Abdominal ultrasound

Definition

Ultrasound technology allows doctors to 'see' inside a patient without resorting to surgery. A transmitter sends high frequency sound waves into the body, where they bounce off the different tissues and organs to produce a distinctive pattern of echoes. A receiver 'hears' the returning echo pattern and forwards it to a computer, which translates the data into an image on a television screen. Because ultrasound can distinguish subtle variations between soft, fluid-filled tissues, it is particularly useful in providing diagnostic images of the abdomen. Ultrasound can also be used in treatment.


Purpose

The potential medical applications of ultrasound were first recognized in the 1940s as an outgrowth of the sonar technology developed to detect submarines during World War II. The first useful medical images were produced in the early 1950s, and, by 1965, ultrasound quality had improved to the point that it came into general medical use. Improvements in the technology, application, and interpretation of ultrasound continue. Its low cost, versatility, safety and speed have brought it into the top drawer of medical imaging techniques.

While pelvic ultrasound is widely known and commonly used for fetal monitoring during pregnancy, ultrasound is also routinely used for general abdominal imaging. It has great advantage over x-ray imaging technologies in that it does not damage tissues with ionizing radiation. Ultrasound is also generally far better than plain x rays at distinguishing the subtle variations of soft tissue structures, and can be used in any of several modes, depending on the need at hand.

As an imaging tool, abdominal ultrasound generally is warranted for patients afflicted with: chronic or acute abdominal pain; abdominal trauma; an obvious or suspected abdominal mass; symptoms of liver disease, pancreatic disease, gallstones, spleen disease, kidney disease and urinary blockage; or symptoms of an abdominal aortic aneurysm.

Specifically:



Abdominal pain

Whether acute or chronic, pain can signal a serious problem-from organ malfunction or injury to the presence of malignant growths. Ultrasound scanning can help doctors quickly sort through potential causes when presented with general or ambiguous symptoms. All of the major abdominal organs can be studied for signs of disease that appear as changes in size, shape and internal structure.

Abdominal trauma

After a serious accident, such as a car crash or a fall, internal bleeding from injured abdominal organs is often the most serious threat to survival. Neither the injuries nor the bleeding are immediately apparent. Ultrasound is very useful as an initial scan when abdominal trauma is suspected, and it can be used to pinpoint the location, cause, and severity of hemorrhaging. In the case of puncture wounds, from a bullet for example, ultrasound can locate the foreign object and provide a preliminary survey of the damage. The easy portability and versatility of ultrasound technology has brought it into common emergency room use, and even into limited ambulance service.

Abdominal mass

Abnormal growths-tumors, cysts, abscesses, scar tissue and accessory organs-can be located and tentatively identified with ultrasound. In particular, potentially malignant solid tumors can be distinguished from benign fluid-filled cysts and abscesses. Masses and malformations in any organ or part of the abdomen can be found.

Liver disease

The types and underlying causes of liver disease are numerous, though jaundice tends to be a general symptom. Ultrasound can differentiate between many of the types and causes of liver malfunction, and is particularly good at identifying obstruction of the bile ducts and cirrhosis, which is characterized by abnormal fibrous growths and reduced blood flow.

Pancreatic disease

Inflammation and malformation of the pancreas are readily identified by ultrasound, as are pancreatic stones (calculi), which can disrupt proper functioning.

Gallstones

Gallstones cause more hospital admissions than any other digestive malady. These calculi can cause painful inflammation of the gallbladder and also obstruct the bile ducts that carry digestive enzymes from the gallbladder and liver to the intestines. Gallstones are readily identifiable with ultrasound.

Spleen disease

The spleen is particularly prone to injury during abdominal trauma. It may also become painfully inflamed when beset with infection or cancer. These conditions also lend themselves well to ultrasonic inspection and diagnosis.

Kidney disease

The kidneys are also prone to traumatic injury and are the organs most likely to form calculi, which can block the flow of urine and cause blood poisoning (uremia).Avariety of diseases causing distinct changes in kidneymorphology can also lead to complete kidney failure. Ultrasound imaging has proven extremely useful in diagnosing kidney disorders.


