CEUS for Ovarian Lesions

1. Role of CEUS in Ovarian Imaging 0%

Enhances Detection of Microvascular Architecture
Differentiates Benign vs Malignant Ovarian Masses
Useful When MRI is Contraindicated or Inconclusive
Real-Time Perfusion Assessment
Can Guide Biopsy or Intervention in Complex Cases

2. Role of CEUS in Ovarian Imaging 0%

2. Benign Ovarian Lesions on CEUS

Simple Cysts: Anechoic with No Enhancement
Hemorrhagic Cysts: Peripheral or Septal Enhancement
Endometriomas: Typically Avascular or Peripheral Flow
Corpus Luteum: Ring of Peripheral Enhancement (Hypervascular Rim)
Dermoid Cysts: No Enhancement, May Contain Calcification or Fat

3. Malignant Ovarian Lesions on CEUS 0%

Irregular, Solid Components with Early Arterial Enhancement
Septations and Papillary Projections Show Vascularity
Rapid Wash-In and Washout of Contrast
Chaotic, Disorganized Microvascular Flow
Useful in Evaluating Peritoneal Implants and Ascites

4. CEUS vs Conventional Technique 0%

Higher Sensitivity for Vascularized Solid Components
Complements Color Doppler and B-mode
Comparable to MRI in Lesion Characterization
Real-Time Contrast Flow Visualization Advantage

5. Ovarian CEUS Case Studies & Quiz 0%

Case 1: Corpus Luteum with Peripheral Contrast Ring
Case 2: Enhancing Solid Mass Suggestive of Serous Cystadenocarcinoma
Case 3: Avascular Endometrioma vs Enhancing Hemorrhagic Cyst
Quiz: Identify Malignant Pattern Based on CEUS Phases
Interpretation Pitfalls: Mistaking Functional Cysts for Tumors
Scenario Review: CEUS vs Doppler in Borderline Tumor Evaluation

Menstrual Cycle Evaluation

Interactive Menstrual Cycle Hormone Graph

Estrogen: 200

Progesterone: 5

LH: 10

FSH: 10

1. Introduction to Menstrual Cycle Evaluation 100%

Role of Ultrasound in Cycle Monitoring
Indications: Infertility, Irregular Cycles, ART Monitoring
Hormonal Regulation of Uterus and Ovaries
TVS as the Primary Modality

2. Anatomy and Hormonal Basics 100%

Uterine and Ovarian Anatomy
Menstrual Hormonal Axis: Hypothalamus → Pituitary → Ovary
Hormone-Dependent Endometrial and Follicular Changes
Relevance to Cycle Phases

3. Ultrasound Protocols and Techniques 100%

Transvaginal Probe Use
Cycle Day-Based Scanning (Day 2, 7, 10, 12, 14, 21)
Endometrial and Ovarian Measurements
Doppler Assessment of Blood Flow and Vascularity

4. Menstrual Phase (Days 1–5) 100%

Thin Endometrium (2–4 mm), Echogenic Shedding
Small Antral Follicles (2–6 mm)
Hypoechoic Endometrial Appearance
Baseline Scan for ART and Cycle Evaluation

5. Follicular Phase (Days 6–13) 100%

Endometrial Proliferation (Trilaminar Appearance)
Gradual Thickening (6–10 mm)
Dominant Follicle Selection (8–22 mm)
Cervical Mucus Correlation

6. Ovulation (Day 13–15) 100%

Dominant Follicle Rupture and Collapse
Free Fluid in POD (Posterior Cul-de-sac)
Perifollicular Flow (Low Resistance Doppler)
Endometrium: Max Thickness ~10–12 mm

7. Luteal Phase (Days 16–28) 100%

Corpus Luteum Formation: Ring of Fire Doppler
Endometrium Becomes Hyperechoic
Thickness Maintained if Pregnancy
Premature Regression in Luteal Phase Defect

8. Endometrial and Follicular Measurements 100%

Endometrial Thickness Chart by Cycle Day
Dominant Follicle Tracking
AFC (Antral Follicle Count) for Ovarian Reserve
Folliculometry for Ovulation Prediction

9. Clinical Applications and Cycle Abnormalities 90%

Anovulation and PCOS Monitoring
Luteal Phase Defect Diagnosis
Endometrial Insufficiency (Thin Lining)
ART Monitoring: Clomiphene, Letrozole, IVF Cycles
Cycle Assessment in Perimenopause

10. Case Studies and Quiz Section 0%

Follicle vs Corpus Luteum
Endometrial Pattern Interpretation
Ovulation Identification on Serial Scans
Quiz on Day-Based Endometrial and Ovarian Features

