Transvaginal Colour Doppler: The Scientific Basis and Practical Application of Colour Doppler in Gynaecology

210 Pages·1995·8.974 MB·English

by  T. Loupas, R. W. Gill (auth.), Tom Bourne MB. BS, Ph.D., MRCOG, Eric Jauniaux M.D., Ph.D., Davor Jurkovic M.D., Ph.D., MRCOG (eds.)

Transvaginal Colour Doppler
Springer
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T.H. Bourne E. Jauniaux
D. Jurkovic (Eds.)
Transvaginal
Colour Doppler
The Scientific Basis
and Practical Application
of Colour Doppler in Gynaecology
With Contributions by
S. Athanasiou, B. Bauer, R. Bicknell, J.E. Boultbee, T.R. Bourne,
G.J. Burton, S. Campbell, L.D. Cardozo, F.A. Chervenak, J.A. Cullinan,
F. Flam, A.C. Fleischer, R. Fox, R.W. Gill, K. Grubock, E. Racket,
J. Rustin, E. Jauniaux, D. Jurkovic, D. Kepple, V. Khullar, T. Loupas,
G. Moscoso, E.S. Newlands, K. Reynolds, G. Sharland,
I.P. van Splunder, C.V. Steer, A. Tailor, M. Toth, L. Valentin,
J. W. Wladimiroff
Springer
TOM BOURNE MB. BS, Ph.D., MRCOG
Academic Department of Obstetrics & Gynaecology
King's College School of Medicine & Dentistry
Denmark Hill, London SE5 8RX
United Kingdom
ERIC JAUNIAUX, M.D., Ph.D.
Academic Department of Obstetrics & Gynaecology
University College London Medical School
86-96 Chenies Mews, London WCIE 6HX
United Kingdom
DAVOR JURKOVIC, M.D., Ph.D., MRCOG
Academic Department of Obstetrics & Gynaecology
King's College School of Medicine and Dentistry
Denmark Hill, London SE5 8RX
United Kingdom
With 97 Figures, Some in Colour
ISBN -13 :978-3 -642-79266-3 e-ISBN -13: 97 8-3-642-79264-9
DOl: 10.1007/978-3-642-79264-9
Library of Congress Cataloging-in-Publication Data. Transvaginal colour Doppler:the scientific
basis and practical applications of colour Doppler in gynaecology/Tom H. Bourne, Eric j auniaux,
Davor jurkovic, eds.:with contributions by S. Athanasiou ... let al.J. p. cm. Includes biblio
graphical references and index. ISBN-13:978-3-642-79266-3 (alk. paper)I.Transvaginal ultrasono
graphy. 2. Doppler ultrasonography. I. Bourne, Tom H., 1959- . II. jauniaux, E.
III. jurkovic, Davor, 1958- . IV. Athanasiou, S. [DNLM: I. Genital Diseases, Female
ultrasonography. 2. Urogenital System-ultrasonography. 3. Prenatal Diagnosis. WP 141 T7713
1995J RGI07.5.T73T72 1995 618.I'07543-dc20 DNLMIDLC for Library of Congress 95-2189
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Preface
Since the pioneering work of Donald and his first Lancet paper in 1958,
the use of ultrasound in obstetrics and gynaecology has evolved rap
idly. The introduction of grey scale techniques enhanced our ability to
identify different tissues on the basis of their texture. However, it was
the introduction of the linear array real-time scanner in the mid seven
ties that changed ultrasound from being an "eccentric art form" to a
readily available and usable technique. This led to the first reports of
the diagnosis of neural tube defects using ultrasound by Campbell, as
well as the establishment of fetal biometry. In the midst of this activity
the parallel development of the transvaginal probe by Kratochwill went
almost unnoticed by most gynaecologists. Yet the application of this
technique has since had a major impact on many areas of gyna
ecological practice, and on infertility in particular. Since the demon
stration of transvaginal follicle aspiration, the vaginal route has
become standard for most invasive ultrasound guided gynaecological
procedures. The relatively new technical advance of transvaginal
colour Doppler may potentially have just as great an impact. The
introduction and use of transvaginal colour flow imaging has facili
tated the study of vascular changes within the pelvis. The follicle and
corpus luteum of the ovary and the endometrium of the uterus are the
only areas in a normal adult body where angiogenesis (the develop
ment of new blood vessels) occurs to any significant extent; the same
process occurs during the growth of carcinomas. The ability to
recognise these early vascular changes with colour Doppler is facilitat
ing the diagnosis of pelvic cancers as well as normal and abnormal
ovarian and uterine function. It seems likely that this new technique
will lead to a greater understanding of how vessel growth is involved in
reproductive pathophysiology. The ability to monitor changes in vas
cularity may enable the development of methods to inhibit or enhance
angiogenic activity in vivo.
