspects in the Diagnosis of Absent End-
Diastolic Flow and Reverse Flow .....................166
Absent End-Diastolic Flow in the Umbilical Artery and/or
FetalAorta .......................................168
Reverse Flow in the Umbilical Artery and/or Fetal Aorta . 168
Clinical Results of AEDF or Reverse Flow in the Umbilical
Artery and/or Fetal Aorta ...........................168
Significance of Severely Abnormal Doppler Findings . . 170
Summary .......................................173
20 Fetal Doppler Findings in Late Pregnancy
K. Vetter
Physiological Findings in Late Pregnancy ............176
Aorta: Quantitative Analysis ........................176
Aorta: Qualitative Analysis .........................176
Cerebral Arteries ..................................177
Renal Arteries ....................................177
Femoral Arteries ..................................177
Changes in Findings at Term and in Postterm
Pregnancies .....................................178
TermEffect ......................................178
Circulatory Balance ...............................179
Summary .......................................180
21 Intrapartum Fetal Heart Rate Changes and Doppler Sonography
E. Weiss
Pathophysiology and Technical Problems ...........182
Changes in Uterine Artery Waveforms during Labor . . 183
Our Results ......................................183
Discussion of Uterine Doppler Changes during Labor ....185
Intrapartum Waveform Changes in Umbilical and
Intrafetal Vessels .................................187
Umbilical Cord Doppler during Labor .................187
Effect of Intrapartum FHR Decelerations on Quantitative
Parameters of Umbilical Blood Flow ..................192
Direct Effect of Intrapartum Fetal Hypoxia or Hypoxemia
on Blood Flow Patterns in the Umbilical Arteries and
Vein ............................................193
Intrapartum Blood Flow Patterns in the Fetal Aorta .....194
Intrapartum Blood Flow Patterns in Fetal Cerebral
Vessels ..........................................195
Summary .......................................196
22 Color Doppler Ultrasound in Fetal Echocardiography
A. Lindinger
Contents
xiii
Congenital Heart Disease—Incidence and Risk
Factors .........................................198
General Introductory Remarks on Color Doppler
Sonography of the Fetal Heart .....................199
Indications for Color Doppler Sonography—Advantages
and Limitations ...................................199
Special Features of Fetal Echocardiography ............199
23 Use of Color Doppler in Echocardiography
U. Gembruch
Importance of Color Doppler Echocardiography in
Prenatal Diagnosis ...............................219
Examination of the Normal Heart ..................219
Equipment Settings ...............................219
Examination Technique ............................220
Cardiac Valve Regurgitation .......................221
Functional Physiological Tricuspid Regurgitation .......221
Pathological Tricuspid Regurgitation .................221
Tricuspid and Mitral Valve Regurgitation ..............221
Semiquantification of AV Valve Regurgitation ..........222
Ultrasound Examination of the Fetal Heart ..........200
Normal Findings ..................................200
Color Doppler in the Diagnosis of Congenital Heart
Disease .........................................205
Management of Suspected Congenital Heart Disease ....218
Anomalies of Visceroatrial Blood Flow ..............222
Anomalies of Atrioventricular Blood Flow ...........223
Anomalies of Ventriculoarterial Blood Flow .........224
Anomalies of Blood Flow through the Cardiac Septa . . 225
Color Doppler Sonography in Fetal Arrhythmias ......226
Summary .......................................227
24 Structure of the Human Placenta and Pathomorphological Changes in Placental Insufficiency
K. R. Reitnauer
Structure of the Human Placenta ...................230
Weight and Dimensions ...........................230
Early Development of the Human Placenta ............230
Structure of the Villous Tree ........................232
Microstructure of the Terminal Villus ................234
Maturation of the Placenta .........................235
Vascular Architecture of the Villous Tree ..............235
Regulation of Villous Blood Flow ....................235
Concept of the Placentone ..........................236
Morphology and Physiological Transformation of the
Maternal Basal-Plate Vessels ........................236
Placental Insufficiency ............................237
Definition and Etiology of Placental Insufficiency .......237
Placental Compensatory Mechanisms ................237
Classification of Placental Insufficiency by its Prog-
ression ..........................................238