Adnexa and ovary

1. Introduction 00%

Role of Ultrasound in Adnexal Evaluation
Indications: Pain, Mass, Infertility, Menstrual Irregularity
TVS vs TAS Approaches
Advantages, Safety, and Limitations

2. Anatomy of Ovary and Adnexa 00%

Ovarian Location and Relations
Ovarian Ligaments and Blood Supply
Tubal Anatomy and Relationship to Ovary
Surrounding Structures: Uterus, Bladder, Bowel, Pouch of Douglas

3. Normal Ovary on Ultrasound 00%

Normal Size and Volume by Age
Follicular Development: Antral, Dominant, Corpus Luteum
Echotexture and Stromal Echogenicity
Periovulatory Changes
Ovarian Volume and Antral Follicle Count (AFC)
Folliculometry and Ovulation Tracking
Doppler Flow Patterns in Different Cycles

4. Physiological and Functional Lesions 00%

Simple Follicular Cyst
Postmenopausal Pelvic Cyst
Ovarian Functional Cyst
Corpus Luteum Cyst
Theca Lutein Cysts (High hCG States)
Luteoma of Pregnancy
Luteinized Unruptured Follicle
Ovarian Changes in Early Pregnancy

5. Ovarian Pathologies 00%

1. Benign Neoplasms

Dermoid Cyst (Mature Cystic Teratoma)
• Dermoid plug (Rokitansky nodule)
• “Tip of the iceberg” sign
• Dermoid mesh (“dot–dash” sign)
• Mobile spherules (floating balls sign)
• Fat-fluid level
Ovarian Fibroma
Brenner Tumor (Transitional Cell Tumor)
Serous and Mucinous Cystadenomas
• Ovarian serous cystadenoma
• Ovarian borderline serous cystadenoma
• Ovarian mucinous cystadenoma
• Ovarian borderline mucinous cystadenoma
• Ovarian serous cystadenofibroma
Sclerosing Stromal Tumor of the Ovary

2. Inflammatory & Infectious Lesions

Ovarian Abscess
Ovarian Vein Thrombosis
Pelvic Congestion Syndrome

3. Endometriosis and Variants

Endometrioma (Ground-glass echogenicity)
Ruptured Endometrioma
Decidualized Endometrioma in Pregnancy

4. Hemorrhagic Ovarian Cyst

Fishnet weave or fine reticular pattern
Retracting clot appearance
Fluid-debris level in hemorrhagic cyst
Ruptured hemorrhagic cyst
Mimicking solid ovarian neoplasm

5. Malignant and Borderline Tumors

Ovarian Dysgerminomas
Complex Cystic-Solid Mass with Papillary Projections
Ascites and Peritoneal Mets
Doppler features for risk stratification

6. Miscellaneous

Punctate Echogenic Foci (Focal Calcification)
Ovarian Remnant Syndrome (ORS)

6. Adnexal Pathologies 00%

Tubo-Ovarian Abscess (TOA)
Hydrosalpinx and Pyosalpinx
Ectopic Pregnancy (Adnexal Ring Sign)
Paraovarian Cysts
Peritoneal Inclusion Cysts

7. Ovarian Torsion 00%

Enlarged Ovary with Peripheral Follicles
Absent or Reduced Doppler Flow
Whirlpool Sign (Twisted Vascular Pedicle)
Differential with Hemorrhagic Cyst or TOA

div class="subtopics"> Polycystic Ovarian Syndrome (PCOS)
Doppler in Luteal Phase
Ovarian Hyperstimulation Syndrome (OHSS)

Vagina

1. Introduction 100%

Role of Ultrasound in Vaginal Pathology Assessment
Indications: Pain, Bleeding, Discharge, Trauma
Comparison: Transvaginal vs Transperineal Ultrasound
Safety, Patient Preparation, and Consent

2. Anatomy of the Vagina 100%

Vaginal Canal and Fornices
Layers: Mucosa, Muscularis, Adventitia
Relation to Urethra, Bladder, Rectum, Cervix
Pediatric, Premenopausal, and Postmenopausal Differences

3. Scanning Techniques 100%

Transvaginal (Endocavitary) Probe Use
Translabial/Transperineal Approach
Probe Positioning and Orientation
Gel Use, Infection Control, and Imaging Planes

4. Normal Vaginal Appearance 100%

Homogeneous Hypoechoic Wall Layers
Collapsed Vaginal Canal (Thin Echogenic Line)
Recognition of Fornices and Cervical Bulge
Variable Appearance with Hormonal Status

