Published online before print June 21, 2002, 10.1148/radiol.2242911110
(Radiology 2002;224:429.)
A more recent version of this article appeared on August 1, 2002
© RSNA, 2002
Echogenic Ovarian Foci without Shadowing: Are They Caused by Psammomatous Calcifications?1
Derek Muradali, MD, FRCPC,
Terence Colgan, MD, FRCPC,
Eran Hayeems, MD, FRCPC,
Peter N. Burns, PhD and
Stephanie R. Wilson, MD, FRCPC
1 From the Departments of Medical Imaging (D.M., E.H., S.R.W.) and Pathology (T.C.), University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4; and Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada (P.N.B.). Received June 25, 2001; revision requested July 27; revision received November 7; accepted January 7, 2002. Address correspondence to D.M. (e-mail: derek.muradali@uhn.on.ca).
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Figure 1. Transvaginal pelvic US scan obtained in 48-year-old woman shows bright echogenic peripheral foci (arrows) in an ovary that otherwise appears to be normal. U = uterus.
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Figure 2a. (a) Transvaginal pelvic US scan obtained in 70-year-old woman with histologically proven serous papillary adenocarcinoma of the right ovary shows numerous bright echogenic foci (arrows) in a large ovarian mass (M). At histologic analysis, intratumoral psammomatous calcifications were detected. (b) Transvaginal pelvic US scan obtained in 55-year-old woman with peritoneal carcinomatosis secondary to metastatic papillary adenocarcinoma of the ovary shows bright EOF (arrowheads) in a visceral peritoneal plaque (arrows) adhering to the surface of a small-bowel loop (B). A = ascites.
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Figure 2b. (a) Transvaginal pelvic US scan obtained in 70-year-old woman with histologically proven serous papillary adenocarcinoma of the right ovary shows numerous bright echogenic foci (arrows) in a large ovarian mass (M). At histologic analysis, intratumoral psammomatous calcifications were detected. (b) Transvaginal pelvic US scan obtained in 55-year-old woman with peritoneal carcinomatosis secondary to metastatic papillary adenocarcinoma of the ovary shows bright EOF (arrowheads) in a visceral peritoneal plaque (arrows) adhering to the surface of a small-bowel loop (B). A = ascites.
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Figure 3. Sagittal US scan of the thyroid gland of 33-year-old man shows multiple bright echogenic foci (arrows) in a solid nodule (N). Papillary thyroid carcinoma associated with psammomatous calcifications was proved at biopsy. T = normal thyroid gland.
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Figure 4a. (a) Transvaginal pelvic US scan obtained in 54-year-old woman shows multiple peripheral (arrowheads) and central (arrows) EOF that are not associated with posterior US artifact. (b) Transvaginal pelvic US scan obtained in 43-year-old woman shows central echogenic foci (arrows) without associated posterior artifact in an otherwise normal ovary.
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Figure 4b. (a) Transvaginal pelvic US scan obtained in 54-year-old woman shows multiple peripheral (arrowheads) and central (arrows) EOF that are not associated with posterior US artifact. (b) Transvaginal pelvic US scan obtained in 43-year-old woman shows central echogenic foci (arrows) without associated posterior artifact in an otherwise normal ovary.
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Figure 5a. (a) Transverse US scan of an ovary resected from 63-year-old woman and imaged while immersed in a water bath shows a dominant simple cyst (C) with multiple bright EOF (arrows) surrounding the cyst and throughout the parenchyma. (b) For direct US-histopathologic correlation, a suture (arrowheads) soaked in black India ink was placed, with US guidance, around one of the EOF (open arrow) depicted in a. Solid arrows point to EOF surrounding the now collapsed dominant cyst (C). (c) Histologic specimen from the ovary depicted in a and b shows multiple small cysts (C) and no evidence of associated psammomatous calcifications in the area where the bright echogenic focus was localized with US guidance in b. Arrowheads point to the surface of the ovary.
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Figure 5b. (a) Transverse US scan of an ovary resected from 63-year-old woman and imaged while immersed in a water bath shows a dominant simple cyst (C) with multiple bright EOF (arrows) surrounding the cyst and throughout the parenchyma. (b) For direct US-histopathologic correlation, a suture (arrowheads) soaked in black India ink was placed, with US guidance, around one of the EOF (open arrow) depicted in a. Solid arrows point to EOF surrounding the now collapsed dominant cyst (C). (c) Histologic specimen from the ovary depicted in a and b shows multiple small cysts (C) and no evidence of associated psammomatous calcifications in the area where the bright echogenic focus was localized with US guidance in b. Arrowheads point to the surface of the ovary.
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Figure 5c. (a) Transverse US scan of an ovary resected from 63-year-old woman and imaged while immersed in a water bath shows a dominant simple cyst (C) with multiple bright EOF (arrows) surrounding the cyst and throughout the parenchyma. (b) For direct US-histopathologic correlation, a suture (arrowheads) soaked in black India ink was placed, with US guidance, around one of the EOF (open arrow) depicted in a. Solid arrows point to EOF surrounding the now collapsed dominant cyst (C). (c) Histologic specimen from the ovary depicted in a and b shows multiple small cysts (C) and no evidence of associated psammomatous calcifications in the area where the bright echogenic focus was localized with US guidance in b. Arrowheads point to the surface of the ovary.
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Figure 6. Transverse US scan of tissue phantom, scanned in a water bath, with two rows of cysts that range in size from 0.30 mm (arrowheads) to 1.66 mm (curved arrow) in diameter shows that cysts that range in size from 0.50 to 1.66 mm in diameter are associated with bright echogenic foci arising from the anterior and posterior walls (straight arrows) of the cysts. However, the smallest cysts, which are 0.30 mm in diameter, appear as a single bright echogenic focus (arrowheads).
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Figure 7. Transverse US scan of glycerol-ethanol phantom. To investigate the effect on the resulting US scan of matching the impedance of the fluid to that of the tissue gel, a phantom with identical voids (size range, 0.30-1.66 mm) was filled with a glycerol-ethanol solution. At US with an 8-MHz transducer, the three largest voids appear as an anechoic space (arrowheads) without evidence of specular echoes. Smaller voids are not seen.
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Figure 8a. Transverse US scans of tissue phantom in a water bath and scanned (a) at different distances from the transducer and (b) at different angles of incidence show persisting echogenic foci, as observed when the tissue phantom was scanned perpendicular to the ultrasound beam (Fig 6). These findings indicate that the observed echogenic foci are specific to the cysts and independent of the geometry of the phantom.
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Figure 8b. Transverse US scans of tissue phantom in a water bath and scanned (a) at different distances from the transducer and (b) at different angles of incidence show persisting echogenic foci, as observed when the tissue phantom was scanned perpendicular to the ultrasound beam (Fig 6). These findings indicate that the observed echogenic foci are specific to the cysts and independent of the geometry of the phantom.
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Figure 9. Transverse US scan of tissue phantom in water bath and scanned with a 70-MHz transducer shows all cysts are resolved, have well-defined margins, and have no evidence of specular reflection. These findings indicate that the specular reflection needed to produce an echogenic focus at scanning with an 8-MHz transducer occurs only in the range of diagnostic US.
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Copyright © 2002 by the Radiological Society of North America.
