The Z technique: an easy approach to the display of the mid-coronal plane of the uterus in volume sonography.

OBJECTIVE: The purpose of our study was to evaluate the ease of learning and clinical applicability of a technique (Z technique) for display of the mid-coronal plane of the uterus in volume sonography. METHODS: Eight physicians were randomly assigned to 2 groups, A and B, after being instructed on the basic principles of post processing of sonographic volumes. Physicians in group A were asked to individually display the mid-coronal plane of the uterus in each of five 3-dimensional volumes of uteri. Physicians in group B were instructed on the Z technique and were then asked to individually display the mid-coronal plane of the uterus in the same volumes as group A. The time needed for display of the mid-coronal plane of the uterus and the quality of the mid-coronal plane image retrieved were recorded for each volume. RESULTS: The mean time required to display the mid-coronal plane of the uterus for all volumes was 47.7 seconds in group B compared with 110.7 seconds in group A (P=.002). Furthermore, a significant improvement in time performance was seen for physicians in group A after learning the Z technique (23.2 seconds after compared with 110.7 seconds before; P=.0001). The quality of the image produced was notably better for all physicians after learning the Z technique. CONCLUSIONS: The Z technique is an easy technique to learn. Physicians who learn this technique are able to retrieve the mid-coronal plane of the uterus faster and improve its image quality in volume sonography.     

Clinical implications of the echo enhancement artifact in volume sonography of the uterus.

OBJECTIVE: The purpose of this report is to present a 3-dimensional (3D) imaging artifact, the echo enhancement artifact, which may have important clinical implications in the display of the midcoronal plane of the uterus in volume sonography and to suggest a technologic modification to current 3D equipment that may help the user in the identification of such an artifact. METHODS: Three coronal planes were retrieved out of a 3D volume of a uterus obtained during the luteal phase of the menstrual cycle by standard postprocessing techniques. The effect of the echo enhancement artifact on the display of the coronal planes was compared. RESULTS: Coronal planes, obtained in the posterior myometrium, below the endometrial cavity, appeared to show what looked like endometria and could potentially be confused with the anatomic midcoronal plane of the uterus by an inexperienced operator because of the echo enhancement artifact. CONCLUSIONS: Physicians reviewing diagnostic images retrieved out of a sonographic volume should be aware of this artifact and should review the anatomic plane that corresponds to the retrieved image before a clinical diagnosis is rendered. A technologic modification to current 3D equipment is suggested.     

Renal sonography with 2-dimensional versus cine organ imaging: preliminary results.

OBJECTIVE: This pilot study was undertaken to determine whether cine organ imaging (COI) of the entire kidney yields a quicker and equally diagnostic study compared with traditional 2-dimensional (2D) scanning. METHODS: Fifty-seven adult patients referred for diagnostic renal sonography underwent 2D sonography followed by COI performed by a second sonographer, who was blinded to the results of the first examination. Images were interpreted blindly by 2 independent readers in 2 separate reading sessions divided into 2D or COI image sets for each patient. The acquisition time and interpretation time of each protocol were recorded. Images were scored for the percentage of kidney visualized and for the presence or absence of hydronephrosis, stones, cysts, and renal lesions (non-simple cysts and solid masses). RESULTS: The average acquisition time decreased from 13.3 to 10.5 minutes between 2D and COI studies, respectively (P = .02). The average image interpretation time increased 37 seconds (P < .0001). A greater percentage of parenchymal visualization was achieved with COI versus 2D imaging. There was no significant difference in detection of renal abnormalities (hydronephrosis, stones, renal cysts, and masses) between the 2 modes, although the detection of cysts on COI was equal to or greater than that on 2D imaging on a per-patient basis. CONCLUSIONS: Cine organ imaging decreased the acquisition time significantly while retaining and possibly improving diagnostic quality. The minimally increased interpretation time may be decreased in the future by fewer volume acquisitions per patient. Further investigations will be needed to assess the impact of color Doppler imaging in volumetric protocols as well as to compare renal lesion detection versus computed tomography and magnetic resonance imaging.     

Three-dimensional sonography of muscle hernias.

