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Magdalena PG, Bartłomiej B, Robert T, Małgorzata S, Hsing-Kuo W, Sebastian K. Acute fatigue-induced alterations in hamstring muscle properties after repeated Nordic hamstring exercises. Sci Prog 2024; 107:368504241242934. [PMID: 38592327 PMCID: PMC11005512 DOI: 10.1177/00368504241242934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This study aimed to investigate the impact of the Nordic hamstring exercises (NHE) on acute fatigue-induced alterations in the mechanical and morphological properties of hamstring muscles. The second aim was to define the blood flow and perfusion after NHE in recreational active volunteers. Twenty-two individuals volunteered to participate in the study. This study investigated fatigue outcomes: rate of perceived exertion (RPE) scale and average force generated during NHE; mechanical properties (stiffness); morphological properties (thickness, pennation angle, and fascicle length), and vascularity index (VI) of the semitendinosus (ST) and biceps femoris long head (BFLH) at baseline, immediately post-exercise and 1-h post-exercise. The NHE fatigue procedure consisted of six bouts of five repetitions. The results showed an increase in thickness and pennation angle of BFLH and ST immediately post-exercise and a decrease in thickness and pennation angle of BFLH and ST 1-h post-exercise. While the fascicle length of BFLH and ST decreased immediately post-exercise and increased 1-h post-exercise. The VI for two muscles increased immediately post-exercise and after 1-h post-exercise. Moreover, we found a relationship between RPE and average force, that is, as RPE increased during NHE, average force decreased. In conclusion, eccentric NHE exercises significantly and acutely affect BFLH and ST. The NHE fatigue protocol significantly affected the mechanical and morphological properties of BFLH and ST muscles, changing their thickness, fascicle length, pennation angle, and VI.
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Affiliation(s)
| | - Bogdański Bartłomiej
- Doctoral School, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Trybulski Robert
- ProvitaZory Medical Center, Zory, Poland
- Department of Medical Sciences, The Wojciech Korfanty Upper Silesian Academy, Katowice, Poland
| | - Smoter Małgorzata
- Department of Basic Physiotherapy, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Wang Hsing-Kuo
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
- Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Klich Sebastian
- Department of Paralympic Sport, Wrocław University of Health and Sport Sciences, Wrocław, Poland
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Chen JY, Yu BL, Wu XJ, Li YF, Zhong LY, Chen M. A longitudinal and cross-sectional study of placental circulation between normal and placental insufficiency pregnancies. Placenta 2024; 149:29-36. [PMID: 38490095 DOI: 10.1016/j.placenta.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/11/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION To longitudinally and cross-sectionally study the differences in the uterine artery pulsatility index (UTPI), umbilical artery pulsatility index (UAPI) and placental vascularization indices (PVIs, derived from 3-dimensional power Doppler) between normal and placental insufficiency pregnancies throughout gestation. METHODS UTPI, UAPI and PVI were measured 6 times at 4- to 5- week intervals from 11 to 13+6 weeks-36 weeks. Preeclampsia (PE) and fetal growth restriction (FGR) were defined as placental insufficiency. Comparisons of UTPI, UAPI and PVI between normal and insufficiency groups were performed by one-way repeated measures analysis of variance. RESULTS A total of 125 women were included: monitored regularly from the first trimester to 36 weeks of gestation: 109 with normal pregnancies and 16 with placental insufficiency. Longitudinal study of the normal pregnancy group showed that UTPI and UAPI decreased significantly every 4 weeks, while PVIs increased significantly every 8 weeks until term. In the placental insufficiency group however, this decrease occurred slower at 8 weeks intervals and UTPI stabilized after 24 weeks. No significant difference was noted in PVIs throughout pregnancy. Cross-sectional study from different stages of gestation showed that UTPI was higher in the insufficiency group from 15 weeks onward and PVIs were lower after 32 weeks. DISCUSSION Compared to high-risk pregnancies with normal outcome, UTPI and UAPI needed a longer time to reach a significant change in those with clinical confirmation of placental insufficiency pregnancies and no significant change was found in PVI throughout gestation. UTPI was the earliest factor in detecting adverse outcome pregnancies.
