Ultrasonografa

Anatoma para el mejor uso de nosotros

Imagen Bsica
Este es el posicionamiento popular de la colocacin de una sonda y las imgenes (foto) en el monitor observando. Esto concuerda con el nivel de AIUM (Instituto Americano de Ultrasonido en Medicina), pero no necesariamente tienen que ser estrictamente igual. Exploracin sagital

Imagen

Imagen Sagital
vientre de lado

Imagen transversa
vientre de lado

cabeza

pie

derecha

izquierda

Parte de atrs
El procesamiento de imgenes examinando a un paciente desde la derecha.

Parte de atrs
El procesamiento de imgenes examinando a un paciente desde el lado de la pierna.

. 2

Organos Abdominales
Los rganos especficos internos de la ecografa abdominal son: el hgado, la vescula biliar, el pncreas, los riones y el bazo. Debido a que la mayora de ellos estn cubiertos con las costillas, una sonda debe ser operado entre las costillas o debajo de los arcos costales.
Hgado Conducto biliar

Bazo Vescula Biliar

Pancreas Rin derecho Interior vena cava

Rin izquierdo

Aorta
.

Sistema Vascular del Hgado

Es crucial comprender la posicin de la va vascular complicada por el hgado. El hgado es el ms grande de los rganos slidos en la cavidad abdominal, tocando la parte inferior de un diafragma. El margen anterior es agudo y delgado, y el margen posterior es esfera redonda.
Vena cava inferior Vena hepatica central Vena hepatica derecha Vena hepatica izquierda Rama izquierda de

Vena porta derecha Vena porta izquierda Rama superior frontal de la vena porta Rama inferior frontal de la vena porta Rama superior posterior de la vena porta Rama inferior posterior de la vena porta Rama superior de la vena porta interior Rama inferior de la vena porta interior Rama superior de la vena porta exterior Rama inferior de la vena porta exterior Ligamento redondo del hgado
: hgado son (Clasificacin de rea de Couinaud)

la vena porta (parte lateral)

Parte umbilical

Vena porta Vescula biliar Conducto biliar comn

Higado
Segmento de hgado: En el diagnstico de ultrasonido, el hgado se divide en ocho segmentos, teniendo la vena porta, la vena heptica, el ligamento, la fisura, etc como indicadores. Ya que la ubicacin de la lesin descrita se indica a menudo por los ocho segmentos, que vale la pena conocer. (Segmento de Couinaud) Couinaud Segment
Right hepatic vein Middle hepatic vein Vesicula biliar IVC Umbilical portion
Caudado del lbulo + Proceso de caudado Left lateral superior sub segment Left lateral segment Left lateral inferior sub segment Left medial segment Right anterior inferior sub segment Right posterior inferior sub segment Right posterior superior sub segment Right anterior superior sub segment Right anterior segment

Liver district classification:

Portal vein

Left lobe

Right lobe

Right posterior segment

Higado
Exploracin derecha subcostal
Middle hepatic vein Liver Rt hepatic vein

Exploracin Sagital

Liver

Cmo localizar la sonda

Como localizar la sonda

El mayor rgano del cuerpo. Se sabe que tiene una gran cantidad de funciones. Desempea un papel crucial en el metabolismo, excrecin, desintoxicacin, mantenimiento de la homeostasis de fluidos corporales, etc. Su resolucin de alcohol es especialmente ampliamente bien conocida. Se segrega la bilis en el duodeno, jugando un cierto papel en la digestin, tambin. Su funcin cuenta al menos ms de 500. Se dice que es imposible producir una fbrica de productos qumicos con las mismas funciones que un hgado hace cuando para expresar la amplia variedad de sus funciones. con un hgado.

Higado
DR Angio RI

MMG

RI

CT CT

MRI

US

Carcinoma hepato celular

La lesin se expresa como la imagen que falta. En la gammagrafa dinmica, la ubicacin es capturada cuando la funcin del hgado es la SPECT.

