Veterinary Quarterly

ISSN: 0165-2176 (Print) 1875-5941 (Online) Journal homepage: http://www.tandfonline.com/loi/tveq20

Ultrasonography: Principles, Indications, and

Limitations

V. Schmid

To cite this article: V. Schmid (1998) Ultrasonography: Principles, Indications, and Limitations,
Veterinary Quarterly, 20:sup1, S80-S81, DOI: 10.1080/01652176.1998.10807430

To link to this article: https://doi.org/10.1080/01652176.1998.10807430

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Published online: 18 Mar 2014.

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• IMAGING & DIAGNOSTICS
ULTRASONOGRAPHY: PRINCIPLES,
INDICATIONS, AND LIMITATIONS
V. Schmid1
Imaging &Diagnostics
INTRODUCTION
Ultrasonography is not a new technology in veterinary medi-
cine, since it has been utilized in various fields for more than
15 years. The decrease in the size and cost of excellent ultra-
sound equipment and the increasing possibilities and indica-
tions for ultrasonography are the reasons why its use is ex-
panding in general, also outside the university setting.
Although ultrasonography is not a necessity in practice and
although extensive training, experience, and time are requi-
red to optimize its use, it can represent a growth potential op-
tion for practice. It is therefore worthwhile to understand the
indications and limitations of ultrasonograpy. Only by
understanding what it can and cannot do, you can evaluate its
potential use in your practice.
ESSENTIALS OF ULTRASOUND PHYSICS
Ultrasound, unlike X-rays, needs a medium for travel.
Diagnostic ultrasound uses sound waves at a very high fre-
quency, in the range of2-10 MHz. (audible sound= 2-20,000
Hz). Ultrasonography is based on the pulse-echo principle,
which means that a pulse of high frequency sound (=ultra-
sound) is sent from the transducer and transmitted into the
body. This pulse travels through the body until it reaches a
reflecting surface, at which time a portion of the ultrasound
pulse (the echo) is reflected back towards the transducer. The
transducer emits pulses less than 0.1% of the time, allowing
it to spend the remaining >99. 9% of the time listening for the
returning echoes. The time needed for the pulse to travel is
proportional to the distance it has travelled and this allows
the determination of the reflecting surface's position, which
will be displayed as a dot on the ultrasound screen at the ap-
propriate depth. The brightness of the dot is determined by
the amount of the ultrasound pulse that is reflected. As ultra-
sound travels through tissues, it grows weaker: this is called
the attenuation.
SCANNING TECHNIQUES
It is very important to take time to prepare the patient prop-
erly. The patient will have to lie on its side or on its back as
quietly as possible for a time that varies from 2-3 minutes
for a quick pregnancy check or an 'ultrasound-guided cysto-
centesis', to 20 minutes or more for a complete, detailed
examination of the abdomen. In any case and even if the
area of interest is very localized (for example, the prostate),
a rapid but complete and systematic overview examination
I Smail Animal Clinic. University o}Bern. CH-3012 Bern. Switzerland.
SBO THE VETERINARY QUARTERLY, VOL.
of the abdomen should be performed in search of other un-
expected abnormalities. Take enough time because it is dif-
ficult to do a good job in a hurry! During the examination
the patient and the examiner must feel at ease. There should
be at least one person present to restrain the patient.
Sedation must be considered in uncooperative patients. The
area to be scanned should be shaved and cleaned, and
enough gel must be applied to the skin surface. The first
images are usually not the best because some time is requi-
red before the contact between transducer and skin is opti-
mal. It is essential, especially in the beginning, to discipline
oneself to a systematic scanning technique in order not to
omit any structure.
INDICATIONS AND CLINICAL APPLICATIONS
It is very important to understand the possibilities and limita-
tions of ultrasound. Radiography remains the imaging
modality of choice when imaging air or bone. It also gives a
better overview of the body cavities and organs and their
relationships. However, it provides 'only' a shadow of or-
gans. Ultrasound goes a step further, by giving better defini-
tion of body structures, especially when the radiographic
shadows are obscured by fluid or a general loss of contrast.
Ultrasound is often the closest thing one can offer to explora-
tory surgery. It can also assist the approach to a surgical ex-
ploration by providing information regarding extent of a dis-
ease within an organ or adjacent structures. It can detect
cases in which surgery is unnecessary (pancreatitis), it can
detect abnormalities in organs not easily accessible to surgi-
cal examination (adrenals, sub lumbar lymph nodes, prostate,
mediastinum) or even eliminate the stress of surgery with
ultrasound-guided aspiration and biopsy.
Ultrasonography is generally used as a complementary
method after clinical examination, labaratory examination
and radiography have been performed. The only indication
for its use as a primary diagnostic technique is pregnancy
diagnosis. In general and with the use of the appropriate
equipment and training, almost any soft tissue structure of
the body can be imaged by ultrasound (not only internal or-
gans and solid structures in the thorax, but also eye, muscles
and tendons, brain, vessels, thyroid, parathyroid, salivary
glands, etcetera) (Table 1) (2,3).
Table 1. Most common indications for ultrasonography in practice.
