scholarly journals Three-Dimensional Power Doppler Analysis of Cerebral Circulation in Normal and Growth-Restricted Fetuses

2009 ◽  
Vol 29 (9) ◽  
pp. 1609-1618 ◽  
Author(s):  
Jose L Bartha ◽  
Eva M Moya ◽  
Blas Hervías-Vivancos

The objective of the present study was to evaluate fetal cerebral circulation by using three-dimensional (3D) power Doppler ultrasound in normal and growth-restricted fetuses. A total of 100 normal grown fetuses were compared with other 25 with growth restriction (FGR). Three-dimensional power Doppler ultrasound was used to assess fetal cerebral 3D vascular indices: vascularization index, flow index (FI), and vascularization flow index (VFI). Both FI and VFI correlated positively with gestational age. On average, all the 3D vascular indices were increased in fetuses with FGR. The proportion of fetuses detected as having hemodynamic redistribution was higher when using 3D power Doppler indices than by means of the middle cerebral artery pulsatility index (52% versus 20%, P = 0.002). In conclusion, two of the three indices increased during gestation. All the fetal cerebral 3D vascular indices are increased in fetuses with FGR. In these fetuses, there were more cases suggesting hemodynamic redistribution than expected by conventional Doppler studies.

Author(s):  
Wiku Andonotopo ◽  
Herman Kristanto ◽  
Julian Dewantiningrum ◽  
Besari Adi Pramono

ABSTRACT Aim The object of this study was to analyze the vascularization index of three-dimensional (3D) power Doppler ultrasound (PDUS) of the placenta in severe pre-eclampsia compared with normal pregnancy conditions by vascular biopsy sampling sphere. Subjects and methods This study is a prospective longitudinal observational study on 80 pregnant women which divided into 2 groups: Group I (study group) were 40 pregnant women with severe pre-eclampsia, group II (control group) were 40 pregnant women without disorder. Variables examined in this study were vascular index (VI), flow index (FI) and vascular flow index (VFI) of the 3D-PD placental perfusion. Its correlation to gestational age in normal pregnancy compared with the condition of preeclampsia were obtained by taking multiple biopsy sampling vascular sphere. All pregnant women underwent 3D PD-US examination (single examination only), data volume recorded of the placenta allows for off-line analysis without the presence of the patient, thus allowing the data analysis done anywhere and anytime by observers for the comparative analysis of interobserver reliability. Results The placenta can be visualized perfectly in both of the study group and also the control group. Average Kappa value for the acquisition of placental vascularization index measurements with 3D PD-US was 0.72 (0.61-0.82), 0.73 (0.65-0.82) and 0.71 (0.61-0.81) for VI, FI and VFI in the range of 20 to 38 weeks showed good interobserver reliability. All 3D power Doppler indices had a significant association with gestational age, with VI showed a less significant relationship (r = 0.207, p = 0.0139) and FI has the most significant relationship (r = 0.582, p < 0.001). FI index increased progressively with gestational age, while the VI index values indicate dispersion pattern and reached a plateau from week 30 onwards. Entering week 37th, there was a decrease in the value of the index VI until the end of pregnancy. Meanwhile, VFI index appears to resemble the pattern of a combination of both VI and FI index (r = 0.692, p <0.001). Conclusion All parameters of 3D power Doppler index was lower in the severe pre-eclampsia compared with normal pregnancy. 3D PD-US can be used to assess the vascularization of the placenta and the intensity of intra-placental blood flow. Placental vascular biopsy method is fairly efficient way to perform routine evaluations evolution of placental vascular branch during pregnancy. How to cite this article Andonotopo W, Kristanto H, Dewantiningrum J, Pramono BA. Difference between Vascularization Indexes of the Placenta in Severe Pre-eclampsia and Normal Pregnancy by Three-dimensional Power Doppler Ultrasound. Donald School J Ultrasound Obstet Gynecol 2014;8(4):329-335.