Carcinoma hepato celular

Carcinoma hepato celular

En la imagen izquierda, la lesin se expresa como el rea de observacin de alta por los medios de contraste. En la imagen de la derecha, los huesos son eliminadas por el proceso de retoque, y la lesin se expresa como la imagen que falta en el rea de observacin bajo.

MRI

US

Tumor en el higado metastsico

Tumor en el higado metastasico Exploracin del corte opcional, y fcil observacin de las lesiones por el excelente contraste de tejidos. Los metstasis de cncer son reconocidos en todo el hgado.

Hemangioma hepatico
Muchos de los angiomas ms brillantes que la reflexin eco del parnquima heptico son reconocidos.

La vescula biliar y sus alrededores

La vescula biliar est en contacto con la parte inferior del hgado, y tiene un volumen de 30 ~ 60 ml. El conducto biliar es una va de bilis, y al final se pasa a travs de la cabeza de pncreas despus de pasar detrs de un duodeno, y se conecta a la papila de Vater en un duodeno. La vescula biliar se puede dividir en tres segmentos de la parte cercana al conducto cstico: la regin cervical, el cuerpo y la parte basilar.
Vena porta: La vena que recoge la sangre notoria desde el estmago, los intestinos, el pncreas, la vescula y el bazo y la dirige hacia el hgado. Un vaso sanguneo funcin del hgado. Estmago etc. lbulos izquierdo y derecho del hgado hepatocitos venas hepticas vena cava inferior Sistema biliar: bilis (camino de los cidos biliares, bilirrubina, colesterol, fosfolpidos, mucina, minerales Solt) Hepatocitos conducto heptico derecho e izquierdo vescula biliar (concentracin, cerca de ocho veces) del conducto biliar comn duodeno.
.

right hepatic duct

left hepatic duct) (left portal vein

right portal vein common hepatic duct

liver

Conducto cstico

main portalvein triple confluence

gall bladder duodenum

splenic vein Vena mesentrica superior

conducto pancreatico principal

papila duodenal ( papila de Vater

Vesicula biliar
Exploracin derecha subcostal Exploracin derecha intercostal

GB

higado

Rama izquierda de la vena porta

portal vein liver

GB

Como localizar la sonda (Consejos) Pida a un alumno para mantener la respiracin profunda para suprimir el movimiento de los rganos. Esto hace ms fcil encontrar el lugar. Para un gordo, de 45 grados la posicin sentada es ms fcil hacer que una imagen clara. (Punto de control) Lumen no tiene eco. Compruebe si hay en el interior de eco. Compruebe si el espesor de la pared de la vescula biliar es an ms.

How to place a probe

(Consejos) A diferencia del arco inferior costal derecho, pida a un alumno que deje de respirar. Para un delgado, a veces se mueve dentro de la pelvis en el lado dereho del abdomen. Se puede hacer una imagen clara de las grasas. (Punto de control) Compruebe si la luz no tiene eco. Espesor de la pared de la vescula es par, ya veces el pequeo se puede observar. Tenga cuidado de no hacer un diagnstico equivocado, teniendo como lesin. .

Vesicula biliar
DR Angio DR MMG RI CT RI MRI US MRI

CT

normal Piedracoleocistitis Carcinoma de vesicula Las funciones del hgado, el conducto biliar y la vescula biliar son observados por la gammagrafa dinmica con el momento. Gallstones The common bile duct enlarged with gallstones is observed without contrast media.

Izquierda: Varios clculos biliares se observan en la vescula biliar. Derecha: Este es el caso de la insercin de un stent en el conducto biliar y la estenosis tratada constreido.

CT

US

Gallstones Gallstones Contrast media enables to check if gallstones are in the gallbladder, and if there are, their sizes. 3D image tells the position, size and shape of a gallstone.

Gallstones

Cholesterol polyp

Both stones and polyps are often rendered in high brightness. They can be distinguished by changing body position and echo loss. .

