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Gray-Scale and Color Doppler Sonographic Features of the Vaginal Cuff and Cervical Remnant After Hysterectomy

¹ Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St., Bronx, NY 10467.
² Department of Obstetrics and Gynecology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467.
³ Department of Epidemiology and Population Health, Biostatistics Unit, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467.

OBJECTIVE. The purpose of this study was to define the sonographic characteristics of the vaginal cuff and cervical remnant after hysterectomy and to establish normal measurements of each after each type of surgery.

MATERIALS AND METHODS. One hundred twenty-one women who had undergone hysterectomy (mean age, 51 years; range, 31-80 years) were studied using transabdominal or transvaginal sonography. Seventy-six patients were acquired retrospectively and 45 prospectively. Hysterectomy types included abdominal, 52% (63/121); supracervical, 17% (20/121); vaginal, 17% (20/121); and unknown, 15% (18/121). Two reviewers, who were blinded to clinical information, evaluated each cuff or remnant in consensus. Transabdominal anteroposterior, transvaginal anteroposterior, and transvaginal length measurements before and after transducer compression, and amount of color Doppler flow as shown by percentage of color pixels (n = 36 patients) were correlated with hysterectomy type and patient age.

RESULTS. Supracervical cuffs were larger (p < 0.01) than abdominal and vaginal hysterectomy cuffs (transabdominal sonography anteroposterior, 2.8 vs 1.5 and 1.6 cm; transvaginal sonography anteroposterior, 3.3 vs 1.8 and 1.7 cm; and transvaginal length, 3.0 vs 2.1 and 1.9 cm). Anteroposterior measurements, but not length, decreased significantly with advancing age. Transvaginal length decreased with compression (mean, 0.84 cm; p < 0.0001). Color Doppler flow scores (minimum, 56% [20/36]; mild, 28% [10/36]; moderate, 14% [5/36]; and absent, 3% [1/36]) did not vary with age, time since surgery, or type of surgery.

CONCLUSION. The remnant is larger in every dimension after supracervical hysterectomy compared with both abdominal and vaginal hysterectomy and commonly shows some color Doppler flow.

Keywords: cervical remnant • color Doppler sonography • gray-scale sonography • gynecological imaging • hysterectomy • pelvic imaging • vaginal cuff

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