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Inversion Mode Display of 3D Sonography: Applications in Obstetric and Gynecologic Imaging

Beryl R. Benacerraf1,2,3

1 Department of Radiology and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
2 Department of Obstetrics and Gynecology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
3 Diagnostic Ultrasound Associates, PC, 333 Longwood Ave., Ste. 400, Boston, MA 02115.


Figure 1
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  		Fig. 1A —Hydrosalpinx. Transverse view of adnexa shows what appears to be septate cyst.

 

Figure 2
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  		Fig. 1B —Hydrosalpinx. Inversion mode of sonographic volume containing adnexa shows that septate cyst actually represents hydrosalpinx when viewed in its entirety.

 

Figure 3
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  		Fig. 2A —Hydrosalpinx. Multiple cysts arranged in line in adnexa. Although hydrosalpinx is in differential diagnosis, definitive diagnosis is not possible with this view.

 

Figure 4
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  		Fig. 2B —Hydrosalpinx. Inversion mode of sonographic volume containing adnexa shows that cysts are actually part of hydrosalpinx. No differential diagnosis is needed.

 

Figure 5
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  		Fig. 3A —Hydrosalpinx and ovarian follicle. Tubular fluid collection in adnexa is seen using traditional 2D sonography, consistent with hydrosalpinx.

 

Figure 6
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  		Fig. 3B —Hydrosalpinx and ovarian follicle. Inversion mode shows hydrosalpinx as echogenic. In addition, rounded cyst (C) is seen just above hydrosalpinx, consistent with follicle in ovary. Also note fimbriated end of tube distally (arrows). These additional features are not all in one plane and can be visualized together only if all cystic areas in entire volume are displayed concurrently. Inversion mode of sonographic volume containing adnexa shows that septate cyst actually represents hydrosalpinx when viewed in its entirety.

 

Figure 7
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  		Fig. 4A —Polycystic ovaries. Standard 2D image of polycystic ovary.

 

Figure 8
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  		Fig. 4B —Polycystic ovaries. Volume display of polycystic ovary shows multiplanar views and inversion mode in right lower quadrant.

 

Figure 9
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  		Fig. 4C —Polycystic ovaries. Magnified image of multicystic ovary seen with inversion mode. Note that all follicles are visible and can be easily counted. Sonography machine can also calculate volume of each highlighted follicle.

 

Figure 10
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  		Fig. 5A —Fibroid and polyp. Standard 2D image taken during saline hysterosonography examination, shows two filling defects in uterine cavity, suggests polyp and fibroid.

 

Figure 11
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  		Fig. 5B —Fibroid and polyp. Coronal view of saline hysterosonography image reconstructed from volume shows polyp (fundus) and fibroid (uterine body).

 

Figure 12
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  		Fig. 5C —Fibroid and polyp. Inversion mode of saline hysterosonography image shows fluid in uterus as echogenic and filling defects as true defects, much like positive contrast.

 

Figure 13
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  		Fig. 6A —Third trimester fetus with hydronephrosis and hydroureter. Longitudinal view of fetal kidney shows hydronephrosis and hydroureter in early third trimester.

 

Figure 14
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  		Fig. 6B —Third trimester fetus with hydronephrosis and hydroureter. Inversion mode of fetal hydronephrosis and hydroureter shows far more than just one plane. Entire distended urinary tract is displayed at once, down to bladder, and includes blunted calyces.

 

Figure 15
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  		Fig. 7A —Third trimester fetus with ventriculomegaly. Transverse view (standard 2D) of fetal head at 38 weeks shows ventriculomegaly with bilateral anterior horn cystic abnormalities. Hydrocephalus and anterior horn cysts were unchanged at birth.

 

Figure 16
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  		Fig. 7B —Third trimester fetus with ventriculomegaly. Volume display of fetal head shows multiplanar views of ventriculomegaly and anterior horn cysts in three orthogonal planes.

 

Figure 17
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  		Fig. 7C —Third trimester fetus with ventriculomegaly. Reconstructed coronal view of fetal head from volume displayed in B shows ventriculomegaly.

 

Figure 18
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  		Fig. 7D —Third trimester fetus with ventriculomegaly. Three views of inversion mode from same patient, show echogenic display of anterior horn cysts anteriorly and dilated ventricles posteriorly.

 

Figure 19
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  		Fig. 7E —Third trimester fetus with ventriculomegaly. Three views of inversion mode from same patient, show echogenic display of anterior horn cysts anteriorly and dilated ventricles posteriorly.

 

Figure 20
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  		Fig. 8A —Second trimester fetus with normal cardiac anatomy. Inversion mode of fetal great vessels of healthy fetus. Ao = aorta, RV = right ventricle, IVC = inferior vena cava.

 

Figure 21
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  		Fig. 8B —Second trimester fetus with normal cardiac anatomy. Inversion mode of fetal great vessels of healthy fetus. Ao = aorta, RV = right ventricle, IVC = inferior vena cava.

 

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