Transabdominal pulse inversion harmonic imaging improves assesment of ovarian morphology in virgin patients with PCOS: comparison with conventional B-mode sonography

Polycystic ovary syndrome: clinical and imaging features

Polycystic ovary syndrome is the most common endocrine disorder occurring in reproductive-age women. The syndrome is complex, multifactorial, and not always easily defined. Diagnosis is based upon a combination of clinical and biochemical criteria and ovarian morphology. The following review describes the clinical features, pathophysiology, diagnosis, and the role of imaging. Diagnostic imaging techniques are discussed, with emphasis on ultrasound as the main modality used worldwide. Contributions of 3-dimensional and Doppler ultrasound are addressed in addition to potential indications for magnetic resonance imaging in the evaluation of patients with suspected polycystic ovary syndrome.

Phase inversion harmonic imaging improves assessment of renal calculi: a comparison with fundamental gray-scale sonography

PURPOSE

To compare phase inversion harmonic imaging (PIHI) with fundamental imaging (FI) in the evaluation of renal calculi.

METHODS

Thirty adult patients with renal calculi (17 men, 13 women; mean age 44 years [range, 25-71]) underwent transabdominal sonographic examination of the urinary system. Both kidneys and renal calculi were examined with PIHI and FI. Overall renal conspicuity, calculus visibility, and clarity of posterior shadowing were assessed subjectively using a 4-point scale (0 being the worst, 3 being the best). The maximum diameter of the calculi was measured using both techniques. The effect of body mass index on qualitative scoring and quantitative measurements was evaluated.

RESULTS

PIHI improved overall renal conspicuity compared with FI (p < 0.001). The visibility of the calculi and clarity of posterior shadowing were significantly better with PIHI than with FI (p < 0.001 for both parameters). The maximum diameter of calculi was larger with PIHI than with FI (p < 0.001). The superiority of PIHI over FI regarding overall conspicuity of the kidney, visibility of the calculus, and clarity of posterior shadowing scores increased in the obese group (p < 0.001 for all 3 parameters). The mean calculus diameter difference between the 2 techniques was significantly higher in the obese group.

CONCLUSION

The routine use of PIHI is recommended in the evaluation of renal calculi.

Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome

OBJECTIVES

To evaluate the diagnostic value of 3-dimensional transrectal ultrasonography (3D-TRS) in adolescent patients with polycystic ovarian syndrome (PCOS).

METHODS

Ovarian follicle number, ovarian volume, ovarian stromal area, total ovarian area, and stromal area to total area ratio (S/A) were evaluated using 3D-TRS in 75 amenorrheic, oligomenorrheic, or asymptomatic virgin patients and 25 healthy controls. Serum biochemical markers of PCOS were assayed during the early follicular phase of the menstrual cycle in menstruating patients and controls, and on a randomly selected day in amenorrheic patients.

RESULTS

When assessing the delicate structure of the ovary in virgin patients, 3D-TRS was convenient, accurate, specific, sensitive, and more reliable overall than transabdominal ultrasonography. Ovarian stromal area and S/A ratio were significantly greater in patients with PCOS than in controls, and also in the patients who had ultrasonically diagnosed polycystic ovaries without clinical or biochemical evidence of PCOS. The S/A ratio was the studied variable most significantly correlated with androgen levels.

CONCLUSIONS

These findings indicated that, in adolescent patients, 3D-TRS combined with transabdominal ultrasonography can improve the precision of the diagnosis of PCOS. The S/A ratio may become the ultrasonographic diagnostic marker for PCOS.

Broadband attenuation and nonlinear propagation in biological fluids: an experimental facility and measurements

The design and construction of a versatile experimental facility for making measurements of the frequency-dependence of attenuation coefficient (over the range 1 MHz to 25 MHz) and nonlinear propagation in samples of biological fluids is described. The main feature of the facility is the ability to perform all of the measurements on the same sample of fluid within a short period of time and under temperature control. In particular, the facility allows the axial development of nonlinear waveform distortion to be measured with a wideband bilaminar polyvinylidene difluoride membrane hydrophone to study nonlinear propagation in biological fluids. The system uses a variable length bellows to contain the fluid, with transparent Mylar end-windows to couple the acoustic field into the fluid. Example results for the frequency-dependence of attenuation of Dow Corning 200/350 silicone fluid, used as a standard fluid, are presented and shown to be in good agreement with alternative measurements. Measurements of finite amplitude propagation in amniotic fluid, urine and 4.5% human albumin solutions at physiological temperature (37 degrees C) are presented and compared with theoretical predictions using existing models. The measurements were made using a 2.25-MHz single-element transducer coupled to a polymethyl methacrylate lens with a focal amplitude gain of 12 in water. The transducer was driven with an eight-cycle tone burst at source pressures up to 0.137 MPa. In general, given an accurate knowledge of the medium parameters and source conditions, the agreement with theoretical prediction is good for the first five harmonics.