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Affiliation(s)
- J Y Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - B L Yu
- Department of Bio Resource Research Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - X J Wu
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Y F Li
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - L Y Zhong
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Classification of Vascular Hotspots and Micro-Vessel Flow Velocity Waveforms in Low-Grade Squamous Intraepithelial Lesions and HPV Condyloma of the Cervix. Diagnostics (Basel) 2022; 12:diagnostics12102390. [PMID: 36292079 PMCID: PMC9601140 DOI: 10.3390/diagnostics12102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and to explore the associations of these sonographic parameters with HPV condyloma and low-grade squamous intraepithelial lesions (LSIL) of the cervix. A total of 39 patients with cervical HPV infections with abnormal cytology and colposcopy results (26 cases of LSIL; 13 cases of HPV condyloma) were enrolled to assess the vascular classification of the cervix and micro-vessel flow velocity using TV-PDU before treatment; 40 individuals with a pathologically normal cervix were used as the control group; seven parameters were measured, including vascular grading classification (Class I, Class II, and Class III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED). According to vascular classification, most LSILs were class I (69.2%, 18/26), followed by class II (26.9%, 7/26) and class III (3.8%, 1/26). Most HPV condylomas were class I (92.3%, 12/13), and one was class II (7.7%, 1/13). PI, RI, VI (p < 0.0001), and the PSs (p < 0.05) were significantly lower in these cases than in the controls. The ED and TAMV were not significantly different between the patients and controls (p = 0.4985 and p = 0.1564). No sonographic parameter was significantly different between LSIL and HPV condyloma. The mean PI, RI, and VI were significantly lower in LSIL than in the controls. For HPV condyloma, a PI of 1.07 had an 84.6% sensitivity, 85.0% specificity, and an AUC of 88.8%; for LSIL, a PI of 1.08 had a 100% sensitivity, 85% specificity, and an AUC of 94.2%; for HPV infection (HPV condyloma + LSIL), a PI of 1.08 had a 94.9% sensitivity, 85% specificity, and an AUC of 92.4%. Hotspot vascular classification and micro-vessel flow velocity waveforms may provide a potential practical method for the auxiliary diagnosis of cervical HPV infection. The PI may represent a valuable index for distinguishing the micro-vessel flow velocity waveforms in LSIL and HPV condyloma. Since the case numbers were limited in the current study, further validation is needed.
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Chen J, Chen M, Wu X, Sun J, Zhang Y, Li Y, Zhong L, Yu B, Luo J, Liu J. The value of placental vascularization indices for predicting preeclampsia and fetal growth restriction in different stages of gestation: A prospective and longitudinal study. Placenta 2022; 122:1-8. [DOI: 10.1016/j.placenta.2022.03.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
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Zeng S, Wu S, Chen C, Zhu X, Liu Y, Zeng Q, Wang L, Xu R. Performance Characteristics of 3-D Power Doppler Ultrasound (3-D-PD) with the Virtual Organ Computer-Aided Analysis (VOCAL) Technique in the Detection of Prostate Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:91-97. [PMID: 34702643 DOI: 10.1016/j.ultrasmedbio.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to test the diagnostic performance of 3-D power Doppler ultrasound (3-D-PD) with the virtual organ computer-aided analysis (VOCAL) technique in the detection of prostate cancers (PCa). A total of 99 male patients referred for needle prostate biopsy owing to elevated serum prostate-specific antigen or abnormal direct rectal examination were prospectively included. The transrectal 3-D-PD-VOCAL quantitative vascularity parameters of vascularization index (VI), flow index and vascularization/flow index (VFI) were obtained before biopsy and compared with histopathologic results. We evaluated the predictive values for the detection of clinically significant PCa in the foci from different zones and the discrimination among various cancer grades. 3-D-PD-VOCAL discriminated malignant from benign foci, with cutoff values of 27.4% for VI, 38.2 for flow index and 8.6 for VFI. All parameters had higher areas under the curve in detecting lesions in the peripheral zone than in the transition zone (p < 0.05). VI and VFI had better diagnostic performance in detecting clinically significant PCa than flow index (p < 0.05). The area under the curve, sensitivity, specificity and accuracy in detecting clinically significant PCa were, for the VI and VFI respectively, 95% and 95%, 86% and 94%, 87% and 76%, and 87% and 85%. 3-D-PD-VOCAL initially demonstrated favorable performance in detecting PCa. Further, larger-sample studies based on prostatectomy specimens are needed to evaluate the exact usefulness of the technique.
