Values Used in Ultrasound

|LIVER | Caudo ~ Cranial (CC) length = < 17 cm Right Lobe Caudo ~ Cranial (CC) length = < 16 cm Anterio ~ Posterior (A ~ P) length = < 16 cm Left Lobe Width = < 11 cm Anterio ~ Posterior (A ~ P) length = < 7 cm Caudate Lobe Caudo ~ Cranial (CC) length = < 8 cm (5 ~ 8 cm) Anterio ~ Posterior (A ~ P) length = < 2. 5 cm (2. 0 ~ 2. 5 cm) Caudate lobe and Right lobe ratio (cc length of caudate lobe/ cc length of right lobe) > 0. 65= 93 % specific for cirrhosis gt; 0. 73= 99 % specific for cirrhosis Normally Right lobe : Caudate lobe = 3 : 2 Pediatric liver size (up to 12 years) = < 11 cm Portal vein Normal diameter= < 13 mm In portal hypertension= > 13 mm (> 15 mm is suggestive) Common bile duct (CBD) Normal diameter in adult= < 7 mm In elderly (70 yr) & after cholecystectomy= 8 ~ 10 mm (In case of older patient 1 mm dilatation with each decade after 40 years of age is normal) Gallbladder Length= 8 ~ 12 cm Width= < 5 cm Distended (mucocele)= Diameter > 5 cm Normal wall thickness= < 3 mm Liver Doppler

PSV of portal vein= 13 ~ 23 cm/sec Congestive index (CI)= Normal range of CI = 0. 070 + 0. 029 cm/sec In cirrhosis CI= 0. 171 + 0. 075 cm/sec Hepatic artery Normal RI= 0. 62 + 0. 04 After meal = 0. 66 + 0. 78 |SPLEEN | Length (L)= < 13 cm Width (W)= < 6 cm Anterio-posterior thickness (A ~P)= < 4 cm Formula of measuring splenic weight = L X W X A~P X 0. 43 (Lengths should be in cm and resultant weight unit expressed in gm) Normal weight: ? Male= < 180 gm Female= < 150 gm Splenomegaly (irrespective of sex): ? Mild= > 200 gm ? Moderate= > 500 gm ? Severe= > 2000 gm Splenic index = L X A~P (expressed in no unit) Normal range of splenic index= < 45 (no unit) Pediatric spleen size measurement formula (up to 12 years): Length (L)= 5. 5 + (age in year X 0. 31) expressed in cm Example exercise for measuring pediatric spleen of a 10-year old kid: Length (L)= 5. 5 + (10 X 0. 31) = 5. 5 + 3. 1 = 8. 6 cm Subjective assessment of splenomegaly: ? If the spleen is crossing the mid-pole of the left kidney, it assumes as enlarged. If spleen is going out of the window of ultrasound, it assumes as enlarged. Normal diameter of the splenic vein= < 10 mm In portal hypertension= > 10 mm |PANCREAS | Length (L)= 12. 5 ~ 15. 0 cm Maximum anterio-posterior (A~P) diameter: ? Head= 3. 0 cm ? Neck= 1. 0 ~ 2. 0 cm ? Body = 2. 5 cm ? Tail= 2. 0 cm Normal diameter of pancreatic duct: ? Average= 2. 0 mm ? Head= 3. 0 mm ? Body= 2. 1 mm ? Tail= 1. 6 mm Common site for the pancreatic mass= Head GIT | Esophagus Length (L)= 25 cm Width (W)= 2. 5 ~ 3. 0 cm Stomach Four coats of the stomach wall: a. Serous coat – peritoneum b. Muscular coat – 3 layers (outer longitudinal, middle circular & inner oblique) c. Submucous coat – connective tissue d. Mucous coat – mucous membrane Normal wall thickness= < 5 mm Hypertrophic pyloric stenosis Length of pylorus= > 18 mm Thickness of pyloric muscle= > 4 mm (one wall) Small Bowel (Duodenum, Jejunum & Ileum)