OBJECTIVE: Muscle hernias through a defect in the fascia can be subtle and difficult to see on 2-dimensional (2D) scans. We describe the appearance of muscle hernias on 3-dimensional (3D) sonographic multiplanar scans and 3D rendering. METHODS: Two patients were examined with a 2D linear 5- to 12-MHz probe. The questionable area was scanned with a 5- to 12-MHz linear 3D transducer. Multiplanar reconstruction and 3D rendering were performed to show the hernia. RESULTS: In both cases, the muscle hernia was small and subtle on 2D scans but became slightly more prominent on examination after the muscle was exercised. In both patients, the hernias were very obvious on 3D scans. CONCLUSIONS: Symptomatic muscle hernias may sometimes be very small and difficult to see on 2D scans. Three-dimensional rendering shows the hernia very well.     

Improving the efficiency of gynecologic sonography with 3-dimensional volumes: a pilot study.

OBJECTIVE: The purpose of this study was to determine whether 3-dimensional (3D) sonography can provide a rapid, efficient, and accurate way to do a transvaginal gynecologic scan compared with traditional 2-dimensional (2D) sonography. METHODS: Thirty-five consecutive patients who underwent gynecologic sonography formed the study cohort. After a standard 2D transvaginal scan was done, including measurements of the endometrium and abnormalities, 4 volume acquisitions were obtained, encompassing the uterus (2 volumes) and the ovaries. These volumes were reviewed offline without any patient information. Endometrium and other measurements were performed on the volumes. The 2D and 3D results were compared by paired t tests. RESULTS: The mean time needed for the standard 2D scan was 2.6 minutes compared with 1.07 minutes for the 3D volume acquisitions. The mean time for the reconstruction, measurement, and interpretation of the volumes offline was 1.19 minutes. The mean time for the entire 3D examination (both parts) was 2.26 minutes (P = .047, comparing 2D with total 3D). There was no significant difference between the measurements of the endometrium, fibroids, and ovarian cysts when comparing 2D and reconstructed 3D images. Two-dimensional and 3D sonography differed little in their ability to identify the organs and the abnormalities on the scans. CONCLUSIONS: This study shows that a complete transvaginal gynecologic examination can be done in 1.07 minutes of scan time and interpreted offline in an additional 1.19 minutes. The 35 cases were scanned and interpreted with the use of 3D sonography in 79.17 minutes total compared with 91.46 minutes of 2D scan time (P = .047). The accuracy of the scan was similar for both techniques.     

阴道超声对子宫内膜增殖症的鉴别诊断价值

目的:探讨阴道超声扫描对子宫内膜增殖症的鉴别诊断价值.方法:对58例患者进行阴道超声检查,检查结果与临床对照,观察各种病因引起子宫内膜增殖的特征性改变.结果:阴道超声扫描正常分泌期内膜增厚、早期妊娠、子宫内膜增生过长及子宫内膜癌有其各自声像图特征.与临床或病理学诊断比较有较好的一致性.结论:作为新的超声扫描技术,阴道内超声扫描对子宫内膜增殖症的鉴别诊断有较高的应用价值.     

Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy.

OBJECTIVE: Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3-dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors. METHODS: Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D sonography and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction images obtained from the patients. The results of 3D sonographic cystoscopy were compared with the findings from conventional cystoscopy, which was considered the reference standard. RESULTS: Twenty-eight (90.3%) of 31 3D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22 of 28 patients; 3D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. Three-dimensional virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a positive predictive value of 93.9%, and a negative predictive value of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a positive predictive value of 97.6%, and a negative predictive value of 84.2% for tumor detection. CONCLUSIONS: Three-dimensional sonography is a promising alternative noninvasive technique for use in detection of bladder tumors, their localization, and perivesical spreading. The location, size, and morphologic features of the tumors shown on 3D sonography agreed well with the findings of conventional cystoscopy.     

Three-dimensional volume sonographic study of fetal anatomy: intraobserver reproducibility and effect of examiner experience.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) sonography in assessing fetal anatomy and to determine the intraobserver reproducibility and the effect of examiner experience. METHODS: Three-dimensional volumes of the head, face, thorax, and abdomen were obtained for 40 fetuses. The volume data sets obtained were explored offline with multiplanar navigation and tomographic ultrasound imaging on a personal computer. Each case was examined twice by the same observer at least 3 months apart. The percentage for identification of fetal anatomic structures, 2-dimensional (2D) and 3D measurements, and the time spent on 2D and 3D examinations were calculated and compared. RESULTS: Ninety-two percent of fetal anatomic structures were identified with multiplanar navigation and tomographic ultrasound imaging. The genitals, the entry of the vena cava, and the ears were visualized in less than 70% of cases. Tomographic ultrasound imaging allowed viewing of 14 structures not seen in the multiplanar study. Intraobserver agreement for anatomic examinations was good (kappa = 0.78). Intraobserver agreement for fetal measurements showed differences between both examinations that approached 0 and intraclass correlation indices close to 0.9. The mean 2D scanning time +/- SD was 10.11 +/- 2.5 minutes, and the acquisition time for the 3D volumes was 1.54 +/- 0.35 minutes. The total time for the second 3D study was 7.23 +/- 1.17 minutes, significantly shorter than the 9.96 +/- 1.53 minutes spent on the first study (P < .001). CONCLUSIONS: Three-dimensional volumes are highly effective for complete fetal anatomic surveys. They show excellent intraobserver reproducibility and take less time to study as the examiner's experience increases.     

