1、 endo-luminal ultrasound（腔内超声）（腔内超声）Real-Time Tissue Elastography(弹性成像弹性成像)Contrast enhanced ultrasound（超声造影）（超声造影）Three-dimensional Ultrasonography（3D 三维超声）三维超声）Indications contraindicationTransvaginal Ultrasounduterine cavity ultrasonographypathologyIA022IB256IC143ambiguity800 acoustic penetration
2、 depth is inversely proportional to the probe frequency。Resolution is proportional to the probe frequency High-frequency,high resolution,clear image Small scanning radius 适应症 禁忌症：1）未婚无性生活史；2）阴道出血；3）阴道炎；4）老年性或放射性阴道萎缩；4）先天性阴道闭锁。相对禁忌症：1）患者不同意阴道超声检查；2）超出阴道探头探查范围的盆腔肿块；3）中、晚期妊娠有阴道出血原因不明者。-临床技术操作规范超声医学分册 s
3、oftsofthardexternal forcesofthard 1 points：deformation,green；2 points：largely deformation,Green and blue mosaic；3 points：Boundary deformationgreen,center part undeformed,blue 4 points：tumor undeformedblue；5 points：tumor and perienchyma undeformed,tumor and perienchymablue 1 points benign 23points Be
4、nign maybe 4 points Pay attention to the differential diagnosis 5 points malignancy maybe strain ratio (应变率应变率)Strain ratio=B/A=FLR=tumor/fatty tissue (reference value 4.3）Strain ratio=B/A=tumor/reference tissue (reference value 3.08）The early diagnosis of cancerBenign,malignant judgement Diffusion
5、region To confirm the therapeutic effec clinical staging of venous thrombosis Hepatic fibrosis The corresponding clinical field：Thyroid,breast,prostate,skin,liver,pancreas,uterus/ovary,lymph node,vascular,rectum,testis The shortage of conventional ultrasound differential diagnosis of benign and mali
6、gnant diseases Low specificity Low sensitivity A diease has abroad spetrum of sonographic apperance，various dieases have common sonographic apperance2D：acoustic impedance acoustic attenuation CDFI：Doppler shift Difference of microcirculation changes increase the echogenicity of the blood Enhance the
7、 difference of tissue perfusion Size sufficiently small(less than red blood cell)Strong signals(more than red blood cell)Pass throughout the body Eliminate via the respiratory system Rapidly contracting and expanding to the pressure changes of the sound make microbubbles several thousand times more
8、reflective than normal body tissue The non-linear oscillation of microbubbles generate harmonic The acoustic result microbubbles burst-定性：心脏、腹部、高频和腔内应用领域的实时造影技术 CnTI-Contrast Tuned Imaging-定量：声学时间强度曲线分析 Wash-in/Wash-out-创新：微血管灌注成像 CMI-Contrast Micro-Imaging Safety non-toxicity Uniform size,less than
9、 10m Pass through the capillaries Generate harmonic Good stability microbubblesBlood circulationPass through the capillariesthe difference of tissue perfusionReflect Blood supply of lesionsThe detection rate of Micro vessels increasedThe echogenic of different tissue were differentReal time contrast
10、 enhance ultrasound局灶性不典型增生gynaecologyobstetricsFemale pelvic medicine；Urogynecologyfamily planning Three dimensional obstetrics ultrasound Three dimensional gynaecology ultrasoundImaging mode：surface mode transparent mode color doppler flow imaging mode multiple plane mode Niche modesurface modetra
11、nsparent modecolor doppler flow imaging mode Two dimensional ultrasound can not get；The image is easy to understand；Make a comprehensive analysis of the interesting zone。Close to the actual anatomy,easy for clinicians and non medical staff understanding,better communication between ultrasound doctor
12、s，clinicians and patient indication Congenital uterine anomalies Intrauterine device intrauterine disease ectopic pregnancy Adnexal masses,follicle detection,ovarian volume measurement Assessment of ovarian response The diagnosis of PCOS Evaluate the uterine morphology and endometrial volume Predict
13、 the outcome of IVF-ET Three dimensional ultrasound guided puncturetesting timeAFS(美国生殖协会美国生殖协会)，1988y（）（）Incomplete septate uterusSide intrauterine pregnancybefore after 内膜 Three vascular index：VIVascular index FIflow index VFIVessels flow index3D：1、To observe the situation of endometrial,ovarian,o
14、varian follicle。2、Evaluation of endometrial receptivity。3、To evaluate the reactivity of ovary。4、To guide the embryo implantation。coded contrast imaging CCI Three dimensional imaging function stereo imagery of tubal morphology and distributiondiagnostic criteria of PCOS diagnostic criteria 1990 NIH 2
15、003 Rotterdam 2006 Androgen Excess Society Ultrasonic PCO criteria:1990 NIH The ovarian periphery 10 small follicles,and each diameter 1cm 2003 Rotterdamunilateral or bilateral ovarian follicles more than 12,19mm in diameter,and or ovarian volume greater than 10ml Endometrial receptivity is one of t
16、he main factors affecting embryo implantation Although various endocrine factors may influence the endometrial receptivity,but endometrial itself environment is a very important reason TVUS can be used to evaluate endometrial thickness,echo and blood flow,but more than 10 years of research shows the
17、 low sensitivity Normal menstrual cycleEndometrial volume：Endometrial vascular：Some studies show that compared with the proliferative phase,secretory phase(the luteal phase)vascular surface area,diameter,capillary number significantly increasedThe new discipline of ultrasound Urogynecology;pelvic floor function evaluation urethrovaginal septum rectovaginal septumthank you！
