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Questions and Answers
What does a pulsatility index (PI) of less than 1.0 indicate in terms of ovarian health?
Which of the following conditions may present with low resistive index (RI) values, potentially mimicking cancer?
In the context of Doppler ultrasound, what is indicated by increased diastolic flow in the ovaries?
What is a primary characteristic of functional ovarian cysts compared to complex ovarian masses?
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What is the normal expected appearance of ovaries in sonographic assessments?
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What is the relationship between tumor complexity and malignancy in solid tumors?
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During which phase of the menstrual cycle should patients with normal cycles be scanned for ovarian assessments?
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Which of the following signs may indicate a malignant adnexal mass?
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What is a common characteristic of ovarian masses during the hyperstimulation phase of infertility treatment?
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What does a decreased resistive index (RI) suggest when evaluating ovarian masses?
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If a solid mass is found, what is crucial for differentiating an ovarian lesion from a pedunculated fibroid?
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What is the implication of a solid ovary with a volume twice that of the opposite side?
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How does the diastolic flow change throughout the menstrual cycle?
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What is the sonographic appearance of a mature corpus luteum after ovulation?
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What occurs to the corpus luteum in the absence of fertilization?
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Which characteristic helps in the identification of postmenopausal ovaries during ultrasound?
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What is the normal ovarian volume for an adult menstruating female?
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When is an ovarian volume considered abnormal in a postmenopausal patient?
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What are small, punctate echogenic foci in the ovary typically indicative of?
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How can the challenge of visualizing ovaries post-hysterectomy be mitigated?
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What does the presence of a typical 'ring' color Doppler pattern indicate in ovarian ultrasound?
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Study Notes
Normal Sonographic Appearance
- Fluid in the cul-de-sac commonly seen after ovulation and peaks in early luteal phase
- Corpus luteum develops after ovulation and may be visualized as hypoechoic or isoechoic structures peripherally within the ovary.
- Color Doppler may show a "ring" pattern around an isoechoic corpus luteum
- Corpus luteum undergoes involutional changes on postovulatory days 8 or 9.
- Multiple small, punctate, echogenic foci are commonly seen in normal ovaries
- Foci are generally small and located in the periphery
- Foci are nonshadowing and can be multiple
- The ovary atrophies postmenopausally and becomes difficult to visualize owing to follicle disappearance.
- A stationary loop of bowel may mimic the appearance of a small, shrunken ovary.
Ovarian Volume
- Normal ovarian volume in an adult menstruating female is up to 22 ml.
- Mean ovarian volume is 9.8 +/- 5.8 ml.
- Ovarian volume greater than 8 ml in a postmenopausal patient is considered abnormal.
- Ovarian volume greater than double the size of the opposite ovary in a postmenopausal patient is considered abnormal.
Doppler of the Ovary
- Doppler imaging can be used to measure blood flow within the ovary.
- Pulsatility index (PI) is a measure of blood flow resistance.
- Resistive index (RI) is another measure of blood flow resistance.
- Increased diastolic flow suggests neovascularity, a potential sign of malignancy.
- Complete absence or minimal diastolic flow usually indicates benign disease.
- A general cut-off value for PI is 1.0 and 0.4 for RI.
- Malignancy is more likely below these values, while benign disease is more likely above these values.
- Inflammatory masses, active endocrine tumors, and trophoblastic disease may give low-resistance values, mimicking cancer.
Ovarian Pathology
- Increased complexity in a solid tumor is more likely to be malignant, particularly if associated with ascites.
- An ovary with a volume twice that of the opposite side is generally considered abnormal.
- Color Doppler can identify a vascular pedicle between the uterus and a mass, helping to differentiate between an ovarian lesion and a pedunculated fibroid.
- Optimal time for scanning patients with normal menstrual cycles is during the fist 10 days of the cycle.
Doppler of the Ovary
- Values for RI and PI may vary considerably during the menstrual cycle in fertile patients.
- The highest resistance and lowest diastolic flow, along with the highest indices, occur in the first 7 days of the cycle.
- Diastolic flow increases, particularly in the dominant ovary, later in each cycle, which can falsely suggest a malignant process.
- Color Doppler can differentiate cysts from vascular structures.
- Pulsed Doppler can demonstrate arterial and venous flow within ovarian tissue and can measure the resistive index or pulsatility index.
- Prominent flow to the ovary may be seen during the hyperstimulation phase of infertility treatments.
Doppler of the Ovary
- Intratumoral vessels, low-resistance flow, and the absence of a normal diastolic notch in the Doppler waveform may suggest malignancy.
- Abnormal waveforms can be seen in inflammatory masses, metabolically active masses (including ectopic pregnancy), and corpus luteum cysts.
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Description
This quiz covers the normal sonographic appearance of ovaries, including the corpus luteum and ovarian volume. It emphasizes ultrasound findings such as fluid in the cul-de-sac and the characteristics of follicles in both menstruating and postmenopausal women. Test your knowledge on the visual indicators and abnormal values within ovaries.