Three-dimensional power Doppler vascular network assessment of adnexal masses: intraobserver and interobserver agreement analysis.

OBJECTIVE: The purpose of this study was to assess intraobserver and interobserver agreement for tumor vascular network evaluation as assessed by 3-dimensional (3D) power Doppler sonography for discriminating benign from malignant adnexal masses. METHODS: Stored 3D power Doppler angiographic volume data from 39 women with a diagnosis of a vascularized adnexal mass who were evaluated and treated at our institution were retrieved from our database for analysis. Two different examiners (observer A, with 6 years of experience in 3D sonography; and observer B, with 1 year of experience) reviewed 3D sonograms blinded to each other. Three-dimensional vascular network reconstruction was done with surface rendering in the color mode. Malignancy was considered in the presence of at least 2 of the following: irregular branching, vessel caliber changes, microaneurysms, and vascular lakes. A definitive histologic diagnosis was obtained in all cases. Intraobserver and interobserver agreement rates were estimated by calculating the kappa index. RESULTS: Twenty (51%) tumors were malignant, and 19 (49%) were benign. Intraobserver agreement was good for observer A (kappa = 0.69) and moderate for observer B (kappa = 0.54). Interobserver agreement was moderate (kappa = 0.49). CONCLUSIONS: We found intraobserver and interobserver agreement to be moderate for 3D power Doppler assessment of the vascular network in adnexal masses.     

Three-dimensional sonography with needle tracking: role in diagnosis and treatment of prostate cancer.

OBJECTIVE: Image-guided prostate biopsy has become routine in medical diagnosis. Although it improves biopsy outcome, it mostly operates in 2 dimensions, therefore lacking presentation of information in the complete 3-dimensional (3D) space. Because prostatic carcinomas are nonuniformly distributed within the prostate gland, it is crucial to accurately guide the needles toward clinically important locations within the 3D volume for both diagnosis and treatment. METHODS: We reviewed the uses of 3D image-guided needle procedures in prostate cancer diagnosis and cancer therapy as well as their advantages, work flow, and future directions. RESULTS: Guided procedures for the prostate rely on accurate 3D target identification and needle navigation. This 3D approach has potential for better disease diagnosis and therapy. Additionally, when fusing together different imaging modalities and cancer probability maps obtained from a population of interest, physicians can potentially place biopsy needles and other interventional devices more accurately and efficiently by better targeting regions that are likely to host cancerous tissue. CONCLUSIONS: With the information from anatomic, metabolic, functional, biochemical, and biomechanical statuses of different regions of the entire gland, prostate cancers will be better diagnosed and treated with improved work flow.     

Comparison of three- and two-dimensional sonography in diagnosis of gallbladder diseases: preliminary experience.

OBJECTIVE: To compare three-dimensional sonography with two-dimensional sonography for diagnosis of gallbladder diseases. METHODS: Sixty-three patients with gallbladder diseases were examined with two- and three-dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared. RESULTS: Both two- and three-dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three-dimensional sonography had no influence on the diagnosis of gallstones compared with two-dimensional sonography. Three-dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two-dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three- and two-dimensional sonography made correct differential diagnoses between non-neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three- and two-dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two-dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three-dimensional sonography improved the diagnosis in these cases. CONCLUSIONS: Three-dimensional sonography adds no advantages for diagnosis of gallstones compared with two-dimensional sonography, but it is better than two-dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.     