5. Vaginal Pathologies 100%

1. Infectious Conditions

Vaginitis (Non-specific, Candidal, Trichomonal)
Bartholin Cyst (Lower Vagina, Posterolateral Wall)
Abscesses and Fluid Collections

2. Traumatic and Post-Surgical

Vaginal Lacerations or Hematomas
Foreign Bodies
Post-Hysterectomy Changes
Fistulas (Vesicovaginal, Rectovaginal)

3. Congenital and Structural

Transverse Vaginal Septum
Imperforate Hymen (Hydrocolpos, Hematocolpos)
Vaginal Agenesis (Müllerian Anomalies)

6. Vaginal Masses and Tumors 70%

Gartner Duct Cyst
Vaginal Polyps
Vaginal Cancer (Rare – SCC, AdenoCA)
Metastasis or Extension from Cervix or Vulva
Evaluation of Vaginal Wall Thickening

7. Role in Pelvic Floor Assessment 40%

Prolapse Evaluation (Cystocele, Rectocele)
Perineal Body Thickness
Vaginal Wall Mobility
Dynamic Strain/Valsalva Maneuver

8. Interventional and Follow-Up Role 0%

Ultrasound-Guided Drainage of Abscess
Monitoring Cyst Resolution or Recurrence
Evaluation of Postoperative Healing
Guidance for Foreign Body Removal

9. Case Studies and Quiz Section 0%

Differentiating Abscess vs Hematoma
Cyst vs Polyp vs Tumor in Vaginal Canal
Trauma vs Congenital Anomaly Cases
Interpretation Practice with Labeled Scenarios

Ureter

1. Normal Anatomy 00%

Upper, Mid, and Lower Thirds of Ureter
Ureteropelvic Junction (UPJ)
Ureterovesical Junction (UVJ)
Relationship with Kidney, Bladder, and Psoas Muscle
Normal Wall Thickness and Lumen Caliber
Challenges in Visualizing Non-Dilated Ureter

2. Ureteric pathology 00%

1. Obstructive Pathologies

Ureteric Calculus – Bright Echogenic Foci with Posterior Acoustic Shadowing
UVJ Calculus – Common Cause of Acute Obstruction
Ureterocele – Anechoic Rounded Bulge within Bladder Wall
Hydroureter – Dilated Tubular Ureteral Segment
Congenital Megaureter – Fusiform Dilatation
Ureteric Strictures – Narrowed, Non-compliant Segments
Vesicoureteral Reflux (VUR) – Indirect Signs in Children

2. Neoplastic and Infiltrative Lesions

Transitional Cell Carcinoma (TCC) of Ureter
Urothelial Masses with Intraluminal Growth
Invasion from Adjacent Malignancy (Cervical, Colorectal)

3. Functional Evaluation

Ureteric Peristalsis – Wave-like Movements on Real-Time Scanning
Use of Color Doppler to Assess Ureteric Jets into Bladder
Absent or Reduced Jet Suggests Obstruction
Comparison of Bilateral Ureteric Jet Frequency

3. Ureter Case Studies and Quiz Section 0%

Clinical Case Review
Image-Based Quiz: Identify Ureteric Calculus
Doppler Flow Quiz: Intermittent vs Absent Ureteric Jet
Pitfalls: Mistaking Bowel Gas for Dilated Ureter

Urinary Bladder

1. Introduction 100%

Importance of Bladder Ultrasound in Urology
Common Clinical Indications (UTI, Hematuria, Retention)
Benefits and Limitations
Role in Emergency, Routine, and Post-Surgical Settings

2. Anatomy and Orientation 100%

Bladder Wall Layers and Normal Thickness
Trigone, Dome, and Neck of the Bladder
Ureteric Orifices and Internal Urethral Opening
Male vs Female Pelvic Anatomy Relationships

3. Scanning Technique 100%

Transabdominal Scanning Approach
Probe Selection (Curvilinear or Phased Array)
Patient Prep – Full Bladder Protocol
Longitudinal and Transverse Views
Bladder Volume Estimation (L × W × H × 0.52)

4. Normal Bladder Sonographic Appearance 100%

Anechoic Fluid-Filled Appearance
Smooth Contour and Symmetric Shape
Wall Thickness: Normal < 3 mm (Distended)
Visualization of Ureteric Jets with Color Doppler

5. Urinary Bladder Pathologies

1. Inflammatory and Infectious

Cystitis
Emphysematous Cystitis
Schistosomiasis (Calcified Bladder Wall)
Urinary Bladder Tuberculosis
Cystitis Glandularis
Bladder Malacoplakia