There are problems to be overcome, however, before we should
become overenthusiastic about this new technology. A brief review of
the literature on the subject reveals a significant variation in results
obtained by different authors. When we first published a series of
ovarian tumours assessed with t:t:ansvaginal colour Doppler, of 30
VI Preface
tumors studied there was one false negative and one false positive test
result for the presence of ovarian carcinoma. The test was never likely
to be perfect. At that time we thought low impedance flow was
pathognomonic for the presence of carcinoma. Subsequently we ob
served that such flow patterns were a ubiquitous finding throughout
many ovarian cycles, and not unusual even in postmenopausal ovaries.
It has become clear that the classification of ovarian tumours in young
women using transvaginal colour Doppler is difficult. Anyone who
actually performs such scans themselves will be familiar with the wide
variety of blood flow patterns that may be generated from premeno
pausal ovaries.
The wide variability in results encountered by many users of
colour Doppler has led to confusion. In fact colour Doppler is neither
as good as some workers proclaim nor as bad as others would have us
believe. The truth lies somewhere in the middle. Used uncritically, in
isolation and in inexperienced hands, transvaginal colour Doppler will
be at best useless and at worst dangerous. One is reminded of a famous
English photographer who observed that whilst there must be millions
of SLR camaras in England, it was a shame that less than ten of the
owners knew how to use them. Unfortunately, whilst obviously an
exaggeration, the situation with colour Doppler machines is not so
very different. The number of doctors who wish to learn colour Dop
pler having had little or no experience of B mode ultrasonography
illustrates the problem.
Notwithstanding the limitations discussed in this book, when ap
plied by expert operators and in a disciplined fashion, colour Doppler
will add significantly to the diagnostic information available. We
believe that there has been a tendency towards overenthusiasm and
uncritical acceptance of transvaginal colour Doppler into clinical
practice. This is unhelpful both for clinicians and patients, as well as
for the technique itself. In this book we believe we have presented a
realistic picture of the work that has been performed to date using this
technique, whilst indicating possible applications in the future. We
hope the reader will be left with a clear picture of what to believe and
not believe when interpreting data related to colour Doppler, and a
better understanding of what to expect from their equipment.
London, February 1995 TOM BOURNE
ERIC JAUNIAUX
DAVOR JURKOVIC
Contents
I. General Principles
Principles of Colour Doppler
T. LOUPAS and R.W. GILL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Angiogenesis
K. REYNOLDS and R. BICKNELL 13
Vascular Anatomy of the Pelvis
G.J. BURTON ......................................... 20
The Human Heart - Development of Form and Function
G. Moscoso ......................................... 28
Vascular Features of Gynaecological Neoplasms
H. Fox.............................................. 42
Vascular Physiology and Pathophysiology of Early Pregnancy
J. HUSTIN ........................................... 47
New Diagnostic and Therapeutic Approaches
to Gestational Trophoblastic Tumors
J.E. BOULTBEE and E.S. NEWLANDS . . . . . . . . . . . . . . . . . . . . . . . 57
II. Uterus
Vascular Changes During the Normal and Artificial Cycle
C.V. STEER .......................................... 69
Uterine and Endometrial Pathology
A.C. FLEISCHER, T.H. BOURNE, J.A. CULLINAN,
and D.M. KEPPLE ..................................... 79
Investigation of the Utero-Placental Circulation
E. JAUNIAUX, D. JURKOVIC, and S. CAMPBELL .............. 88
