Endovaginal sonography of the nongravid uterus.

Ultrasound of the endometrium: facts, controversies, and future trends

“…TAS requires a full bladder and is often uncomfortable and time-consuming, particularly in the postmenopausal woman. For specific evaluation of the endometrium in the patient with a normal-sized uterus, TAS is unnecessary as the first step [1][2][3]. Furthermore, as the patient becomes well hydrated to fill her bladder for TAS, a partially full bladder interferes with TVS and HSG, which are best performed with the bladder completely empty [4].…”

“…The patient, technologist/ sonographer, or sonologist can insert the probe. Imaging is in the coronal or sagittal plane, and the endometrium is well suited for this technique due to its proximity to the vaginal apex, allowing for high resolution scanning [1][2][3][4][5] (Fig. 1).…”

“…As with other Doppler applications in the pelvis, there is considerable overlap of benign and malignant abnormalities when measuring indices of resistance, which, when decreased, suggest angioneogenesis associated with neoplasms. Unfortunately, the normal cyclic physiology of the female pelvis produces angioneogenesis in both ovaries and uterus, making these analyses difficult [2]. However, as will be discussed, color Doppler may have a role in differentiating endometrial polypoid lesions.…”

“…Measurements of the endometrial thickness are best made on TVS or HSG because of the proximity of the transducer to the uterus. The measurement is best made in the sagittal plane, and the convention is to use the full thickness of the endometrium minus any fluid that may be present [2,3,8] (Figs. 1, 3A, 4A, 5).…”

“…The endometrium becomes thicker, reaching a maximal thickness of 12 mm [9,10]. Furthermore, the endometrium becomes more echogenic due to the change in glandular content from absence of secretions to glycogen and mucin [2,10] (Figs. 2, 6).…”