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Affiliation(s)
- Shi Zeng
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuiqing Wu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yushan Liu
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qi Zeng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China.
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Pérez-Martín SM, Quintero-Prado R, Lara-Barea A, López-Tinoco C, Torrejón R, Bugatto F. Fetal cerebral three-dimensional power Doppler vascularization indices and their relationships with maternal glucose levels in pregnancies complicated with gestational diabetes. Diab Vasc Dis Res 2022; 19:14791641221078109. [PMID: 35236142 PMCID: PMC8907605 DOI: 10.1177/14791641221078109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to evaluate fetal cerebral circulation using three-dimensional power Doppler (3DPD) vascular indices and to study their relationships with maternal lipid and glycaemic profiles. METHODS Case-control study in women with and without gestational diabetes mellitus (GDM) at 28-32 weeks in which feto-maternal Doppler study and 3DPD cerebral vascularization indices (FI, VI and VFI) were determined. Maternal lipid and glycaemic profiles were also analysed. Both groups were compared and the correlations of the 3DPD indices with studied variables were analysed. RESULTS There were significant differences between groups in cerebral FI (p= 0.02), mean maternal Uterine artery PI (p= 0.009) and glucose levels (p= 0.001), being higher in the GDM group. Significant negative correlations were found in GDM group between VFI and MCA PI (p = 0.02) and between VI and MCA PI (p= 0.01). In the GDM group we found a negative significant correlation between FI, VI, VFI and maternal glucose (r= -0.52, p<0.001; r= -0.32, p=0.03 and r= -0.36, p= 0.01, respectively). CONCLUSIONS Fetal cerebral FI values were higher in GDM pregnancies. All 3DPD vascular indices showed an inverse correlation with maternal glucose levels. These findings support the view that GDM may also represent a fetal vascular disorder influencing fetal neurodevelopment.
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Affiliation(s)
- Sara M Pérez-Martín
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Rocío Quintero-Prado
- Department of Obstetrics and
Gynaecology, Puerto Real University
Hospital, Puerto Real, Cádiz, Spain & Ginemed Clínicas, San
Fernando, Cádiz, Spain
| | - Almudena Lara-Barea
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Cristina López-Tinoco
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Biomedical Research and Innovation
Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Rafael Torrejón
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Fernando Bugatto
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Fernando Bugatto, Obstetrics and
Gynaecology Department, Puerta del Mar University Hospital, Avda, Ana de Viya,
21, Cádiz 11009, Spain.
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Ciarmela P, Delli Carpini G, Greco S, Zannotti A, Montik N, Giannella L, Giuliani L, Grelloni C, Panfoli F, Paolucci M, Pierucci G, Ragno F, Pellegrino P, Petraglia F, Ciavattini A. Uterine fibroid vascularization: from morphological evidence to clinical implications. Reprod Biomed Online 2021; 44:281-294. [PMID: 34848152 DOI: 10.1016/j.rbmo.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023]
Abstract
Uterine fibroids are the most common cause of solid pelvic tumours, occurring in 20-30% of fertile women and presenting clinical complications that seriously affect women's health. They commonly cause severe symptoms, such as heavy, prolonged menstrual bleeding and anaemia. The study of microscopic and macroscopic vascular aspects of uterine fibroids is important for understanding the clinical manifestations of uterine fibroids, for predicting the effectiveness of alternative treatments to surgery, i.e. uterine artery embolization, for improving surgery outcomes and for carrying out a differential diagnosis with other benign conditions, e.g. adenomyosis, or malignancy, e.g. leiomyosarcoma, and to develop new therapeutic approaches. In this review, current knowledge of how the vascular network and angiogenesis are implied in the formation of uterine fibroids and in the pathogenesis of related symptoms is explored, and evidence on the role of ultrasound in evaluating fibroid vascularization is summarized. This review combines anatomical, morphological and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections. Uterine and fibroid vascularization need further investigation to gain a deeper understanding of the pathogenetic elements that lead to the formation of uterine fibroids and their clinical manifestations.