Author(s):  
Sumesh Choudhary ◽  
Vineet Mishra ◽  
Rohina Aggarwal ◽  
Kavita Mistry

Background: In recent years there have been significant developments in the use of 3D Power Doppler (3DPD) imaging and quantitative 3DPD histogram analysis to estimate both placental volume and intraplacental vasculature. This study is to evaluate the distribution and variation of placental vascular indices according to gestational age and placental volume and position. Co relate the umbilical Doppler indices with placental vascular indices.Methods: From September 2016 to October 2017, three-dimensional (3D)-power Doppler ultrasound was performed in 200 singalton pregnancies from 20 to 40 weeks of gestation. Using the same pre-established settings for all patients, power Doppler was applied to the placenta and placental volume was obtained by the rotational technique (VOCAL). The 3D-power histogram was used to determine the placental vascular indices: vascularization index (VI), flow index (FI) and vascularization-flow index (VFI). Umbilical Doppler was measured on the free loop of umbilical cord. The placental vascular indices were then plotted against gestational age placental volume, position and umbilical Doppler SD ratio, PI and RI. These values were evaluated in IUGR fetus.Results: Analysis of the results showed that the placental vascular indices estimated by 3D-power Doppler ultrasonography presented constant distribution throughout gestation despite the significant increase in placental volume. Placental position at fundal region shows higher value of VI, FI, and VFI. Placental position with relation to VI, FI, and VFI shows statistically significant with p value <0.01. Placental vascular indices VI, FI and VFI when corelated with systolic/ diastolic ratio, pulsatility index and resistive resistance index of umbilical artery shows poor negative correlation, only VI and FI shows statistically significant with SD ratio as p value is <0.01and <0.04. VFI did not show statistically significant as p value is 0.10(NS). With pulsatility index p value is statistically significant is less than<0.01 with vascular indices. Resistive index p value is statistically significant is less than <0.01 for VI and VFI but not significant with FI as p value is 0.06.Conclusions: Doppler ultrasound assists in the evaluation of placental vascularization in normal and IUGR pregnancies, may play an important role in future research on fetoplacental insufficiency.


Author(s):  
Toshiyuki Hata ◽  
Sarah Cajusay-Velasco

ABSTRACT Advanced ultrasound technology has been a valuable tool in the assessment of placental anatomy and physiology. Conventional two-dimensional (2D) sonography reveals placental morphological characteristics, 2D color Doppler can assess blood flow in the placenta, 2D power Doppler can evaluate placental vascular trees, and three-dimensional (3D) ultrasound gives more detailed information on the surface anatomy. Recent advances, such as 3D power Doppler with virtual organ computer aided-analysis (VOCAL) and histogram analysis can measure the placental volume, and assess uteroplacental and fetoplacental perfusions. In particular, ‘placental vascular sonobiopsy’ can specifically evaluate the second- and thirdtrimester placental blood flow and vascularity by obtaining several spherical samples from the placenta that will represent the entire placenta. This article presents normal placental development and pathological findings of the placenta using 3D power Doppler ultrasound, and discusses 3D power Doppler assessments of placental perfusion in high-risk pregnancies, such as fetal growth restriction, pregnancy-induced hypertension and preeclampsia, and, from this basis, re-establishes the importance of 3D power Doppler ultrasound as a screening, diagnostic, and surveillance tool in normal and abnormal pregnancies. How to cite this article Tanaka H, Cajusay-Velasco S, Noguchi J, Hata T. Three-dimensional Power Doppler Ultrasound Study of the Placenta. Donald School J Ultrasound Obstet Gynecol 2014;8(4):400-409.


Author(s):  
AYŞEGÜL CANSU ◽  
EMİN AYAN ◽  
SİBEL KUL ◽  
İLKER EYÜBOĞLU ◽  
ŞÜKRÜ OĞUZ ◽  
...  

Background/aim: To evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3DPDUS) in differentiation of benign and malignant thyroid nodules. Materials and methods: Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns and with the largest diameter of between 10 mm and 30 mm were prospectively evaluated using 3DPDUS. Nodule volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cyto-histopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis. Results: Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (p<0.05). In benign nodules, mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93 and VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43 and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) were calculated as 0.68, 0.61 and 0.67 for VI, FI and VFI, respectively. At optimal cut-off values of 10.2 for VI, 40.8 for FI and 5.5 for VFI, sensitivity and specificity were 72%/55.4%, 68%/57.1% and 68%/67.9%, respectively. Conclusion: 3DPDUS could be useful in the characterization of thyroid nodules. Key words: Thyroid nodules; three-dimensional power Doppler ultrasound; vascular indices; VOCAL


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