Ultrasound terminology & organ echogenicity

What are sonographers responsible for reviewing before performing an exam?

A patient’s ultrasound request for the exam.

Why is familiarity with medical terminology and ultrasound terms important in sonography school?

It helps students understand what they're studying and communicate effectively in the professional field.

Why is understanding medical terminology essential for professional sonographers?

It allows them to effectively communicate with doctors and medical staff.

What are sonographers responsible for identifying and describing?

Both normal and abnormal anatomy.

Where do many sonographic descriptions come from?

From how something appears on the screen during the imaging process.

What is the imaging process called when viewing anatomy on the ultrasound screen?

B-Mode imaging

What does the “B” in B-Mode imaging stand for?

Brightness Display Mode.

What is another name for B-Mode imaging?

Grayscale imaging.

What type of ultrasound is used while scanning?

B-Mode or grayscale imaging.

What does grayscale imaging display?

Organs and tissues in various shades of blacks, grays, and whites.

What determines the color of structures on a B-Mode ultrasound image?

The structure’s density and the amount of sound penetration, absorption, and reflection.

What do weak reflections look like on a B-Mode image?

Darker areas (more black).

What do strong reflections look like on a B-Mode image?

Brighter areas (more white).

How can sonographers control the brightness of the ultrasound screen?

By adjusting different parameters on the keyboard.

What kind of reflector is a very stiff structure like bone?

A weak reflector.

How does bone appear on B-Mode ultrasound and why?

Black, because it absorbs all the sound and gives no reflection.

How do fluids like blood appear on ultrasound?

Black, because they transmit all the sound and cause no reflection.

How do tissues and organs typically appear on B-Mode imaging?

In varying shades of gray.

Why are tissues and organs considered “good reflectors”?

Because they vary slightly in how they reflect sound.

How do air-filled structures appear on ultrasound?

With varying degrees of black or white due to scattering of the ultrasound wave.

What is “parenchyma”?

A term for the tissue of an organ.

What does parenchyma describe in ultrasound?

The appearance and texture of an organ's tissues.

Give an example of how to use the word "parenchyma" in ultrasound.

The parenchyma of the liver appears ______________.

What is meant by the “border” of a structure in ultrasound?

The edge of the structure.

How can the border of a structure appear?

Smooth, well-defined, irregular, etc.

What is “echogenicity”?

The brightness of echoes in an organ.

What affects the echogenicity of a structure?

The structure’s stiffness and density.

Why are differences in echogenicity important in ultrasound?

They help distinguish one structure from another and identify normal vs. abnormal appearances.

What does "anechoic" or "sonolucent" mean?

Without internal echoes or echo-free.

How do anechoic structures appear on ultrasound?

Black.

Why do anechoic structures appear black on ultrasound?

Because they are fluid-filled, transmit sound easily, and produce no echoes.

What are common examples of anechoic structures and what are they filled with?

• Blood vessels (blood)

• Bladder (urine)

• Gallbladder (bile)

• Cysts (misc. fluid)

Where does posterior enhancement occur?

Behind (posterior to) anechoic/sonolucent/fluid-filled structures.

What causes posterior enhancement in ultrasound?

Sound travels easily through fluid-filled structures and is not absorbed well, increasing the intensity of echoes behind the structure.

How does posterior enhancement appear on ultrasound?

As a bright reflection behind or beneath the fluid-filled structure.

Why is the echo behind a fluid-filled structure enhanced?

Because it is brighter than the fluid itself due to increased sound transmission.

Why is posterior enhancement clinically useful?

It helps confirm whether a structure is truly fluid-filled.

What does the presence of posterior enhancement suggest about an anechoic structure?

That it is truly cystic and filled with simple fluid.

Why do true cystic (fluid-filled) structures show posterior enhancement?

Because no sound is absorbed as it passes through, enhancing the echoes behind it.

What does “hypoechoic” mean?

Having low-level gray echoes and decreased echogenicity compared to surrounding tissues.

How is the term “hypoechoic” used in ultrasound?

To describe solid structures like organs that appear darker than nearby tissues.

What does it mean if a mass is “hypoechoic to the liver”?

The mass has echoes that are darker than the liver tissue.

Is a hypoechoic structure the same as an anechoic structure?

No, hypoechoic is gray (darker than surrounding tissue), while anechoic is black (no echoes).

What does “hyperechoic” or “echogenic” mean?

A structure that reflects sound very intensely or brightly.

How do hyperechoic structures appear on ultrasound?

More light gray or white.

How does hyperechoic compare to anechoic?

It’s the opposite; hyperechoic structures produce many echoes, while anechoic structures produce none.

What does it mean if a structure is “hyperechoic to” another?

