Recent Updates in Female Pelvic Ultrasound

Abstract

Ultrasound of gynecologic diseases has evolved with growing understanding of disease pathophysiology and technical advancements. We review recent literature and summarize relevant changes in practice guidelines for evaluation of endometrial thickening, ovarian masses, and polycystic ovarian syndrome. Endometrial thickening can be a sign of endometrial cancer, but normal thickness varies greatly by menstrual state and medication use. Endometrial thickness should raise suspicion at cut-offs of > 5 mm by SRU and > 4 mm by ACOG guidelines for symptomatic postmenopausal women and ≥ 11 mm for asymptomatic postmenopausal women, but is less useful in the premenopausal state or with tamoxifen use. It is now understood that simple ovarian cysts are widely prevalent with a very low likelihood of malignancy, and follow-up and treatment guidelines have been revised. The recently proposed Ovarian-Adnexal Reporting and Data System provides consistent terminology and management guidelines for additional ovarian masses. Polycystic ovarian syndrome diagnosis includes imaging and clinical criteria, with imaging findings requiring > 20 follicles per ovary and/or ovarian volume ≥ 10 mL without presence of corpora lutea, cysts, or dominant follicles. This review provides updates of recent changes in female pelvic ultrasound imaging, and we hope it will aid radiologists in accurate diagnosis and management of gynecologic diseases.