ISUOG Basic Training Examining the Uterus: Myometrium

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1 ISUOG Basic Training Examining the Uterus: Myometrium

2 Learning objectives At the end of the lecture you will be able to: Recognise the typical ultrasound appearances of the normal myometrium Recognise the typical ultrasound appearances of abnormalities in the myometrium

3 Key questions What are the typical ultrasound findings of a normal myometrium? What are the typical ultrasound findings of common abnormalities in the myometrium? Know when to refer for a specialist opinion

4 Normal myometrium before menopause

5 Uterine measurements

6 Myometrial pathology: MUSA

7 Myometrial pathology: MUSA Common Leiomyoma (fibroids) Adenomyosis Rare Calcifications Enhanced myometrial vascularity

8 Most common myometrial pathology - myoma Benign tumour of the smooth muscle Subserosal Intramural Submucosal 0/1/2

9 Most common myometrial pathology - myoma Echogenicity Shadowing Vascularity

10 Uniform Hypoechogenic Non-uniform Mixed echogenicity Myoma Echogenicity Uniform Isoechogenic Non-uniform Echogenic areas Uniform Hyperechogenic Non-uniform Cystic areas

11 Uniform Hypoechogenic Non-uniform Mixed echogenicity Myoma Echogenicity Uniform Isoechogenic Uniform Hyperechogenic Non-uniform Echogenic areas Non-uniform Cystic areas Low threshold for specialist referral if atypical features

12 Shadowing Most common myometrial pathology - myoma

13 Normal Vascularity in the myometrium

14 Most common myometrial pathology Vascularity - myoma Circumferential Intra-lesional

15 Vascularity in myoma

16 Editable text here Basic training Basic Training

17 Editable text here Basic training Basic Training

18 Editable text here Basic training Basic Training

19 Relatively common myometrial pathology - adenomyosis Abnormal presence of endometrium tissue within the myometrium

20 Relatively common myometrial pathology - adenomyosis Enlarged uterus Asymmetrically enlarged Globally enlarged Fan shaped shadowing Myometrial cysts Poorly defined endometrial-myometrial border

21 Relatively common myometrial Enlarged uterus pathology - adenomyosis Asymmetrically enlarged Globally enlarged

22 Relatively common myometrial pathology - adenomyosis Abnormal myometrial echogenicity Fan shaped shadowing 'Rain in the forest' sign

23 Relatively common myometrial pathology - adenomyosis Myometrial cysts Poorly defined endometrial-myometrial border

24 Junctional Zone (JZ) zone

25 JZ zone (3D) Exacoustos C. et al, BPR; 2014 (28;

26 Relatively rare myometrial pathology Calcification uterus Enhanced myometrial vascularity

27 Normal myometrium after menopause Myometrial calcifications

28 etained products of conception (RPOC) / Enhanced myometrial vascularity (EMV) Timmerman D. UOG, 2003 (21): 570-7; Van den Bosch JUM : ; Timor-Tritsch IE, AJOG, 2016:214: 731 e1-10

29 Editable text here Basic training Basic Training

30 Standardisation of the routine examination of the myometrium Measurement of the uterus Symmetry of the myometrium walls Echogenicity Myometrial lesions ( well / ill defined) Number of lesions (location/max diam) JZ zone Vascularity Midsagittal/ transverse/ 3D

31 Which patients should I refer for specialist opinion? Those in whom you are uncertain about the diagnosis (especially if you suspect malignancy)

32 Key points We should use a standardized terminology when we describe ultrasound images of: Adnexal lesions (IOTA) The endometrium /uterine cavity (IETA) The myometrium (MUSA) Deep infiltrating endometriosis (IDEA)

33 Key points When in doubt: refer for second opinion

34 Acknowledgments These slides were created by: Shabnam Bobdiwala Maya Al-Memar Lil Valentin Anneke Steensma

35 ISUOG Basic Training Examining the Uterus: Myometrium

Basic Training Programme. 16 Februrary 2018, ROTTERDAM. Pre and Post-Course Test Answers

Basic Training Programme. 16 Februrary 2018, ROTTERDAM. Pre and Post-Course Test Answers Basic Training Programme 16 Februrary 2018, ROTTERDAM Pre and Post-Course Test Answers Your details: Name: Conference registration number/ BT delegate number: Email address: Are you already performing