Morphological Counterparts of Latent or Overt Placental
Insufficiency .....................................238
25 Morphological and Morphometric Studies of the Placenta with Doppler Abnormalities of the Fetal
Umbilical Arteries*
T. Hitschold
Clinical Aspects of Placental Insufficiency ...........249
Pathophysiological Aspects of Placental Insufficiency . 249
Pathomorphological Aspects of Placental
Insufficiency ....................................250
Validation of Doppler Findings by Placental
Histology .......................................251
Resistance Index of the Umbilical Arteries .............251
End-Diastolic Blood Flow Velocities in the Umbilical
Arteries .........................................252
Clinical and Diagnostic Value of Doppler Sonography of
the Umbilical Arteries .............................254
xiv
Contents
Gynecological Ultrasound
26 Sonographic and Doppler Sonographic Examination of Uterine Anomalies
S. Kupesic and A. Kurjak
Classification of Uterine Anomalies .................260
Diagnosis and Complications of Septate Uterus ......261
Ultrasound in the Diagnosis and Treatment of Septate
Uterus—Authors’ Results ..........................261
Patients and Methods .............................261
Results ..........................................262
New Thoughts on Old Problems ....................264
27 Doppler Examination of the Normal Endometrium and Benign Endometrial Changes
S. Kupesic and A. Kurjak
Changes in the Normal Endometrium during the
Menstrual Cycle ..................................266
Changes in Endometrial Blood Flow during the
Menstrual Cycle ..................................266
Submucous Leiomyomas ..........................268
Endometrial Polyps ..............................269
Endometrial Hyperplasia ..........................270
Adenomyosis ....................................271
Endometritis ....................................272
Incomplete Abortion .............................272
Decidua .........................................272
28 Transvaginal Color Doppler and Pulsed Doppler Diagnosis of Benign Changes in the Uterine
Myometrium
A. Kurjak and S. Kupesic
Examination Technique, Anatomy, and Physiology ...274
Leiomyomas (Fibroids) ...........................274
Vascularization of Leiomyomas .....................275
Management of Uterine Leiomyomas and the
Importance of Color Doppler Sonography ...........277
Medical Treatment with GnRH Agonists ..............277
Surgical Treatment ................................277
Vascular Diseases in the Lesser Pelvis (Varicose Veins
or Arteriovenous Malformations) ..................278
29 Use of Color Doppler in the Evaluation of Suspicious Endometrial Findings
M. Holländer, C. Villena-Heinsen, A. K. Ertan, and W. Schmidt
Incidence of Endometrial Carcinoma ...............280
Diagnostic Investigation of Suspicious Endometrial
Findings ........................................280
Color Doppler Sonography .........................280
Examination of the Uterine Artery .................281
Experience at the Department of Obstetrics and
Gynecology, Homburg University Hospital, Saar ......281
Patients and Methods .............................281
Visualization and Morphology of the Vessels ..........282
Resistance Indices of Endometrial Vessels .............284
Effect of Menopausal Status and Hormone Use .........284
Effect of Histopathological Parameters, with Reference
to Prognostic Factors ..............................285
Subendometrial and Myometrial Vessels ..............286
Summary .......................................286
30 Malignant Uterine Tumors
A. Kurjak and S. Kupesic
Contents
xv
Endometrial Carcinoma ...........................288
Incidence ........................................288
Risk Factors ......................................288
Target Group for Screening .........................288
Screening: Dream or Reality? .......................288
Authors’ Experience ...............................292
Review of the Literature ............................293
Uterine Sarcoma .................................296
Authors’ Experience ...............................296
Cervical Carcinoma ...............................297
Conclusion ......................................297
31 Blood Flow Changes in Cervical Carcinoma Treated by Primary Chemotherapy
C. Villena-Heinsen, A. K. Ertan, M. Holländer, and W. Schmidt
Treatment of Cervical Carcinoma ...................299
Assessing Treatment Response with Pulsed Color
Doppler Sonography ..............................299
Authors’ Studies ..................................299
Discussion .......................................301
Summary .......................................302
32 Color Doppler Imaging of Benign Adnexal Masses—A Spectrum of Findings
