Fig. 5

Multimodal ultrasonography of cervical lesions. (a) Transrectal gray-scale US (GE voluson E10 RIC5-9-D, General Electric Company, Boston, Massachusetts, the United States) showing an enlarged cervix with multiple cystic lesions of various sizes and a few solid components. The solid components are hyperechoic. The cystic lesions are irregular, honeycomb-shaped, and of various sizes and were encompassed by relatively larger cysts. (b) Transabdominal CEUS ((PHILIPS EPIQ7, Philips Healthcare, Seattle, Washington, the United States) showing perfusion of the solid components of the cervical lesions before the myometrium. (c) Transabdominal CEUS image showing an unevenly enhanced uterine myometrium, unenhanced cystic echoes, and equally enhanced solid components when peaked. (d) Measurement of the mass volume using VOCAL software. (e) Three-dimensional TUI (General Electric Company, Boston, Massachusetts, the United States) of blood flow in the cervical lesion indicates that its blood supply is located in the intercyst septate and solid components. (f) Biplane transrectal US sagittal view using Biplane Endocavity convex-linear array transducer (ELC13-4U, Mindray, Shenzhen, Guangdong, China) revealing the normal structure of the vagina without penetration of the cancerous lesion. (g) Biplane transrectal US sagittal view showing intact and smooth rims of the anterior and posterior vaginal fornices without thickening or penetration of the lesion. Abbreviation AVF, anterior vaginal fornix; AVW, anterior vaginal wall; AVW, anterior vaginal wall; BL, bladder; CC, cystic component; CE, cervical effusion; CEUS, contrast-enhanced ultrasonography; CX, cervix; HE, hyperecho; PB, perineal body; PVF, posterior vaginal fornix; PVW, posterior vaginal wall; PVW, posterior vaginal wall; R, rectum; RVS, rectovaginal septum; SC, solid component; TUI, tomographic ultrasound imaging; UM, uterine myometrium; US, ultrasound