Length (L)= 6 meter Diameter= 4 cm (2. 5 cm at lower end) Normal wall thickness= < 3 mm Large Bowel The colon Length (L)= 1. 5 meter Diameter= 6 cm Normal wall thickness= < 5 mm In Crohn’s diseae: (The lesion usually involves the distal ileum and colon) Thickness of the affected bowel segment = > 5 mm Rectum Length= 12 cm The Appendix Length= 9 cm Diameter= 5 mm Diameter in acute appendicitis = > 6 mm (outer wall ~ outer wall) |KIDNEY | Length (L)= < 12 cm

Width (W)= < 6 cm Anterio-posterior thickness (A~P)= < 3 cm (Difference of kidney length should not be > 2 cm in normal adult) Normal weight= 120 ~ 170 gm Cortex and medulla ratio < 30 years : cortex : medulla = 2. 0 : 1. 0 30 ~ 50 years: cortex : medulla = 1. 6 : 1. 0 > 50 years: cortex : medulla = 1. 0 : 1. 0 Ureter Normal diameter= < 5 mm Pediatric kidney size measurement Formula a) For the children over one year of age Kidney length (in cm)= 6. 79 + (0. 22 X age in year) Example exercise of a kid of 10 year: Kidney length= 6. 79 + (0. 22 X age in year) = 6. 9 + (0. 22 X 10) = 6. 79 + 2. 2 = 8. 99 cm b) For the children less than one year of age Kidney length (in cm)= 4. 98 + (0. 155 X age in month) Example exercise of a kid of 10 month: Kidney length= 4. 98 + (0. 155 X age in month) = 4. 98 + (0. 155 X 10) = 4. 98 + 1. 55 = 6. 5 cm Note: Asymmetry in renal lengths exceeding 5 mm in infants and 10 mm in older children should raise the suspicion of an underlying problem even if both kidneys are within the normal range. Normal renal pelvic diameter in fetus ? 15 ~ 20 weeks= < 4 mm ? 20 ~ 30 weeks= < 8 mm ? > 30 weeks= < 10 mm

Prostate Measurement of weight= L X W X A~P X 0. 55 (expressed in gm) Normal weight= < 30 gm (If any measurement appears more than 37 mm, it assumes prostate is enlarged) Urinary bladder Normal wall thickness= 3 mm (in distended bladder = 6 mm (in partially filled bladder) Thickened bladder wall= > 4 mm (In pediatric patient a PMR more than 30 ml is generally considered as pathological) Kidney Doppler Renal artery PSV= 60 ~ 140 cm/sec (< 180 cm/sec) Resistive index (RI)= 0. 56 ~ 0. 70 Pulsatility index (PI)= 0. 70 ~ 1. 40 In obstructive uropathy RI = > 0. 7 UTERUS | Size Neonatal (at birth)= 3. 5 cm Adult (nullipara) Length (L)= 6 ~ 9 cm (mean 7. 5 cm) Width (W)= 3 ~ 5 cm (mean 4 cm) Anterio-posterior thickness (A~P)= 2 ~ 3 cm (mean 2. 5 cm) Adult (multipara) Length (L)= 9 ~ 11 cm (mean 10 cm) Width (W)= 4 ~ 6 cm (mean 5 cm) Anterio-posterior thickness (A~P)= 3 ~ 4 cm (mean 3. 5 cm) (Uterine size in length becomes enlarged for 1 cm for each delivery up to three deliveries) Ratio of body with cervix In infantbody : cervix = 1 : 2