A. Kurjak, S. Kupesic, and A. K. Ertan
Appearance of Normal Ovaries by B-Mode and Color
Doppler Ultrasound ..............................304
Specific Adnexal Masses ...........................304
Cystic and Cystic-Solid Ovarian Masses ...............304
Solid Ovarian Masses ..............................307
Conclusions .....................................308
33 Malignant Adnexal Tumors
A. Kurjak, S. Kupesic, and A. K. Ertan
Color Doppler Sonography of Adnexal Malignancies . . 310
Review of the Literature ..........................310
Neoangiogenesis ..................................312
Detecting Blood Vessels and Def ining their Location ....312
Vascular Patterns .................................312
Pulsed Doppler Waveforms .........................313
Vascular Impedance ...............................314
Blood Flow Velocities ..............................315
Stages of Malignant Tumors ........................315
False-Positive Results ..............................316
Conclusions .....................................317
34 Three-Dimensional Power Doppler Sonography in Evaluating the Angiogenesis of Ovarian Tumors
A. Kurjak, S. Kupesic, and B. Breyer
Contribution of Transvaginal Color Doppler
Sonography .....................................319
Three-Dimensional Imaging .......................320
Three-Dimensional Imaging of Vascular Patterns .......320
Types of Image Acquisition and Equipment for Three-
Dimensional Ultrasound ...........................320
Display Modes for Three-Dimensional Vascular Images . . 320
Ultrasound Technology in Tumor Diagnosis .........321
Problems in the Interpretation of 3D Power Doppler
Data ............................................321
Brief Review of the Mathematical Basis of New
Technologies .....................................321
Current Methods for Evaluating Vascular Geometry and
Function ........................................322
xvi
Contents
Technique for Evaluating Vascular Geometry ..........322
Example of 3D Power-Mode Imaging of Benign and
Malignant Gynecological Tumors ....................322
Advances in Tumor Therapy ........................326
Summary .......................................326
Future Outlook ...................................326
35 Ovarian Cancer Screening
A. Kurjak, W. Schmidt, A. K. Ertan, and S. Kupesic
Incidence and Five-Year Survival Rates of Ovarian
Cancer ..........................................330
Requirements of a Screening Program ..............330
Definition .......................................330
Screening Methods ................................331
Screening Parameters .............................331
Possible Screening Tests ..........................332
Bimanual Pelvic Examination .......................332
Cul-de-sac Washings and Radiological Studies .........332
Tumor Marker ....................................332
Ultrasound ......................................333
Who Should be Screened? .........................335
Age Distribution ..................................335
Family History ...................................336
Conclusion ......................................336
Other Risk Factors ................................336
36 General Aspects of the Ultrasound Investigation of Blood Flow in Breast Tumors
C. Villena-Heinsen, M. Holländer, and W. Schmidt
Historical Development ...........................339
Specific Parameters in the Doppler Examination of
Breast Tumors ...................................339
Blood Flow Detection ..............................339
Number of Tumor Vessels ..........................341
Resistance Index ..................................342
Absolute Velocities ................................342
Number and Intensity of Color Pixels and Color Areas . . . 343
Doppler Waveform ................................345
Comparison of “Mirror Image Areas” .................345
Conceptual Misunderstandings in the Interpretation
of Doppler Measurements .........................345
37 Color Doppler Sonography in the Diagnosis of Breast Cancer
H. Madjar
Evolution of Breast Cancer Diagnosis ...............348
Continuous-Wave Doppler ........................350
Pulsed Doppler Techniques ........................351
Color Doppler ...................................351
Equipment Settings ...............................352
Examination Technique ............................353
Blood Flow Analysis ...............................354
Study Results ....................................355
Discussion .......................................356
Conclusions .....................................359
38 Usefulness of the Minimum Resistance Index in the Benign–Malignant Discrimination of Breast Tumors
C. Villena-Heinsen, M. Friedrich, J. König, and W. Schmidt