Abdominal aortic aneurysm.This is a bulging weak spot in the abdominal aorta, which supplies blood directly from the heart to the entire lower body. These aneurysms are relatively common and increase in prevalence with age. A burst aortic aneurysm is imminently life-threatening. However, they can be readily identified and monitored with ultrasound before acute complications result.


Ultrasound technology can also be used for treatment purposes, most frequently as a visual aid during surgical procedures-such as guiding needle placement to drain fluid from a cyst, or to extract tumor cells for biopsy. Increasingly, direct therapeutic applications for ultrasound are being developed.

The direct therapeutic value of ultrasonic waves lies in their mechanical nature. They are shock waves, just like audible sound, and vibrate the materials through which they pass. These vibrations are mild, virtually unnoticeable at the frequencies and intensities used for imaging. Properly focused however, highintensity ultrasound can be used to heat and physically agitate targeted tissues.

High-intensity ultrasound is used routinely to treat soft tissue injuries, such as strains, tears and associated scarring. The heating and agitation are believed to promote rapid healing through increased circulation. Strongly focused, high-intensity, high-frequency ultrasound can also be used to physically destroy certain types of tumors, as well as gallstones and other types of calculi. Developing new treatment applications for ultrasound is an active area of medical research.


Description

Ultrasound includes all sound waves above the frequency of human hearing-about 20 thousand hertz, or cycles per second. Medical ultrasound generally uses frequencies between one and 10 million hertz (1-10 MHz). Higher frequency ultrasound waves produce more detailed images, but are also more readily absorbed and so cannot penetrate as deeply into the body. Abdominal ultrasound imaging is generally performed at frequencies between 2-5 MHz. An ultrasound machine consists of two parts: the transducer and the analyzer. The transducer both produces the sound waves that penetrate the body and receives the reflected echoes. Transducers are built around piezoelectric ceramic chips. (Piezoelectric refers to electricity that is produced when you put pressure on certain crystals such as quartz). These ceramic chips react to electric pulses by producing sound waves (they are transmitting waves) and react to sound waves by producing electric pulses (receiving).
Bursts of high frequency electric pulses supplied to the transducer causes it to produce the scanning sound waves. The transducer then receives the returning echoes, translates them back into electric pulses and sends them to the analyzer-a computer that organizes the data into an image on a television screen. Because sound waves travel through all the body's tissues at nearly the same speed-about 3,400 miles per hour-the microseconds it takes for each echo to be received can be plotted on the screen as a distance into the body. The relative strength of each echo, a function of the specific tissue or organ boundary that produced it, can be plotted as a point of varying brightness. In this way, the echoes are translated into a picture. Tissues surrounded by bone or filled with gas (the stomach, intestines and bowel) cannot be imaged using ultrasound, because the waves are blocked or become randomly scattered.


This is the simplest type of ultrasound in which a single transducer scans a line through the body with the echoes plotted on screen as a function of depth. This method is used to measure distances within the body and the size of internal organs. Therapeutic ultrasound aimed at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus of the destructive wave energy.

In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. Ultrasound probes containing more than 100 transducers in sequence form the basis for these most commonly used scanners, which cost about $50,000.

The M stands for motion. A rapid sequence of B-mode scans whose images follow each other in sequence on screen enables doctors to see and measure range of motion, as the organ boundaries that produce reflections move relative to the probe. M-mode ultrasound has been put to particular use in studying heart motion.

Doppler ultrasonography includes the capability of accurately measuring velocities of moving material, such as blood in arteries and veins. The principle is the same as that used in radar guns that measure the speed of a car on the highway. Doppler capability is most often combined with B-mode scanning to produce images of blood vessels from which blood flow can be directly measured. This technique is used extensively to investigate valve defects, arteriosclerosis and hypertension, particularly in the heart, but also in the abdominal aorta and the portal vein of the liver. These machines cost about $250,000.