10

Pancreas, Spleen and the Surroundings

portal vein accessory papilla
accessory pancreatic duct

spleen)

duodenal

pancreatic duct

duodenal papilla left kidney

pancreas main pancreatic duct

)
abdominal aorta

The upper side of the pancreas touches the antrum of stomach and the duodenal bulb, and the caudal portion touches the gastric corpus. Therefore, to decrease influence from gastrointestinal gas, 45-degree sitting position, water as much as an examinee can drink, etc are taken to replace the gas with liquid. However, in case of an examinee who is fat or has a contracted pancreas, the examination is difficult because sometimes gastrointestinal tracts are overlapped on the abdominal side of a pancreas, thick fatty layers of omentum or lesser omentum lie in between, etc.

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Pancreas
Sagittal Scan Pancreas longitudinal Scan

liver pancreas liver pancreas

SMA

How to place a probe. (Advice) Render the image of the hepatic left lobe and the ramification point of aorta and super mesenteric artery (SMA). Render the image of the artery in membrane cavity and the image of the pancreas body at the end. (Checkpoint) The normal image is oval. The parenchyma is even spotted echo. How to place a probe. (Advice) Turn the probe by 90 degrees in the examination on the left picture so that the liver remains in the top of the image. Tilt the probe so that it looks down the feet and render the image referring to the splenic vein. When rendering the image is difficult, make an examinee sit or drink water (500 ml), and give the examination as echo window*. *echo window: A window which has a good passage of echo beams by water to eliminate the influence from gas generated by stomach, etc. (Checkpoint) Surface is smooth, and magatama-shaped organ. The paremchyma is even spotted echo. Long follow-up survey is possible for the pancreatic vein. The norm is below 2 mm in a pancreatic duct diameter. .

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Spleen

How to place a probe.

Left Intercostal Scan

Immune Function: In the white pulp spleen, B cell (B lymphocyte), T lymphocyte and plasmocyte are matured, holding immune system against pathogens which increase in blood. When people removed the spleen suffer from malaria, it tends to be serious. Hematogenesis Function: During a prenatal period, a red blood corpuscle is produced in a spleen before a bone marrow starts hematogenesis. After delivery, this function disappears, but at massive hemorrhage or suppress of bone marrow function, its found that a spleen sometimes start hematogenesis (extramedullary hematopoiesis). Rats and mice continue hematogenesis in a spleen after delivery. Destruction of Blood Cell: The spleen destroys old blood cells. It destroy hemoglobin in red blood corpuscles and collect iron, on the other hand.

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Pancreas
DR Angio MMG DR RI CT MRI RI US

pancreatic head carcinoma Left: The second and third ramifications are clearly described. Right: A disrupted small pancreatic duct is also clearly described.

chronic pancreatitis

normal
Its performed when a malignant tumor in a pancreas is suspected owing to a lot of gonadal exposure.

CT

MRI

US

myelolipoma/pancreatic duct network In the left image, low absorption region (lesion) is recognized, and the body of the pancreas and the pancreatic duct is clearly described. In the right image, blood vessels providing nutrition to the pancreas can be observed three dimensionally by 3D processing. A pancreas cancer is suspected.

normal
The positions of the bile duct and the pancreatic duct can be observed by noninvasive way without contrast media.

enlargement of the pancreatic duct Its difficult to render the image of the whole pancreas by the gas influence. Enlargement of the pancreatic duct becomes a diagnostic indicator. .

14

Kidney and the Surroundings

Kidneys are in retroperitoneum, on both sides of a spine. The left one is located in a higher position, and bigger than the right one. The port of a kidney is called portal renis. Tubular structure is arranged in the order of a renal vein, a renal artery and an ureter from an antrum wall.

right adrenal gland renal cortex

sdrenal gland

spleen

renal artery

renal pelvis renal calyx right kidney renal pyramid ureter

renal vein

left kidney

The right adrenal gland is triangle, and located directly above the kidney. The left one is semicircular and located in the front upper. They are small organs in adipose tissue of upper retroperitoneum.
.

