New Advances in Genitourinary

Ultrasound

Jared D. Christensen, MD
Vikram S. Dogra, MD
- Basic ultrasound physics
The piezoelectric effect
The pulse-echo principle
Acoustic impedance
- Types of ultrasound
Conventional grayscale (B-mode)
Doppler ultrasound
- Acquisition and processing enhancement
Harmonic imaging
Spatial compound imaging
Speckle reduction imaging
Extended field of view
Three-dimensional ultrasound
Four-dimensional ultrasound
- Innovations in ultrasound
Contrast agents
High-intensity focused ultrasound
Compact ultrasound systems
- Emerging technologies
Sonoelastography
Near-infrared ultrasound
Animal imaging in genitourinary ultrasound
Capacitative micromachined ultrasonic transducers
- Summary
- References
Fig. 1. Longitudinal B-mode sonogram of
normal kidney demonstrates
characteristic parenchymal
echogenicity.
Fig. 2. Ovarian torsion. (A) Grayscale ultrasound
demonstrating an enlarged, heterogenous right
ovary. (B) Colorflow Doppler reveals a lack of
parenchymal vascularity consistent with torsion.
(C) Power Doppler confirms the lack of flow.
Fig. 3. Comparison of techniques to improve ultrasound imaging resolution. (A)
Harmonic imaging of a normal kidney reveals improved tissue contrast with better
corticomedullary differentiation in comparison to conventional B-mode ultrasound
(see Fig. 1). (B) Spatial compound imaging. (C) Speckle reduction.
Fig. 4. Gray-scale sonogram of left testis
with extended field of view demonstrating
the full extent of a spermatocele and its
relation to the adjacent testis.
Fig. 6. Three-dimensional volume acquisition of
septate uterus. Three-dimensional imaging assists
in defining the anatomic relationships of the uterine
cornua, fundus, and muscular septum. (Courtesy of
Philips Medical Systems; with permission.)
Fig. 5. Three-dimensional volume acquisition of the
uterus in the coronal plane with surface rendering
illustrates normal myometrium and endometrium.
(Courtesy of Philips Medical Systems; with
permission.)
Fig. 7. Three-dimensional power Doppler Fig. 8. Ultrasound contrast on grayscale imaging
sonogram with maximum intensity projection outlining the renal arterial blood supply.
algorithm shows tortuous cavernosal artery
caused by atherosclerosis with severe
segmental stenosis (arrow) in a patient who
has erectile dysfunction.
Fig. 9. Apparent normal two-dimensional grayscale image of the prostate (A). The
corresponding sonoelastogram (B) reveals a discrete peripheral mass (arrows) seen as
a dark area within normal parenchyma (green). Note that the color overlay corresponds
to tissue elasticity, with black being most hard or stiff. This lesion was subsequently
biopsied and proven to represent prostatic carcinoma. (Courtesy of Kenneth Hoyt,
Rochester, NY.)
Summary

Ultrasound technology and its application in the evaluation of genitourinary disease

continue to improve (Table 1). Advances in signal acquisition and processing have
resulted in better spatial resolution and image quality, particularly for conventional
2D applications. Multidimensional imaging provides detailed spatial relationships
that can be reconstructed from any viewing angle and readily compared over time.
New transducer materials and components allow for volumetric imaging and real-
time variable frequency selection. A role for ultrasound as a therapeutic modality is
being established through broadening applications of HIFU.
Ultrasound contrast agents and emerging hybrid technologies incorporating NIR
diffusive imaging permit the assessment of vascularity and flow states previously
achievable only with CT and MR imaging. The rapid rate of new advances in
ultrasound applications requires close consultation and collaboration with
nonimaging specialists to ensure that patients receive the highest standard of care.
TERIMA KASIH