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Affiliation(s)
- Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy.
| | - Giovanni Delli Carpini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy; Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Nina Montik
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Luca Giannella
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Lucia Giuliani
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Camilla Grelloni
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Francesca Panfoli
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Michela Paolucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gloria Pierucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Federica Ragno
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital Florence, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
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Chen X, Wei X, Zhao S, Huang H, Wang W, Qiu J, Chen X, Cheng C, Tian Z, Rychik J. Characterization of Placental Microvascular Architecture by MV-Flow Imaging in Normal and Fetal Growth-Restricted Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1533-1542. [PMID: 33073868 DOI: 10.1002/jum.15531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/29/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To observe the microvascular architecture in the placental bed and explore the feasibility and clinical utility of MV-Flow imaging (Samsung Medison Co, Ltd, Seoul, Korea) during normal pregnancy and fetal growth restriction (FGR). METHODS Placental microvascular structure ultrasound imaging by MV-Flow was performed on 227 unaffected and 17 FGR fetuses between 11 and 41 weeks' gestation. A placental vascular index (VIMV ) was acquired by application of various MV-Flow regions of interest (ellipse, rectangle, and manual trace). Unaffected control and FGR groups were assessed for umbilical artery, middle cerebral artery, and uterine artery pulsatility indices and the cerebroplacental ratio calculated by ultrasound. RESULTS No significant difference in the VIMV by varying regions of interest or placental regions was observed in the control group. The VIMV in the first trimester was lower than that in the second and third trimesters, with 5th through 95th percentile normal VIMV reference values of 18.39 to 63.79 for 13.6 weeks and earlier, 28.53 to 66.64 for 14 weeks to 27 weeks 6 days, and 21.95 to 67.45 for 28 weeks and later. The VIMV values in the FGR group were lower than those in the control group in the upper, middle, and lower parts of the placenta (mean ± SD, 24.9 ± 13.9 versus 45.0 ± 13.4; P < .01; 30.5 ± 16.1 versus 44.7 ± 14.3; P < .01; and 29.9 ± 17.4 versus 47.6 ± 12.2; P < .01, respectively). Higher umbilical artery and uterine artery pulsatility indices and a lower cerebroplacental ratio were found in the FGR group compared with the control group (P < .01). CONCLUSIONS MV-Flow technology can display and quantify placental microvascular architecture at the level of the stem villi and villous leaves, and the VIMV provides for quantification of tissue vascularity. MV-Flow is a potentially powerful and promising tool to explore placental microvascular perfusion and provide new information on a host of pregnancy-related conditions.
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Affiliation(s)
- Xinlin Chen
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Xia Wei
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Sheng Zhao
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Hui Huang
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Weiyun Wang
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Junyu Qiu
- First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiao Chen
- First People's Hospital of Jinzhong, Jingzhong, China
| | - Chen Cheng
- Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Zhiyun Tian
- Fetal Heart Program, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jack Rychik
- Fetal Heart Program, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Schiffer VMMM, Pellaers D, Hoenen JLJM, van Kuijk SMJ, Spaanderman MEA, Al-Nasiry S. Feasibility of three dimensional power Doppler ultrasonography methods to assess placental perfusion. Eur J Obstet Gynecol Reprod Biol 2020; 254:321-328. [PMID: 33008645 DOI: 10.1016/j.ejogrb.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Given the crucial role of the placenta in establishing a healthy pregnancy, reliable non-invasive methods to measure placental perfusion are desirable. The aim of this study is to determine the reproducibility and potential bias in different three-dimensional power Doppler (3DPD) methods assessing placenta perfusion. METHODS Ten singleton pregnancies around 16 weeks of gestation, with an anteriorly located placenta and centrally inserted umbilical cord were included in this study. Eight different combinations of a specific placental sweep and sonobiopsy method were used to evaluate placental perfusion. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were determined offline using the 4D-view program. Reproducibility and repeatability of the methods, expressed as correlation coefficients and Bland-Altman mean differences, were calculated. Differences between sampling methods were analyzed using t-test or Mann-Whitney U test. RESULTS Intra- and inter-class correlation coefficient (CC) was highest when using a spherical centrally placed sonobiopsy of 2 cm3 in a whole placenta sweep (method 1; IntraCC VI 0.985, FI 0.769, VFI 0.993, InterCC VI 0.986, FI 0.784, VFI 0.987). Overall, intraCCs were higher compared to interCCs. Lowest mean differences in VI and FI were found comparing spherical to manual sonobiopsies, whereas the mean differences in VFI were lowest when comparing central versus peripheral located sonobiopsies. Comparing the three vascular indices, best median intra- and interCC and lowest mean differences were found for VFI. CONCLUSIONS Three dimensional placental vascularization analysis showed best reproducibility using whole placental sweep volume and centrally located, spherical sonobiopsy of 2 cm3.