2. Obstructive and Structural

Bladder Diverticulum
Trabeculated Bladder
Bladder Neck Obstruction
Urethral Valves in Pediatric Patients
Neurogenic Bladder
Congenital Megaureter

3. Masses and Neoplasms

Bladder Tumors (Papillary, Sessile)
Transitional Cell Carcinoma (TCC)
Post-radiation Changes
Benign Masses and Polyps
Primary Bladder MALToma
Bladder Metastasis
Bladder Pheochromocytoma

4. Calculi and Foreign Bodies

Bladder Stones – Echogenic with Shadowing
Vesical Calculus / Bladder Calculus
Ureterovesical Calculus
Ureteric Calculus
Prostato-Urethral Calculus
Catheter-Related Findings
Foreign Bodies: IUCD, Stents Migrated

6. Post-Void and Volume Studies 30%

Pre- and Post-Void Volume Assessment
Post-Void Residual (PVR) Calculation
Use in Neurogenic Bladder Evaluation
Biofeedback and Monitoring Protocols

7. Interventional & Post-Surgical Evaluation 0%

Suprapubic Catheter Evaluation
Post-TURBT Monitoring
Cystotomy Site Ultrasound
Role After Bladder Repair or Reconstruction

8. Case Studies and Quiz Section 0%

Bladder Tumor Detection Case
Diverticulum vs Cyst Case
Image-Based Questions on Bladder Pathologies
Interpretation Challenges and Pitfalls

CEUS for prostate Cancer Localization

1. Introduction to CEUS 100%

Basics of Contrast Agents (e.g., SonoVue, Lumason)
Physics of Microbubbles and Harmonic Imaging
Advantages: Real-Time, Non-Ionizing, Repeatable
Applications in Tumor Imaging and Biopsy Guidance

2. CEUS Phases and Interpretation 100%

Arterial Phase (10–30 sec): Hypervascular Tumor Identification
Portal Phase (30–120 sec): Washout Evaluation
Late Phase (up to 5 min): Persistence or Loss of Enhancement
Enhancement Patterns: Rim, Centripetal, Mosaic, etc.

3. CEUS for Liver Cancer Localization 100%

Hepatocellular Carcinoma (HCC): Arterial Hyperenhancement + Late Washout
Cholangiocarcinoma: Rim Enhancement + Rapid Washout
CEUS LI-RADS Classification
Differentiation from Hemangioma, FNH, Cysts

4. CEUS in Kidney Tumors 100%

Clear Cell RCC: Intense, Early Enhancement
Papillary RCC: Hypovascular
Angiomyolipoma: No Washout
Indeterminate Complex Cysts (Bosniak III/IV)

5. CEUS for Prostate Cancer Localization 10%

Focal Early Enhancement in the Peripheral Zone
Identification of Suspicious Nodules Missed on Grey-Scale TRUS
Enhancement Timing: Tumor Shows Earlier and Stronger Enhancement than Normal Tissue
Microvascular Architecture Visualization: Disordered, Chaotic Vessels in Malignancy
Improved Targeting for TRUS-Guided Biopsy in Lesion-Directed Approach
Useful in Re-Biopsy Cases after Negative Systematic Biopsies
CEUS-mpMRI Fusion: Correlation and Added Sensitivity in Lesion Detection
Assessment of Tumor Volume and Extracapsular Extension (ECE)
CEUS Elastography Combination for Stiffness-Based Detection
Role in Monitoring Focal Therapy Outcomes (e.g., HIFU, Cryoablation)

6. CEUS in Other Organ Cancers 60%

Pancreas

Hypoenhancing Adenocarcinoma vs Hypervascular NETs
Guidance for EUS-FNA in Borderline Lesions

Thyroid

Irregular, Rapid Washout in Malignancy
Distinguishing Benign Nodules with Persistent Enhancement

Breast

Irregular Margins, Central Necrosis Patterns
Use in Dense Breasts and Pre-Biopsy Evaluation

7. CEUS-Guided Interventions 0%

Targeted Biopsy of Enhancing Lesions
Intra-procedural Localization for Ablation
Monitoring Ablation Zone Post-Treatment
Real-Time Adjustment Based on Enhancement Changes

8. Limitations and Pitfalls 0%

User Dependency and Learning Curve
Limited Role in Deep Lesions (Obesity/Gas Interference)
Misinterpretation of Benign Hyperenhancing Lesions
Microbubble Destruction Artifacts

9. Case Studies and Quiz Section 0%

Liver Tumor CEUS Interpretation Quiz
RCC vs AML CEUS Cases
Washout Pattern Analysis Practice
Doppler vs CEUS vs MRI Correlation Scenarios