It appears brighter than the surrounding structure

What are examples of hyperechoic or echogenic structures?

• Stones / Gallstones

• Kidney sinus (center of the kidney)

• Plaque / Calcium

• Fat

• Ligaments

What does “isoechoic” mean in ultrasound?

Having the same echogenicity as the surrounding structures.

What does the prefix “iso-” mean?

Same.

When is the term “isoechoic” used?

When a mass or structure has similar echogenicity to the surrounding tissue.

Give an example of how “isoechoic” is used in a sentence.

The mass is isoechoic to the liver.

What does it mean if the liver is isoechoic to the spleen?

The liver and spleen have very similar echogenicities.

What does “homogeneous” mean in ultrasound?

Having a uniform or similar echo pattern in an organ’s parenchyma.

What is parenchyma?

The tissue of an organ.

How is “homogeneous” used to describe organ texture?

It means the organ’s tissue has a uniform texture.

Give examples of organs often described as homogeneous.

Liver, thyroid, and testicular parenchyma.

Why is detecting non-homogeneous texture important?

It helps detect and diagnose pathology.

What is the opposite of homogeneous?

Heterogeneous

What does “heterogeneous” mean in ultrasound?

Having an irregular or mixed echo pattern in an organ’s parenchyma.

What does a mixed echo pattern include?

A combination of hypoechoic, hyperechoic, and possibly anechoic areas.

How is parenchyma described when it is heterogeneous?

It is not uniform in texture.

What types of structures are often described as heterogeneous?

Tumors with both hypo- and hyperechoic characteristics.

What is the opposite of heterogeneous?

Homogeneous.

What causes shadowing in ultrasound imaging?

When a sound beam hits a very solid or calcified object that it cannot penetrate.

How does shadowing appear on ultrasound images?

As black spaces behind very dense objects.

What is “edge artifact” or “edge shadowing”?

Shadowing that appears at the edges of a curved structure while the center still allows sound to penetrate.

Why does edge shadowing occur?

Because the sound beam is blocked or bent at the edges of a curved object, not through the center.

Can shadowing occur only behind solid objects?

No, it can also occur at the edges of curved objects as edge shadowing.

What is the correct order of normal echogenicity from least to most echogenic?

Kidney cortex < Liver & Spleen < Pancreas.

Which organ should appear the brightest on ultrasound?

The pancreas.

How does the kidney cortex appear compared to the liver and spleen?

More hypoechoic (darker).

Is it always abnormal if the liver and kidney appear isoechoic?

No, sometimes this is considered normal.

Why is knowing normal echogenicity patterns important in ultrasound?

To recognize when an organ's appearance is abnormal and potentially pathological.

What is the term for comparing echogenicity between organs?

Interface.

How should the kidney cortex appear compared to the liver on ultrasound?

Hypoechoic or isoechoic to the liver.

What does it indicate if the kidney cortex appears hyperechoic to the liver?

Something is likely wrong with the kidney.

In the kidney/liver interface, which structure should be brighter?

The liver

How does the liver appear compared to the pancreas on ultrasound?

The liver is hypoechoic to the pancreas.

Which organ is more echogenic: liver or pancreas?

The pancreas.

What is the normal liver/pancreas interface appearance?

Liver < Pancreas (liver is darker than pancreas).

What does a variation from the normal liver/pancreas echogenicity pattern suggest?

Possible disease

How does echogenicity typically change with age?

The differences in echogenicity between organs become more varied and appear less textbook.

How do acute diseases affect an organ’s size and echogenicity?

They make the organ appear larger (swollen) and more hypoechoic.

Why do acutely diseased organs appear more hypoechoic?

Because increased blood and fluid rush to the site, and blood produces darker echoes.

What is a real-life analogy for how an acute condition affects an organ?

Like a bee sting—swollen and filled with fluid shortly after injury.

How do chronic diseases affect an organ’s size and echogenicity?

hey make the organ appear smaller (shrunken) and more hyperechoic.

Why do chronically diseased organs appear more hyperechoic?

Because damaged tissue is replaced with fatty deposits, which reflect sound brightly.

What is a real-life analogy for how chronic disease affects an organ?

Like a plum drying into a prune—it shrinks and becomes denser over time.

How can echogenicity help in identifying masses?

By comparing a structure's appearance to its normal echogenicity, we can detect abnormalities.

What does normal thyroid parenchyma look like on ultrasound?

Homogeneous with even, mid-level gray echoes.

What should raise concern for a possible mass in the thyroid?

An interruption in the homogeneous appearance of the thyroid parenchyma

Why is it important to know the normal echogenicity of organs?

So abnormalities or masses can be identified when the pattern changes