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Kidney
Rt Kidney (intercostal scan) Lt Kidney (intercostal scan)

spleen liver Lt kidney Rt kidney

How to place a probe.

How to place a probe.

The kidney is one of organs in a urinary system. Its a crucial organ. Its major functions are to filter and excrete extra water and waste from blood and maintain homeostasis of body fluid. The right one touches the liver, and the image can be rendered over the liver. Fatty liver can be diagnosed by comparing echo brightness of renal parenchyma and liver parenchyma. (liver-kidney contrast)
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Kidney
DR Angio MMG DR RI CT MRI RI US

hydronephrosis Left: DIP examination. Checking shapes and functions of the kidney, the ureter and the urinary bladder with time being. Right: RP examination. Its observed that the ritght ureter of the urinary bladder flows backward and reaches the kidney.

No findings Dynamic scintigraphy: it can observe forms and functions of the kidney and the urinary system.

CT

MRI

US

Renal cell carcinoma For the kidney, contrast media is effective. Lesion (low absorption area) can be confirmed clearly by an examination with contrast media. 3D image makes it possible to check the location, size and form three dimensionally.

Renal cell carcinoma

It gives fine contrast in soft tissues and clear observation for infiltration of lesions.

Renal angiomyolipoma Its described as the lesion with focal high brightness in the area of low brightness in kidney cortex. .

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Male Reproductive Organ and the Surroundings

peritoneum

bladder pubis prostate

rectum

seminal vesicle puctus deferens prostatic utricle

corpus cavernosum

testicle scrotum

anus

18

Prostate
Transabdominal Scan Transrectal Scan

bladder prostate

How to place a probe

How to place a probe

(Advice) Perform an examination by the full bladder technique. Its suited to find a lesion in a bladder and observe the prostate gland, but not suited to perform diagnosis of a form or parenchyma, for which a probe specialized in a transrectal is usually used instead of it. (Checkpoint) Check if theres no echo with no stones in the bladder, and the bladder wall is thin and smooth. The prostate gland is under the bladder, gives high echo and described evenly. Check if therere no stones or nodes.

(Advice) Render image referring to no echo area in the bladder. If image is arranged upside down, it corresponds to a transabdominal scan in a vertical relationship. It makes it easy to understand. It sometimes renders an hazy image in bladder. (urinary flow) (Checkpoint) The whole of the bladder or the prostate gland can be scanned by turning a probe to the right and left. . 19

 Prostate
DR Angio DR MMG RI CT CT MRI MRI US

Benign prostatic hypertrophy

Right: CUG examination. Exclusion of the bladder and the urethra can be well observed

Normal range

Prostatic carcinoma Progress of the lesion can be easily observed.

US

Benign prostatic hypertrophy

Prostate calcification

Transabdominal observation of the prostate gland is possible by the full bladder technique, but a transrectal examination gives more detailed observation. High brightnessmeans calcifications. .

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Obstetrics and Gynecology

bladder cavity of uterus uterus

symphysis pubica

urethra vagina

Obstetrics Image of size of a baby in the uterus, the position, movement, volume of amniotic fluid and aberration in the pelvis can be rendered. US is often applied to symptoms that require examinations at the time of pregnancy, delivery and postpartum. Gynecology US is profitable to estimate an ovulation day for infertility, find out inflammation in hypogastrium and discriminate between benign tumors and malignant ones. In both areas, US renders clear image since scan for body cavity through the vagina enables contacting mucous membrance and receive no influence from intestinal gas. Therefore its often used and indispensable in diagnosis of pregnancy in the early stage and placenta previa. Recently, with a transvaginal probe, needle aspiration of cysts and ovum collection for artificial fertilization are studied. US is under great development as a tool of diagnosis and treatment. . 21

uterine tube douglas ovary

anus

uterine cervix

rectum

 Uterus
Transabdominal scan

bladder

uterus

uterus

How to place a probe

endometrium Longitudinal Scan of Uterus

How to place a probe

Transverse Scan of Uterus

(Advice) Perform an examination by the full bladder technique. Render image of uterine referring no echo bladder area. After rendering uterine image, observe both ovaries. Transverse scan can easily find them. Size of the uterine differs by ages and individuals.

