Gynecological ultrasound.

Despite the development of other noninvasive modalities to image the female pelvis, ultrasound continues to be the workhorse with respect to imaging the uterus and adnexae. Over the past decade, there has been a shift away from the transabdominal approach, and in most cases a complete examination can be done successfully using a transvaginal approach. 10 Lack of a distended urinary bladder minimizes patient discomfort, and a shorter distance between the transducer and target organs allows the use of higher-frequency transducers. In addition, in conjunction with physical palpation of the lower pelvis, the vaginal probe can be used in a manner similar to a bimanual gynecologic examination to determine organ mobility and the site of maximal pelvic tenderness. Continued investigations with both gray-scale and Doppler techniques have improved the ability to characterize ovarian masses. It is often possible to determine with a high degree of confidence masses that can be observed versus those that require additional imaging or surgery. With respect to the uterus, careful observation and understanding pathophysiologic changes have improved the ability to characterize adenomyosis and to differentiate this condition from uterine fibroids. Endometrial pathology can now be imaged optimally by sonohysterography, and as a result logical decisions can be made with regard to the need for hysteroscopy as opposed to endometrial biopsy or curettage. The more recent addition of three-dimensional imaging also shows great promise, especially for characterizing uterine anomalies, evaluating endometrial cancer, and complementing sonohysterography. This article focuses on the ovary and uterus and emphasizes practical approaches for analyzing pathology that relates to these organs.