Three-dimensional sonographic evaluation of the infant spine: preliminary findings

PURPOSE: The aims of this study were to evaluate normal spinal anatomy in neonates and infants as seen by 3-dimensional sonography (3D US), to determine the value of 3D US in the evaluation of occult spinal dysraphia in infants, and to correlate the findings of 3D US with those of 2-dimensional sonography (2D US) and MRI, when available. METHODS: We used 2D US and 3D US to examine the lumbosacral spine in infants with cutaneous stigmata, syndromes associated with spinal dysraphia, and abnormal radiographs. We also evaluated, as controls, healthy infants who had no markers of spinal abnormality. 2D sonograms, 3D sonograms, radiographs, and MRI scans, when available, were compared to assess differences in the display of the infant spine. RESULTS: In total, we examined 29 infants: 18 subjects and 11 control infants. The correlation between 2D US and 3D US was 100% in the detection of congenital defects of the spinal cord, although 3D US allowed superior visualization of the vertebral bodies and posterior spinal elements. When a gross abnormality of the posterior spinal elements occurred with pathologic overlying soft tissue, interpretation was simpler with MRI than with sonography. CONCLUSIONS: 3D US is a useful adjunct to 2D US when screening the infant spine for congenital defects, particularly in showing alignment of posterior spinal elements and integrity of vertebral bodies. This ability is important because posterior spinal defects may be associated with underlying spinal cord abnormalities.     

Three-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord: value and limitations.

OBJECTIVE: The purpose of this study was to examine the value of 3-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord. METHODS: Cases in which the diagnosis of a true knot of the umbilical cord was suspected by prenatal 2-dimensional sonography were reviewed. The presumably affected segment of the cord was examined with 3-dimensional power Doppler sonography for further characterization. Confirmation of the prenatal diagnosis was sought by reviewing the delivery records and contacting the referring obstetrician and the patients themselves. RESULTS: Eight consecutive cases were studied. Three-dimensional power Doppler sonography displayed a vascular spatial configuration pattern consistent with a true knot of the umbilical cord in all of them. However, the prenatal diagnosis was confirmed at delivery in only 5 cases (62.5%). Although there were no cases of a false knot mimicking a true knot of the umbilical cord, all incorrect diagnoses in this series were associated with multiple loops of the umbilical cord in the third trimester. CONCLUSIONS: Three-dimensional power Doppler sonography seems to be helpful in determining the presence of a true knot of the umbilical cord in utero, especially in the second trimester. However, this should not be considered a definitive method for the diagnosis because multiple loops of the umbilical cord lying close to each other can generate a sonographic image that can be undistinguishable from a true knot of the umbilical cord prenatally, especially when located in a small pocket of amniotic fluid. Therefore, the presumable diagnosis of a true knot of the umbilical cord in utero should be taken with caution.     

Three-dimensional transvaginal sonography of interstitial pregnancy

We describe the case of a 33-year-old pregnant woman, gravida 1 para 0, who was referred to us with a presumptive diagnosis of an interstitial pregnancy. The patient had had amenorrhea for 7 weeks and had previously undergone myomectomy. Two-dimensional sonographic examination revealed a gestational sac located outside the uterine cavity but could not define its exact anatomic position. Using transvaginal 3-dimensional sonography, we were able to correctly depict the sac, which was located where the fallopian tube crossed the uterine horn. We performed a cornual resection, during which the diagnosis of interstitial pregnancy was confirmed. The use of 3-dimensional sonography in this patient's case thus led to appropriate early treatment and avoidance of possible subsequent morbidity.     

Intraobserver and interobserver reproducibility of 3-dimensional power Doppler vascular indices in assessment of solid and cystic-solid adnexal masses.

OBJECTIVE: The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3-dimensional (3D) power Doppler angiography-derived vascular indices in evaluation of vascularized solid and cystic-solid adnexal masses. METHODS: Stored 3D power Doppler angiographic volume data from 12 consecutive women with a diagnosis of a complex adnexal mass (6 cystic-solid and 6 solid) evaluated and treated at our institution were retrieved from our database for analysis. Two examiners performed the calculations blinded to each other. Calculations were performed offline in a computer using Virtual Organ Computer-Aided Analysis software (plane A, 9 degrees rotation step) to assess volume and vascularization (vascularization index, flow index, and vascularization-flow index) from solid areas within the tumor. In all cases, a definitive histologic diagnosis was obtained. Intraobserver and interobserver reproducibility was assessed by calculating the intraclass and interclass correlation coefficients for each index. RESULTS: All tumors proved to be malignant after surgical removal. Intraobserver reproducibility for both examiners and interobserver reproducibility were high for all indices (interclass correlation coefficient > 0.95). CONCLUSIONS: Three-dimensional power Doppler angiography is a reproducible technique for offline assessment of stored 3D volume data of vascularized adnexal masses.     

Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience.

OBJECTIVE: To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. METHODS: From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. RESULTS: Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography. A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. CONCLUSIONS: Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.     

Contrast-enhanced three-dimensional fusion sonography of small liver metastases with pathologic correlation

PURPOSE: To demonstrate that liver metastases with a diameter of < or =40 mm show characteristic features on three-dimensional (3D) fusion sonographic images and that these sonographic findings can be correlated with histopathologic features of surgical specimens. METHODS: Liver metastases measuring < or =40 mm were examined via contrast-enhanced 3D fusion sonography. The characteristic sonographic findings of 17 tumor nodules in 11 patients with a histopathologically confirmed diagnosis of liver metastases were investigated, and their correspondence to the pathologic features were examined in 12 resected nodules. RESULTS: On sonograms, central vessels were visualized in all 17 tumor nodules and peripheral vessels were visualized in 12 nodules. On histopathologic examination, the portal triad vessels corresponded to the central vessels and were located at the center of the tumors. A thin layer of peritumoral hepatocytes showing various changes was also observed, and a group of tiny vessels were seen running along this layer of cells. CONCLUSIONS: Liver metastases measuring 40 mm or less in diameter were characterized by the presence of both central and peripheral vessels on contrast-enhanced 3D fusion sonography. There was good correlation between sonographic and histopathologic findings.     

Automated sonography: defining the spatial relationship of standard diagnostic fetal cardiac planes in the second trimester of pregnancy.

OBJECTIVE: This study defines the spatial relationship of the diagnostic planes of the fetal heart to the 4-chamber view plane in the second trimester of pregnancy as a first step in the automation process. METHODS: Three-dimensional static volumes of the fetal chest were acquired at the level of the 4-chamber view on 75 fetuses between 18 and 23 weeks' gestation. The spatial relationship of the diagnostic cardiac planes to the 4-chamber view plane were determined for each gestational week by using rotations along the x-, y-, and z-axes and a parallel slide (millimeters) when applicable. RESULTS: The 5-chamber view (cardiac 1 plane) was best obtained by an initial parallel slide of the reference plane (plane A) toward the fetal head followed by a rotation along the y-axis. The right ventricular outflow tract (cardiac 2) and the abdominal circumference (cardiac 3) planes were best obtained by a parallel slide only: toward the fetal head in cardiac 2 and toward the fetal abdomen in cardiac 3. CONCLUSIONS: This study shows the spatial relationship of fetal cardiac diagnostic planes to the 4-chamber view plane in the second trimester of pregnancy in 3-dimensional volumes. Testing the clinical applicability of automated software based on these formulas is the next step.     

Contrast-enhanced two- and three-dimensional sonography for evaluation of intra-abdominal hemorrhage.

OBJECTIVE: To determine whether a contrast agent enhances sonographic detection of bleeding sites in the abdomen and whether contrast-enhanced three-dimensional sonography provides additional information compared with contrast-enhanced two-dimensional sonography. METHODS: Bleeding sites were created within the livers (n = 3), spleens (n = 5), and kidneys (n = 3) of 3 dogs. A sonographic contrast agent with vascular and parenchymal enhancement capabilities was administered intravenously at a dose of 0.02 mL/kg. Before and after each contrast agent injection, the bleeding sites were imaged with two- and three-dimensional sonography in gray scale harmonic imaging and color flow modes. Sonographic findings were compared with gross pathologic findings. RESULTS: Noncontrast-enhanced sonography was not able to show the specific location of the active bleeding in any of the organs evaluated. The contrast agent enhanced the sonographic detection of blood flow in normal vessels and extravasated blood from damaged vessels or organs in all cases. Intrasplenic and intrahepatic hematomas were better identified on delayed imaging sequences because there was marked enhancement of the normal parenchyma, whereas the hematomas remained unenhanced. Reconstructed three-dimensional sonography showed spatial relationships of the bleeding sites and surrounding structures. Gross pathologic findings were consistent with the contrast-enhanced sonographic results. CONCLUSIONS: Contrast-enhanced sonography improves the detection and evaluation of abdominal bleeding sites. Contrast-enhanced three-dimensional sonography appears to provide additional information when compared with two-dimensional sonography.