VIII Contents
Transvaginal Colour Doppler in Trophoblastic Disease
F. FLAM............................................. 99
III. Ovaries and Fallopian Tubes
Vascular Changes During the Ovarian Cycle
1. VALENTIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Ovulation and the Periovulatory Follicle
T.H. BOURNE, S. ATHANAS IOU, and B. BAUER 119
The Study of Ovarian Tumours
T.H. BOURNE, K.GRUBOCK, and A. TAILOR. . . . . . . . . . . . . . . .. 131
Transvaginal Color Doppler Ultrasound
in Pelvic Inflammatory Disease
M. TOTH and F.A. CHERVENAK. . . . . . . . . . . . . . .. . . .. . . . . .. 146
Transvaginal Colour Doppler Studies of Ectopic Pregnancy
D. JURKOVIC, E. JAUNIAUX, and S. CAMPBELL .............. 153
Hystero-Contrast-Salpingography - Colour Doppler
and the Study of Fallopian Tube Patency
T.H. BOURNE and E. HACKET . . . . . . . . . . . . . . . . . . . . . . . . . . .. 161
IV. Embryo or Fetus
Assessment of the Early Foetal Circulation
J.W. WLADIMIROFF and I.P. VAN SPLUNDER 175
Transvaginal Examination of the Foetal Heart
G. SHARLAND ........................................ 184
V. Urinary Tract
Doppler Studies of the Lower Urinary Tract
V. KHULLAR and 1.D. CARDOZO ......................... 195
Subject Index ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203
List of Contributors
ATHANAS IOU, S., M.D., MRCOG
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SES 8RX, United Kingdom
BAUER, B., M.D.
The Ovarian Screening and Gynaecological Scanning Unit,
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SES 8RX, United Kingdom
BICKNELL, R., Ph.D.
Molecular Angiogenesis Group, Imperial Cancer Research Fund
Laboratories, Institute of Molecular Medicine,
University of Oxford, John Radcliffe Hospital, Headington,
Oxford OX3 9DU, United Kingdom
BOULTBEE, J.E., MRCP
Department of Radiology, Charing Cross Hospital,
Fulham Palace Road, London W6 8RF, United Kingdom
BOURNE, T.H., MB. BS, Ph.D, MRCOG
Ovarian Screening and Gynaecological Ultrasound Unit,
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SES 8RX, United Kingdom
BURTON, G.J., M.D.
Department of Anatomy, University of Cambridge,
Downing Street, Cambridge CR2 3DY, United Kingdom
CAMPBELL, S., FRCOG
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SES 8RX, United Kingdom
X List of Contributors
CARDOZO, L.D., M.D., FRCOG
Academic Department of Obstetrics and Gynaecology,
The Urogynaecology Unit, King's College Hospital,
Denmark Hill, London SE5 8RX, United Kingdom
CHERVENAK, F.A., M.D.
Department of Obstetrics and Gynaecology,
The New York Hospital, Cornell Medical Center,
525 East 68th Street, New York, NY 10021, USA
CULLINAN, J.A., M.D.
Department of Radiology and Radiological Sciences, Section
of Diagnostic Sonography, Vanderbilt University Medical Centre,
Nashville, TN 37232-2675, USA
FLAM, F., M.D.
Department of Obstetrics and Gynaecology, Karolinska Hospital,
17176 Stockholm, Sweden
FLEISCHER, A.C., M.D.
Department of Radiology and Radiological Sciences, Section
of Diagnostic Sonography, Vanderbilt University Medical Centre,
Nashville, TN 37232-2675, USA
Fox, H., M.D., FRCOG, FRC Path.
Department of Pathological Sciences, Stop ford Building,
University of Manchester, Manchester M13 9PT, United Kingdom
GILL, R.W., Ph.D.
Ultrasonics Laboratory, Division of Radiophysics - CSIRO,
126 Greville Street, Chatswood NSW 2067, Australia
GRUBOCK, K., M.D.
The Ovarian Screening and Gynaecological Scanning Unit,
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SE5 8RX, United Kingdom
HACKET, E., M.D.
The Ovarian Screening and Gynaecological Scanning Unit,
Academic Department of Obstetrics and Gynaecology,
King's College School of Medicine and Dentistry, Denmark Hill,
London SE5 8RX, United Kingdom
HUSTIN, J., M.D., Ph.D.
Institut de Morhologie Pathologique, Allee des Templiers,
41,6280 Loverval, Belgium