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Affiliation(s)
- V M M M Schiffer
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands.
| | - D Pellaers
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands
| | - J L J M Hoenen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - S Al-Nasiry
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
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10
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Sharma N, Saravanan M, Saravanan Mbbs L, Narayanan S. The role of color Doppler in assisted reproduction: A narrative review. Int J Reprod Biomed 2020; 17:779-788. [PMID: 31911960 PMCID: PMC6906874 DOI: 10.18502/ijrm.v17i10.5484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/06/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022] Open
Abstract
Color Doppler of perifollicular vascularity is a useful assessment tool to predict the growth potential and maturity of Graafian follicles. Power Angio is independent of the angle of insonation and morphometry and provides reliable clues to predict the implantation window of the endometrium. Color Doppler can be used for the prediction of ovarian hyperstimulation syndrome. It can also be used to identify the hyper responder and gonadotropin-resistant type of polycystic ovaries. The secretory scan of corpus luteum can accurately predict its vascularity and functional status. A corpus luteum with decreased blood flow is a very sensitive and specific indicator of threatened and missed abortions. Color Doppler and Power Angio need to be standardized and identical settings should be maintained if different patients, or if changes over time within the same patient are to be compared.
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Affiliation(s)
- Nidhi Sharma
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Mahalakshmi Saravanan
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Lakshmanan Saravanan Mbbs
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Sindujhaa Narayanan
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Han H, Mo X, Ma Y, Zhou Y, Zhang B. The Role of Blood Flow in Corpus Luteum Measured by Transvaginal Two-Dimensional and Three-Dimensional Ultrasound in the Prediction of Early Intrauterine Pregnancy Outcomes. Front Pharmacol 2019; 10:767. [PMID: 31354483 PMCID: PMC6637309 DOI: 10.3389/fphar.2019.00767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/13/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: The purpose of this study was to explore the application of transvaginal two-dimensional and three-dimensional power Doppler ultrasound in pregnancy corpus luteum to predict the final outcome of early intrauterine pregnancy. Methods: This is a prospective observational cohort study. Six hundred early intrauterine pregnant women in Shanghai Changning Maternity and Infant Health Hospital were selected as the research objects from January 2015 to December 2015. According to the follow-up of 12 weeks, these pregnant women were divided into the normal pregnancy group (group A, n = 512) and the terminational pregnancy group (group B, n = 88). They all underwent both transvaginal two-dimensional ultrasound and three-dimensional power Doppler ultrasound to obtain relevant parameters of corpus luteum, namely, the average diameter of the corpus luteum (D), resistance index (RI), pulsatility index (PI), corpus luteum volume (V), vascularization index (VI), blood flow index (FI), and vascularized blood flow index (VFI). Among them, V, VI, FI, and VFI were calculated with the virtual organ computer-aided analysis method. Receiver operator characteristic (ROC) curves were drawn. The corresponding diagnostic cut-off, sensitivity, and specificity were calculated and compared. Results: Compared with group A, the D, V, VI, FI, and VFI of corpus luteum in group B were statistically significant lower while RI and PI were statistically significant higher (P < 0.05). The diagnostic cut-off values in the prediction of early intrauterine pregnancy outcomes were D: 14.48, RI: 0.56, PI: 0.81, V: 3.89, VI: 21.48, FI: 38.99, and VFI: 10.21 respectively, and the sensitivity and specificity were D (99.2%, 67.0%), RI (98.9%, 65.0%), PI (78.4%, 89.1%), V (95.1%, 78.4%), VI (74.%, 90.9%), FI (91.8%, 90.9%), and VFI (93.9%, 87.5%) respectively. The area under the ROC curve of the combined index (RI + FI) was 0.963, which was not significantly higher compared with any single index, and both the sensitivity and specificity were 94.3%. Conclusion: Both transvaginal two-dimensional and three-dimensional ultrasonography are of high diagnostic value in predicting the early intrauterine pregnancy outcomes.