Flow Resistance in Malignant Breast Tumors ........360
Authors’ Studies .................................360
Patients and Methods .............................360
Results and Discussion .............................361
Summary .......................................363
Contents
39 Effect of Menopausal Status and Hormone Replacement on Therapy Resistance Indices and Blood Flow
Velocities in Breast Tumors
C. Villena-Heinsen, I. Tossounidis, and W. Schmidt
Menopausal Status and Benign–Malignant Tumor
Discrimination ..................................364
Authors’ Studies .................................364
Patients and Methods .............................364
Results ..........................................365
Discussion .......................................366
Summary .......................................370
40 Benign–Malignant Tumor Discrimination and Prognostic Evaluation of Breast Tumors with
Color Doppler Sonography
C. Villena-Heinsen, A. K. Ertan, D. Mink, and W. Schmidt
Applications of Color Doppler Sonography in Breast
Cancer ..........................................371
Authors’ Studies .................................372
Methods ........................................372
Results ..........................................372
Discussion .......................................376
Conclusion ......................................377
xvii
Index ...........................................379
xviii
Abbreviations
5-HETE hydroxyeicosatetraenoic acid
ABCD profile amniotic fluid index, biometry, kinetochardio-
graphy, Doppler examination
AEDF absent end-diastolic flow
AFI amniotic fluid index
AGA appropriate for gestational age
AR autoregression
ARED absent or reverse end-dialostic flow
ASD atrial septal defect
AV atrioventricular
BI balance index
bpm beats per minute
CATCH 22 cardiac defects, abnormal facies, thymic hypo-
plasia, cleft palate, hypocalcemia, and chromo-
some 22
CDS color duplex sonography
CFM color-flow mapping
CGRP calcitonin gene-releated peptide
CIN intraepithelial neoplasia of the cervix
CRL crown-rump length
CT computed tomography
CTG cardiotocography
CVI color velocity imaging
CW continuous wave
DA ductus arteriosus
EDRF endothelial-derived relaxing factor
EEG electroencephalogram
EFI extended amniotic fluid index
EFSUMB European Federation of Societies for Ultra-
sound in Medicine and Biology
EP ectopic pregnancy
ERF endothelial relaxing factor
ES extrasystole
EST erythrocyte sedimentation rate
ET embryo transfer
FFT fast Fourier transfer
FHR fetal heart rate
FIGO International Federation of Gynecology and
Obstetrics
FIP frequency index profile
FNA fine-needle aspiration
FSH follicle-stimulating hormone
GIFT gamete intrafallopian transfer
GnRH gonadotropin-releasing hormone
GRIT Growth Restriction Intervention Trial
H&E hematoxylin and eosin
hCG human chorionic gonadotrophin
hMG human menopausal gonadotrophin
HPL human placental lactogen
HR heart rate
HRT hormone replacement therapy
HSG hysterosalpingography
Hy-Co-Sy hysterosalpingo-contrast-sonography
ICA internal carotid artrey
ICSI intracytoplasmic sperm injection
ICU intensive care unit
I
SPTA
spatial peak time average intensity
IUD intrauterine device
IUGR intrauterine growth retardation
IUI intrauterine insemination
IVF in-vitro fertilization
IVF-ET in-vitro fertilization and embryo transfer
KCTG kinetocardiotocography
LH luteinizing hormone
LMP last menstrual period
LPD luteal phase defect/deficiency
LUF syndrome luteinized but unruptured follicle syndrome
MAGS microscopic angiogenesis grading system
MCA middle cerebral artery
MEM maximum entropy method
MI mechanical index
MIP maximum intensity projection
MRI magnetic resonance imaging
Mv
max
peak systolic velocity
NC nuchal cord
NS not significant
OAPR overall predictive ratio
ODS Output Display Standard
PAS periodic acid-Schiff
PCO polycystic ovary (syndrome)
PGF
2α
prostaglandin F
2α
PI pulsatility index
PID Pelvic inflammatory disease (PID)
PIH pregnancy-induced hypertension
PIV pulsatility index for veins
Po
, Pco
2
2
oxygen [carbon dioxide] partial pressure
PPO postmenopausal palpable ovaries
PRF pulse repetition frequency
PROST pronucleus-stage transfer
PVIV peak velocity index for veins
PW pulsed wave
PZD partial zona dissection
RI resistance index
ROC receiver operating characteristic
ROI region of interest
SGA small-for-gestational-age
SUZI subzonal insemination
TASAV temporal average of spatial average velocities
TEM transparent energy mode
TET intratubal embryo transfer
TGC time gain compensation
THI tissue harmonic imaging
TI thermal index
TKD tocodynamometry
TORCH toxoplasmosis, rubella, cytomegalovirus, and
herpes
TVCD transvaginal color Doppler sonography
UA umbilical artery
VSD ventricular septal defect
ZIFT zygote intrafallopian transfer