In adultbody : cervix = 2 : 1 Hypoplastic uterus Length of uterus in adult= < 5. 5 cm (with normal body & cervix ratio) Post-menopausal uterus Smaller size with normal body & cervix ratio Cervix Normal length= 2. 5 ~ 4. 5 cm(in reproductive age) = 2. 1 ~ 2. 6 cm (in post-menopausal state) Cervical incompetence= < 2. 5 cm in length (Elongated cervix > 4. 5 cm may be a cause of infertility) Endometrium Normal thickness a. In pre-menopausal women ? In proliferative phase= 2 ~ 8 mm ? During ovulation= 13 mm ? Secretory phase= 8 ~ 14 mm b. In postmenopausal women With hormone therapy = < 8 mm ? Without hormone therapy = < 5 mm Endometrial hyperplasia Endometrial thickness= > 14 mm(in pre-menopausal women) = > 8 mm(in postmenopausal women) Gynae Doppler |Status |Ovarian Artery |Uterine Artery | |Different phases/stages |RI |PI |Velocity | | |Early proliferative phase |0. 65 ~ 0. 70 |1. 80 ~ 2. 20 |20 cm/s |1. 45 ~ 1. 0 | |Late proliferative phase |0. 55 ~ 0. 60 |1. 00 ~ 1. 30 |40 cm/s |1. 50 ~ 2. 30 | |Secretory phase |0. 60 ~ 0. 65 |1. 30 ~ 1. 80 | |1. 55 ~ 2. 90 | |Non-conception |0. 60 ~ 0. 70 |1. 80 ~ 2. 20 | |2. 75 ~ 4. 95 | |Post-menopausal |0. 60 ~ 1. 00 |1. 30 ~ 4. 00 | |1. 80 ~ 3. 80 | Ovarian mass Resistive index (RI)= < 0. 4 suggestive of malignant 0. 4 ~ 0. 5 suggestive of intermediate (suspicious) = > 0. 5 suggestive of benign |OBSTETRICS | Embryonic stage= Up to 10 weeks of gestational age Fetus= > 10 weeks of gestational age Mean Sac Diameter (MSD) in TAS (Transabdominal sonography) At 20 mm size= Yolk sac must be present At 25 mm size= Embryo must be present Blighted ovum Neither yolk sac nor embryo is present within the gestational sac when – ? In transvaginal sonography (TVS) MSD measures= > 16 mm ?

In transabdominal sonography (TAS) MSD measures= > 25 mm Yolk Sac ? Normal diameter= < 6 mm ? Normally seen= 5 ~ 12 weeks of gestational age ? Wall= Thin and regular ? Content= Anechoic ? Diameter > 6 mm and/or persistence after 12 weeks of gestational age may be due to chromosomal abnormality) ? In case of monochorionic monoamniotic twin pregnancy low-level echoes can be seen inside yolk sac, which is due to thick fluid content to provide nutrient for two developing fetus from one yolk sac) ? Number of yolk sac indicates number of zygote Placenta Start developing= At 7 ~ 8 weeks of gestational age

Thickness in mm= Corresponds with gestational age in weeks Thickened placenta= > 50 mm Thin placenta= Thickness is 2. 5 cm or less at/after 35 weeks of gestational age Low-lying placenta= Cervical end of the placenta lying 2. 5 cm vicinity of internal os Causes of thickened placenta: ? Diabetes mellitus ? Fetal hydrops ? Fetal infection (e. g. Cytomegalovirus) ? Chromosomal abnormality (especially triploidy) Placental grading: |Features |Latest Grading |Old Grading | |Cervical end of the placenta |2. cm within the vicinity of the |5 cm within the vicinity of the internal | | |internal os = Low-lying |os = Type I placenta praevia | |Placenta just touching the internal os |Marginal placenta praevia |Type II placenta praevia | |Placenta partially covers the os |Partial placenta praevia |Type III placenta praevia | |Placenta completely covers the internal |Complete placenta praevia |Type IV placenta praevia | |os | | | Placental maturity: ? Grade – 0 ? Grade – I ? Grade – II ? Grade – III Amniotic fluid Contents: a. Water = 98% ~ 99% b. Organic components i. Protein (50%) ii. Others (50%) o Carbohydrate o Fat o Enzymes o Hormones o Pigments c. Inorganic constituents – inorganic salts Volume: At10 weeks= 25 ml 20 weeks= 350 ml 35 weeks = 1000 ml 43 weeks = 250 ml (peaks at 36 weeks) Source:

In early pregnancy: Amniotic membrane, transudate from mayernal blood From 2nd trimester: Fetal kidney starts to contribute (about 500 ml/day). (Fetal swallowing of amniotic fluid starts at 11 ~ 13 weeks. At later stage of pregnancy fetus swallows about 400 ml/day) Assessment: Subjective assessment= Eye ball assessment (needs experience and orientation) Objective assessment a) Maximum vertical pocket measurement (Chamberlain Method) b) Measurement of AFI (Phelan Method) Maximum vertical pocket measurement (Chamberlain Method) Interpretation: Normal range 2 ~ 8 cm < 1 cm = Severe oligohydramnios 1 ~ 2 cm = Significant oligohydramnios 2 ~ 8 cm= Normal 8 ~ 12 cm= Mild polyhydramnios 12 ~ 16 cm = Moderate polyhydramnios gt; 16 cm = Severe polyhydramnios Measurement of AFI (Phelan Method) Interpretation: Normal range 5. 5 ~ 22 cm < 5. 5 cm = Oligohydramnios 5. 5 ~ 8 cm = Suspicious for oligohydramnios 8 ~ 22 cm= Normal > 22 cm = Polyhydramnios (Dolicocephaly is a common finding in oligohydramnios) Landmarks for measuring biparietal diameter (BPD) ? Falx cerebri ? Paired thalami ? Cavum septum pellucidum Landmarks for measurement of abdominal circumference (AC) ? Fetal spine ? Stomach bubble ? Portal sinus Head circumference (HC)= BPD outer-to-outer X OFD outer-to-outer X 1. 57 Cephalic index (CI)= Normal CI= 0. 70 ~ 0. 86 Head is dolicocephalic if CI= < 0. 70

Head is brachycephalic if CI= > 0. 86 Obstetric Doppler Umbilical artery S/D Ratio At 20 weeks = < 4 30 weeks = < 3 35 weeks = < 2. 5 term = < 2 Pulsatility index (PI) At 20 weeks = 1. 10 ~ 1. 70 (mean 1. 35) 28 weeks = 0. 80 ~ 1. 45 (mean 1. 10) 36 weeks = 0. 55 ~ 1. 20 (mean 0. 55) Uterine artery resistive index (RI) At 20 weeks = 0. 50 ~ 0. 76 (mean 0. 65) 28 weeks = 0. 37 ~ 0. 67 (mean 0. 53) 36 weeks = 0. 35 ~ 0. 65 (mean 0. 50) Middle Cerebral Artery (MCA) Pulsatility index (PI) At 20 weeks = 1. 20 ~ 2. 10 (mean 1. 70) 28 weeks = 1. 40 ~ 2. 37 (mean 1. 90) 36 weeks = 1. 20 ~ 2. 10 (mean 1. 60) Spectral analysis of umbilical artery

Normal appearance= Saw tooth appearance with good diastolic flow In IUGR: Decrease or absent diastolic flow= Indicates feto-placental insufficiency Reverse diastolic flow = Established IUGR In term pregnancy Absence or reverse flow = Indication of immediate delivery by caesarian section Prepared by: Dr. Md. Nazrul Islam Bangladesh e-mail: drjhinuk@yahoo. com ———————– PV cross sectional area (cm2) M PV flow velocity cm/sec PSV = Peak Systolic Velocity Portal vein area = diameter A X diameter B PV flow velocity = 0. 57 X max. PV velocity (angle 18 mm ? Thickness of pyloric muscle = > 4 mm (one wall) BPD outer-to-outer OFD ———————– Values used in ultrasound [pic]