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Affiliation(s)
- Huijuan Han
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Xinhai Mo
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuqin Ma
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuqing Zhou
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Bo Zhang
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Cruz-Martínez R, Etchegaray A, Molina-Giraldo S, Nieto-Castro B, Gil Guevara E, Bustillos J, Martínez-Rodríguez M, Gámez-Varela A, Saldivar-Rodríguez D, Chávez-González E, Keller R, Russo R, Yepez-García E, Coronel-Cruz F, Torres-Torres J, Rojas-Macedo A, Ibarra-Ríos D, Ordorica-Flores R, Nieto-Zermeño J, Alcocer-Alcocer M. A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry. Prenat Diagn 2019; 39:519-526. [PMID: 30980408 DOI: 10.1002/pd.5458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.
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Affiliation(s)
- Rogelio Cruz-Martínez
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Adolfo Etchegaray
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Saulo Molina-Giraldo
- Unidad de Terapia, Cirugía Fetal y Fetoscopia, División de Medicina Materno Fetal, Departmaneto de Ginecología y Obstetricia, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | - Belen Nieto-Castro
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Enrique Gil Guevara
- Instituto Unidad de Medicina Fetal, Peruano de Medicina y Cirugía Fetal, Lima, Peru
| | - Joaquin Bustillos
- Unidad de Medicina Fetal, Hospital CIMA San Jose, San José, Costa Rica
| | | | - Alma Gámez-Varela
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | | | | | - Rodolfo Keller
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ricardo Russo
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Eduardo Yepez-García
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Fausto Coronel-Cruz
- Departamento de Medicina Materno Fetal, Hospital General de México, Mexico City, Mexico
| | | | - Alejandro Rojas-Macedo
- Departamento de Neonatología, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Daniel Ibarra-Ríos
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Ricardo Ordorica-Flores
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Jaime Nieto-Zermeño
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Manuel Alcocer-Alcocer
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
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Cruz-Martinez R, Martínez-Rodríguez M, Nieto-Castro B, Gámez-Varela A, Cruz-Lemini M, Luna-García J, Juárez-Martínez I. Longitudinal changes in lung size and intrapulmonary-artery Doppler during the second half of pregnancy in fetuses with congenital diaphragmatic hernia. Prenat Diagn 2018; 39:45-51. [PMID: 30511776 DOI: 10.1002/pd.5401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objectives of the study are to evaluate longitudinal changes in lung size and intrapulmonary-artery (IPa) Doppler in fetuses with congenital diaphragmatic hernia (CDH) and assess their contribution in predicting neonatal survival. METHODS The observed/expected lung-to-head ratio (O/E-LHR) and IPa-pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) were evaluated in a cohort of left-sided CDH fetuses managed expectantly during pregnancy. Longitudinal changes were analyzed by multilevel analysis, and their value to predict survival using the multiple logistic regression and decision-tree analysis was assessed. RESULTS A total of 232 scans were performed on 69 CDH fetuses. The O/E-LHR values remained unchanged during fetal monitoring, whereas IPa-PI and PEDRF showed a progressive increase throughout follow-up, becoming abnormal on average at 30 weeks of gestation. Absent/reversed end-diastolic velocity (EDV) in the IPa was observed in 20.3%. O/E-LHR and IPa Doppler indices were significantly associated with probability of survival (O/E-LHR ≥ 26%, odds ratio [OR] 19.0; IPa-PI <+2.0 z score, OR 3.0; and positive EDV, OR 7.4). All cases with IPa-reversed EDV died after birth. CONCLUSION While lung size remains stable during pregnancy, CDH fetuses show progressive deterioration in intrapulmonary blood flow. IPa Doppler evaluation may aid in predicting survival of CDH fetuses managed expectantly during pregnancy.