(Checkpoint) The uterine locates under the bladder, described as rather high brightness. The posterior wall can be also clearly described. Inside of the uterine has layer structure and its outline is well-ordered. Check if therere no uterine swelling or abnormal tumors in the uterine.
.

22

Ovary and Transvaginal Echo

Ovary Transvaginal Scan

bladder ovary Ovarian follicle

endometrium
How to place a probe (Advice) Perform an examination by the full bladder technique. Direct a probe a little bit to the shoulder side comparing to observation by cervical transverse scan and render image of both ovaries. Its recommended to refer to the old record of The ovarian follicle should be scanned from follicle size, how many days after the onset of the multiple directions and measure the maximum period, etc. diameter. Check if theres no abnormality around ovaries. (Checkpoint) More detailed observation than transabdominal An ovarian follicle is not necessarily one. An approach. ovarian follicle is round, described as round like Image from the cervix of uterus to the body is low echo area (low space). rendered after inserting a probe to the end.

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Uterus
DR Angio DR MMG RI CT MRI MRI US

Primary infertility Contrast media has been flowed in a thin uterine tube.

Wombcancer cervix

Normal womb

Its easy to confirm the location of the lesion because any slices are available (photo: SAG image). Excellent contrast in soft tissues and clear image of structure in muscle layers of the uterine body are rendered.

CT

US

Uetrus myoma
With the effect of contrast media, the marginal of lesion is faintly contrasted.

Normal womb

Embryo

Observation of a uterine is possible with transabdominal examination by the full bladder technique, but a transvaginal probe can render clear fetus image . .

24

Ultrasonography of Mamma Gland

and Thyroid Gland

Mammary gland
Mammary gland
Number of examination is increasing with the spread of breast cancer screening, and US exam is indispensable. Information obtained from palpation and technique discriminating between the benign lesion and malignant one are necessary. As examination record, its recommended to render image and scan in more than two directions including a normal part.
skin Fat layer

Thyroid gland
Thyroid gland
Lymph nodes and thyroid glands are considered as a target of US examination. High resolution image is much employed for high frequency around 10MH.

skin

mammary gland

right

throttle

left

pectoralis major muscle retromammary fat retromammary space)

carotid a. carotid v.

26

Mammary Gland
Sagittal Scan

Thyroid Gland
Transverse Scan

trachea

(Advice) Perform examination after finding abnormality by palpation. Scan the whole breast. Remember that layer of mammary glands are not necessarily even. (Checkpoint) Breast parenchyma is described as slightly coarse structure with high brightness when there is no tumor image or abnormal reflection.

(Advice) When it is not easy to place a probe, use of a water bag is recommended. Simultaneous image rendering of right and left breasts is recommended to compare. (Checkpoint) The thyroid gland has a butterflylike form, the left lobe and the right one are joined in front of the trachea. The carotid artery tomogram can be rendered at the same time. The surface has little concaves and convexes. . 27

Mammary gland
DR Angio MMG RI MMG CT MRI US

In case of MMG, one image per one film. Check if therere no abnormal parts placing images of right and left breast symmetrically. Left: These two images are right and left breasts of the same examinee scanned from the cranio-caudal direction. By comparing them, calcifications were found. Right: These two images are right and left breasts of the same examinee scanned from the side.

CT

MRI

US

Lay an examinee facing down. In blood vascular system, it gives effect of contrast media.

Both sides are observed at the same time. Excellent contrast in soft tissues and easy to observe lesions.

Limiting is unclear, and cancers are found with calcification inside . .

