Contrast ultrasound: a simple-to-use phase-shifting medium offers saline infusion sonography–like images  Dominique de Ziegler, M.D.  Fertility and Sterility  Volume 92, Issue 1, Pages 369-373 (July 2009) DOI: 10.1016/j.fertnstert.2008.04.032 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Normal uterine cavity. (A) Typical image of the uterine mucosa (endometrium) as provided by standard transvaginal ultrasound. Arrows indicate the interface provided by the anterior and posterior endometrial-myometrial boundaries. (B) Typical contrast ultrasound image of a normal uterine cavity. The endometrial cavity, normally virtual, is distended by 1–3 mL phase-shifting medium (PSM) instilled in the uterine cavity, thereby providing saline infusion sonography–like images. Because the PSM has the sonographic characteristics of water (sonotransparent), the distended cavity appears black on conventional ultrasound rendering. In this example, the uterine cavity is free of pathologies. Fertility and Sterility 2009 92, 369-373DOI: (10.1016/j.fertnstert.2008.04.032) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Submucosal extension of uterine fibroid. (A) Typical image of the uterine mucosa seen by standard transvaginal ultrasound in a woman presenting with dysfunctional uterine bleeding resistant to hormonal treatment. An irregularity of the mucosa with an inner echo lets us suspect an intrauterine pathology. Yet the exact submucosal extension of the fibroid cannot be precisely identified on this regular ultrasound image. (B) Typical contrast ultrasound image of an intrauterine pathology. In the same patient, the contrast interface created by the phase-shifting medium allows us to easily delineate the boundaries of the submucosal extensions of a fibroid and determine that >50% of the fibroid protrudes submucosally. Fertility and Sterility 2009 92, 369-373DOI: (10.1016/j.fertnstert.2008.04.032) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions