الفهرس 
The Nature of UltrasoundOnly 14 pages are availabe for public view
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Abstract
Abnormal uterine bleeding requires careful evaluation to detect the cause of bleeding, as it ranges from some emotional upset up to malignancy. Although cancer is not the most common etiology of abnormal uterine bleeding (especially in perimenopausal women), it is the most important.
Invasive techniques are very helpful in diagnosing the cause of abnormal uterine bleeding such as hysteroscopy and endometrial sampling.
Endometrial biopsy and tissue examination is considered an important diagnostic tool for the evaluation of abnormal uterine bleeding. The documented safety and accuracy of plastic endometrial sampling devices have made them popular for use in the office.
However, there are some limitations for the use of endometrial sampling. As regard the contraindications, D&C biopsy is contraindicated in cases of pelvic inflammatory diseases, profuse bleeding, cervicitis, endometritis, cervical cancer and coagulopathy. On the other hand, D&C needs anesthesia, skilled physician and empty bladder. However, some complications were reported with the use of D&C biopsy. These complications ranges from slight lower abdominal pain after D&C to perforation of the uterus. Furthermore, infection, bleeding, uterine synechiae, amenorrhea, infertility and abnormalities of placental attachment in later pregnancies are possible after D&C.
Despite the development of other noninvasive modalities to image the female’s pelvis, ultrasound continues to be the workhorse with respect to imaging the uterus and adnexum.
Recent years have witnessed a surge of interest in the application of ultrasound as a diagnostic non-invasive tool. Today, diagnostic ultrasound enjoys a principal position in medical imaging and its future application is sure to be even much more important.
Doppler velocimetry is a non-invasive technique that uses high frequency ultrasound for investigation of blood flow. Color Doppler scanners are able to superimpose a color map over the grey scale image.
The ability to assess blood supply and tumor vascularity makes color Doppler ultrasound a potentially useful tool to differentiate benign from malignant neoplasms, to predict the clinical behavior of the disease and to monitor the efficacy of chemotherapy.
TVCD can depict endometrial carcinoma, even in asymptomatic women, determine the depth of myometrial invasion and help in tumor staging. The use of color Doppler to assess neovascularization and blood impedance in or around the endometrium could allow flow early detection of endometrial carcinoma.
The present study aimed at making a correlation between results obtained by TVUS with color coded Doppler of uterine artery and endometrial histopathological findings in a trial to disclose the helpful role of TVCD for detecting malignancy as a cause of abnormal uterine bleeding. This study has been conducted on 80 patients presented with abnormal uterine bleeding and were admitted in the Obstetrics and Gynecology Department of Ain Shams University Maternity Hospital during the period from August 2006 to May 2008, 40 of them were diagnosed as benign endometrial lesion and the other 40 patients were diagnosed as malignant endometrial lesion by D&C biopsy and histopathology.
As regard the results of TVUS in the present study, there was no definite cutoff point of endometrial thickness for differentiating malignant from benign cases, at which both sensitivity and specificity are satisfactory as our patiants were examined after D&C in our hospital or outside.
However, when color Doppler velocimetric measurements were superimposed, the diagnostic accuracy for malignancy was more strong. Color Doppler velocimetric measurements revealed that, according to (1) Uterine artery: RI of 0.64 and PI of 0.905 (2) Arcuate artery: RI of 0.645, (3) Radial artery: RI of 0.675 were the lower limits for benign lesions, below which malignancy is diagnosed.
To summarize, the results of present study were promising about TVCD and it could replace the histopathological examination as an invasive diagnostic method in diagnosing malignancy in women suffering from abnormal uterine bleeding. However, we need further studies concerning the role of TVCD in abnormal uterine bleeding and its accuracy as regards malignancy diagnosing to be used and applied safely even as a screening method for all women with abnormal uterine bleeding.
In closing, we owe a debt gratitude to those who created the technology for our generation to develop and utilize in patient care. We need to continually explore how to utilize this technology in ways to more precisely manage our patients and where possible, reduce the cost of care. Education and information dissemination must continue to be a priority Quality assurance of the accuracy of diagnosis and improvement in patient outcome must be ongoing.