28

 Thyroid gland
DR DR Angio MMG RI RI CT MRI CT US

Normal
The thyroid cartilage image is rendered without blocked up shadows from halation.

Thyroid tumor
Tumors are missing image owing to radioactive medication which accumulates in the thyroid gland.

Thyroid cancer is suspected.

Thyroid cancer is suspected.

Image of the enlarged thyroid gland is rendered unevenly. By 3D reconstruction, the location of lesions, form and size are available.

MRI

US

Normal

Normal

Because of good contrast in tissue, its possible to discriminate between soft tissue like the thyroid gland and the sounding tissue.

Follicular adenoma: surrounded by the band of low echo with the clear borderline. In case of Hashimoto disease, the thyroid gland is swelling as a whole. .

29

Orthopedic Osteoarthritis ()
The thickness of the cartilage can be measured
US makes it easy to observe cartilages, which cant be caught by X ray. Worn out cartilages are clearly found.
Knee cartilage

Affected side Normal side

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Orthopedics Osteoarthritis
Furthermore, subluxation of the inner meniscus and thickening of the inner sub ligament are observed.
X-Ry

Ultrasound

Meniscus

Knee medial collateral ligament

31

Orthopedic

Carpal Tunnel Syndrome

( )

The nerve can be described

Since image of inner structure of nerves can be rendered clearly, diagnosis of the lesion in neural parenchyma and peripheral neuropathy stenosis is possible.

Carpal tunnel syndrome

affected side

unaffected side

32

Orthopedics
Insufficiency Fracture Surface of the Rotator Cuff Bursitis The cuff tear can be observed
With excellent solution ability, outline image of the torn edge of the tendon is clearly rendered.

Suprapinatus Tendon

Greater Tubercle

Image after injecting local analgesic into synovial bursa

.

33

Orthopedics Fracture Mechanism of fracture is imaged

Normal X ray describes fracture of the base of middle phalanx, but US describes more than that: avulsion fracture of the attachment of the volar plate.

Volar Plate

Lesion Side

Normal Side

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Clinical Echocardiography

Examination of Heart
Excellent real time imaging, cardiac muscle, movement of valve and blood flow can be observed. The heart is surrounded by ribs and lungs, the place to place a probe has a lot of limitation.

The main approach left parasternal approach apical approach subcostal approach suprasternal approach

Ribs

lungs

Recommended body positions for placing probes. child dorsal position adult left lateral position , dorsal position , sitting position
.

36

Blood Flow of Heart

Ventricular Diastore Ventricular Systole
pulmonary artery (to the right & left lungs)

ascending aorta pulmonary artery superior vena cava left atrium ascending aorta (from head/cervical region) (to the whole body) ? right pulmonary vein left pulmonary vein pulmonary valve (open) from the right lung from the left lung pulmonary valve (close) left atrium mitral valve (open) tricuspid valve (close) right atrium left ventricle tricuspid valve (open) right ventricle right ventricle Inferior vena cava (from abdomen) Inner pressure of the atrium becomes thicker than inner pressure of the ventricle, and the tricuspid valve and the mitral valve are pushed to open, and blood that has flowed in atrium from the whole body and lungs comes to the ventricle. Since pressure in the aorta and the pulmonary artery is higher than inner pressure of the ventricle, the aortic valve and the pulmonary valve close, and pressure of the ventricle to send out blood becomes lowest.

left atrium aortic valve (open) mitral valve (close) left ventricle

Inner pressure of the ventricle rises and the tricuspid valve and the mitral valve close to avoid flowing back of blood that has flowed in the atrium. When inner pressure of the ventricle becomes higher than pressure of aorta and the pulmonary artery, the aortic valve and the pulmonary valve are pressed to open, the ventricle contracts more strongly and send out blood to the whole body and lungs with maximum pressure.
.

37

Parasternal Left Ventricular Long-Axis View

Lying on the left side with 45-degree slant backward in face-up position, approach from the left sternal border, the third or the fourth intercostal.