Pleural and peritoneal effusions
Prostatic disease
Pregnancy examination and evaluation of the female genital tract
Urinary tract disease and cystocentesis
Mass lesions
Cardiac diseases
Ultrasound-guided aspiration and biopsy
20, SUPPLEMENT 1, APRIL 1998
• IMAGING & DIAGNOSTICS
INTERPRETATION: ARTEFACTS AND OTHER DIFFI-
CULTIES
Ultrasound is known to be an operator-dependant imaging
technique. Unlike radiography, where the images represent
an objective document, ultrasound images must be interpre-
ted as they are acquired and hard copies are usually made to
document an observation rather than to produce something
to be interpreted at a later date.
The operator must prepare the patient correctly, select the
appropriate scanning technique and the setting of the
machine, and recognize artefacts, in addition to having the
necessary knowledge of anatomy. Also the ability to think in
3D is mandatory, since ultrasound makes it possible to image
anatomy in any desired tomographic plane.
The structures seen during the echographic exam will usually
be evaluated on the basis of their position, size, shape, echo-
genicity (= echo intensity: hyper-, hypo-, an-, isoechoic or
mixed) and echotexture (fine, coarse, uniform or nonuniform
parenchymal texture, which depends on the size, spacing and
regularity of the dots that form the image). All these para-
meters are more or less standardized for the different organs
and tissues. For example, the liver is known as an organ with a
medium level of echogenicity, with a uniform and homoge-
nous parenchyma, and with a texture coarser than that of the
spleen. The interpretation of the sonographic appearance re-
mains always somewhat subjective and depends on the opera-
tor, the setting of the machine and the presence of artefacts.
ULTRASONOGRAPHY OF THE CRANIAL
ABDOMEN: LIVER, SPLEEN, PANCREAS,
AND GASTROINTESTINAL TRACT
S.A.E.B. Boroffka1
INTRODUCTION
Ultrasonography is a well established, noninvasive, diag-
nostic imaging technique that provides unique information
about the structure of soft tissues and enables the eval-
uation of the motion pattern of certain organs and structu-
res. In addition, Doppler techniques allow mapping of vel-
ocity and flow patterns of blood within the heart and
vessels. In order to gain as much information as possible
from an ultrasonographic examination, it is necessary to
obtain good quality images and to be familiar with the nor-
mal anatomy and appearances of various body tissues. For
larger patients a 5.0 MHz transducer is used, whereas for
small to medium-sized dogs and for cats a 7.5 MHz or 10.0
MHz transducer is preferred. Abdominal ultrasonography
is usually performed through the ventral abdominal wall
with the patient in dorsal recumbency. The hair is clipped
and contact gel is applied for good transducer-skin contact
1 Department of Radiology, F acuity of Veterinary Medicine, Utrecht University, P. 0.
Box 80164, NL-3508 TD Utrecht, the Netherlands.
S81 THE VETERINARY QUARTERLY, VOL.
FURTHER DIAGNOSTIC STEPS: ULTRASOUND-
GUIDED INTERVENTIONAL TECHNIQUES
Ultrasonographic evaluation of organ disease may not
yield a definitive result based on image interpretation
alone because ultrasound is a sensitive but a rather nonspe-
cific technique for the characterization of lesions. Cy-
tologic or histologic examination will provide the neces-
sary information to make a diagnostic and prognostic
determination of a particular disease state. There are two
main ultrasound-guided procedures for this purpose: fine-
needle aspiration and true-cut needle tissue biopsy ( 1).
Fine-needle aspiration is less invasive and has a lower
morbidity rate than tissue biopsy but it requires a veteri-
nary pathologist specialized in cytology to interpret the
findings.
Ultrasound guidance can be used for other procedures (4,5)
such as percutaneous drainage of abscesses or cysts, in situ
injections of pharmaceuticals, or placement of catheters.
Examples of interventional techniques that have been de-
scribed are: drainage of prostatic abscesses, injection of con-
trast agents into the renal pelvis for pyelography, injection of
alcohol in liver metastasis in humans. Among the interven-
tional techniques one can also mention intraoperative ultra-
sonography to assist the surgeon in locating foreign bodies,
in the localization of spinal and intracranial lesions, or locali-
zation of intrahepatic vascular shunts.
to obtain optimal image quality. Sedation of the patient is
rarely necessary. During the systematic examination of the
abdomen the size, shape, and delineation of each organ is
evaluated and the different parenchymous organs are com-
pared with each other as far as echogenicity and texture are
concerned. Sweeps of the transducer are made to image
each organ completely in both the longitudinal and the
tranverse plane. Additional oblique scan planes can be
used to obtain optimal images of organs, their delineation,
and interrelations. If the image quality remains poor after
optimal adjustment of the ultrasound machine, it is impor-
tant not to give up too soon. Usually the image quality im-
proves during the examination, possibly through better be-
tween the transducer and the skin contact, through
relaxation of the abdominal muscles of the patient, and
through displacement of the gas filled stomach and/or
intestines. Also, examining the patient in left or right la-
teral recumbency or in standing position can provide addi-
tional information. Repositioning of the patient may cause
interfering gas in the gastrointestinal tract to be displaced,
20, SUPPLEMENT 1, APRIL 1998