Inter ventricular septum right ventricle left ventricle aorta

aortic valve mitral valve left atrium

right ventricle aorta left ventricle left atrium anterior mitral leaflet posterior mitral leafket

38

Parasternal Left Ventricular Short-Axis View

Lying on the left side with 45-degree slant backward in face-up position, approach from the left left sternal border, the third or or the fourth intercostal. At the major axis section of the left left sternal border, turn a probe by 90 degrees clockwise. Observe from a to b by slanting a probe to the inside upper or outside down.

a
Right ventricular outflow tract Tricuspid valve

RA

RV

LA

PV AO

a b

MV

39

Parasternal Left Ventricular Short-Axis View

Between a. the short axis of the aortic valve base and . the short axis of the mitral orifice, the left ventricular outflow tract is also described. a Left Ventricular Outflow Tract b

right ventricular right atrium left atrium pulmonary valve right coronary cusp noncoronary cusp left coronary cusp left ventricular outflow tract

40

Parasternal Left Ventricular Short-Axis View

Lying on the left side with 45-degree slant backward in face-up position, approach from the left left sternal border, the third or or the fourth intercostal. At the major axis section of the left left sternal border, turn a probe by 90 degrees clockwise. Observe from c to d by slanting a probe to the inside upper or outside down.

RV IVS LV

LVapex

Papillary muscle

41

Parasternal Left Ventricular Short-Axis View

Between . the short axis of the papillary muscle and . the short axis of apex, the left ventricular outflow tract is also described.

mitral chordae tendineae

.

42

Apical Four-Chamber View

Lying on the left side with 45-degree slant backward in face-up position, approach from the apex.
RV TV IVS LV MV

RA

LA

43

Apical Two-chamber View

Lying on the left side with 45-degree slant backward in face-up position, approach from the apex. From probe position of four-chamber view image, turn a probe by 30 degrees clockwise: the place where the right ventricular chamber cant be seen.

LV
MV

LA

44

Apical Left Ventricular Long-Axis View

Lying on the left side with 45-degree slant backward in face-up position, approach from the apex. From the position of the first oblique tomographical image, give more 90-degree turn clockwise.

left ventricle left atrium aorta right ventricle

45

Cardiac
DR Angio Angio MMG RI CT MRI RI US

acute myocardial infarction

Left: left ventriculography, RAO30, diastole phase Right: contraction phase, scanned by 60f/s, movement of cardiac muscle is partly bad ( ), valvular disease is found ( ).

No Evidence

Normal

Reconstruction image of SPECT (left) and SPECT data of ECG synchronization are processed by QGS software for automatic rendering left ventricle image. Checking cardiac function is possible with moving cine mode. (right)

CT

MRI

US

mural thrombus in the left atrium By imaging effectiveness, uneven mass is found in the left atrium.

Normal
Scanning from multiple directions, the whole image is captured.

Normal

Normal

Various sections are available like the long axis view of left sternal LV (Left) and the apical four-chamber view. Real time diagnosis of cardiac muscle, movement of the valve, etc. .

46

Ultrasonography of Carotid Artery

Carotid Artery

Right side

Area examined by US

(ICA) Internal carotid artery

(ECA) External carotid artery

(VA) vertebral artery

SCA Subclavian artery

(CCA) common carotid artery

BCA) Truncus brachiocephalicus artery

ICA is outside of the center of a face (median sagittal plane), ECA is inside. ECA has bifurcation.
.

48

CCA (Common Carotid Artery)

Transverse Image Longitudinal Image Rendering the transverse section of the carotid artery Turn a probe by 90 degrees at the position running beside the thyroid gland. of a round slice image rendered. Chasing the range which can render image by the short axis.

90Rotaion

The right common carotid artery starts from the brachiocephalic branched at the artery aortic arch, and the left common carotid artery starts directly from the left aortic arch. Both carotid arteries ascend the inside of the sternocleidomastoid muscle, and branch into the internal carotid artery and the external carotid artery at the height of the superior margin of the thyroid cartilage. The height of branch, position and angle differ from each individual.

49

ICA (Internal Carotid Artery) ECA (External Carotid Artery)

It is found that the common carotid artery is divided into the internal carotid artery and the external carotid artery, sliding the probe to the head side from the position where the slice of the carotid artery. Its easy to see when its colored.

CCA

ICA

ECA

The common carotid artery is divided in two halfway when chasing it.
.

50

ICA (Internal Carotid Artery)

The internal carotid artery ascends the winding route outside of the pharynx, passes through the carotid canal, flows in Willis arterial circle entering the tectum of brain, and reaches the cranium.

ICA

Pay attention to the internal carotid artery, and get image of longitudinal section with turning a probe by 90 degrees.
51

ECA (External Carotid Artery)

ECA

1.

2.

Slant a probe a little bit inside from the position rendering longitudinal section image of the external carotid artery. Pay attention to the external carotid artery and get image of longitudinal section with turning a probe by 90 degrees.

52

Discrimination between Internal Carotid Artery and External Carotid Artery

The internal carotid artery is outside and the external carotid artery is inside. The internal carotid artery is thicker than the external carotid artery. The internal carotid artery has much end-diastolic blood flow. (Because of low resistance) The internal carotid artery has much total blood flow. The external carotid artery has bifurcation. End-diastolic blood flow of the external carotid artery touches near the baseline. (Because of high resistance) In case of the external carotid artery, a wave form changes when the place around the temple is pressed. (Influence of the superficial temporal artery)

ICA

ECA
.

53

Vertebral Artery
Processus Transversus

Transverse process of vertebra

VA

While rendering image of common carotid artery, move a probe from the body front to the back. Usually the lower is the vertebral artery of two blood vessels in transverse process. Loosen the steering. Lower a bit the flow speed range.
.

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Intima-Media Thickness IMT

By measuring the thickness of intima-media complex, check the whole arteries about arteriosclerosis. US can catch internal media complex thickness that is the combination of intimal and media in vessel wall of the common carotid artery. when its over 1.1mm, it is called plaqaue.

The thickest part

cm

cm

1) Measurement of maximum IMT Measure the part which is thickest in the rendered area. (Measure the two points with the maximum thickness in the area from the common carotid artery and carotid body ~ the internal carotid artery.) 2) Measurement of average IMT Measure the place with even blood vessel diameter, without the carotid body, the internal carotid artery and the external carotid artery. At many hospitals, its measured by taking successive 2 cm area containing the thickest part, dividing it into two equal parts and calculate the average of three measured values.

How to Measure Three-Point Method IMT Average of Three Points

Point A Point B Point C Mean

B Mode Distance B Mode Distance B Mode Distance Calculation: ABC/

mm mm mm mm

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IMT Measurement Point

Intimal

Intima-Media Complex (IMC)

Media

Outer

Normality 0.6mm

Outside of high brightness Inside of low brightness

Doubt of arteriosclerosis(1.3mm)
.

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Carotid Artery
DR DR Angio MMG RI Angio CT MRI US RI

Constriction in the region of origin of the internal carotid artery and the external carotid artery

Severe constriction in the region of origin of the right internal carotid artery

No Evidence

No Evidence

Constrictions are observed clearly in both the images.

LeftAortography RightImaging the right common carotid artery

No Evidence Condition of the common carotid artery and subclavian artery can be observed.

CT

MRI

US

Constriction in the left internal jugular vein

Suspicion of constriction in the left external carotid artery

In the left image, severe constriction in the left internal jugular vein is observed with contrast media. In the right image, the routes of blood vessels and the forms can be observed threedimensionally.

Normal The image of blood vessels of wide area can be rendered depending on a coil.

Carotid stenosis Its profitable to observe constriction which is unclear only by black and white image in color Doppler. .

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 Hitachi Medical Corporation.2007. All rights reserved.

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