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Affiliation(s)
- Rogelio Cruz-Martinez
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Belén Nieto-Castro
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Alma Gámez-Varela
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Monica Cruz-Lemini
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Jonahtan Luna-García
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Department of Fetal Surgery, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico Fetal Medicine Mexico Foundation, Queretaro, Mexico
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Placental vascularization indices and prediction of pre-eclampsia in high-risk women. Placenta 2018; 70:53-59. [PMID: 30316328 DOI: 10.1016/j.placenta.2018.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess ability of first and second trimester Placental Vascularization Indices (PVIs) to predict pre-eclampsia (PE) in high-risk pregnancies. METHOD PVIs derived from 3-Dimensional power Doppler imaging were measured at 11+0-13 + 6 (n = 194) and 19+0-21 + 6 weeks (n = 195). Logistic regression (LR) models used PE as the outcome. To quantify added value of PVIs to baseline characteristics in predicting PE, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices were calculated. RESULTS Overall rate of PE was 12% (n = 26). Lower first trimester PVIs were seen in women with PE (mean, SD); Vascularization Index (VI,%): 10.0 (6.2) v 14.7 (7.6), P = 0.005, Flow Index (FI): 37.7 (9.1) v 42.9 (10.4), P = 0.03, Vascularization Flow Index (VFI): 3.8 (2.5) v 6.6 (4.0), P < 0.001). All first trimester PVIs predicted PE in LR models adjusted for covariates. IDI and NRI analyses confirmed added clinical utility of VI (IDI 0.05, P = 0.004; NRI 0.66, P < 0.001) and VFI (IDI 0.06, P = 0.004; NRI 0.53, P = 0.91). In the second trimester, FI was lower in women with PE (39.6 (9.1) v 44.4 (8.6), P = 0.01) and predicted PE in adjusted LR models (standardised OR 0.53, 95% CI 0.29-0.97, P = 0.04). FI discriminated between cases and non-cases of PE (IDI 0.04, P = 0.04). CONCLUSION First trimester placental vascularization indices (VI, FI and VFI) have the potential to predict PE in high-risk pregnancies, with FI remaining predictive in the second trimester.
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15
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Testa AC, Moro F, Pasciuto T, Moruzzi MC, Di Legge A, Fuoco G, Autorino R, Collarino A, Gui B, Zannoni GF, Gambacorta A, Miccò M, Rufini V, Scambia G, Ferrandina G. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:110-118. [PMID: 29119649 DOI: 10.1002/uog.18953] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. METHODS Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. RESULTS Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. CONCLUSIONS Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A C Testa
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Pasciuto
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M C Moruzzi
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Legge
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Fuoco
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Autorino
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - A Collarino
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Gui
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - G F Zannoni
- Department of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Gambacorta
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - M Miccò
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - V Rufini
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ferrandina
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Health Science and Medicine, University of Molise, Campobasso, Italy
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16
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Heres HM, Schoots T, Tchang BCY, Rutten MCM, Kemps HMC, van de Vosse FN, Lopata RGP. Perfusion dynamics assessment with Power Doppler ultrasound in skeletal muscle during maximal and submaximal cycling exercise. Eur J Appl Physiol 2018; 118:1209-1219. [PMID: 29569054 DOI: 10.1007/s00421-018-3850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/17/2018] [Indexed: 10/24/2022]
Abstract
PURPOSE Assessment of limitations in the perfusion dynamics of skeletal muscle may provide insight in the pathophysiology of exercise intolerance in, e.g., heart failure patients. Power doppler ultrasound (PDUS) has been recognized as a sensitive tool for the detection of muscle blood flow. In this volunteer study (N = 30), a method is demonstrated for perfusion measurements in the vastus lateralis muscle, with PDUS, during standardized cycling exercise protocols, and the test-retest reliability has been investigated. METHODS Fixation of the ultrasound probe on the upper leg allowed for continuous PDUS measurements. Cycling exercise protocols included a submaximal and an incremental exercise to maximal power. The relative perfused area (RPA) was determined as a measure of perfusion. Absolute and relative reliability of RPA amplitude and kinetic parameters during exercise (onset, slope, maximum value) and recovery (overshoot, decay time constants) were investigated. RESULTS A RPA increase during exercise followed by a signal recovery was measured in all volunteers. Amplitudes and kinetic parameters during exercise and recovery showed poor to good relative reliability (ICC ranging from 0.2-0.8), and poor to moderate absolute reliability (coefficient of variation (CV) range 18-60%). CONCLUSIONS A method has been demonstrated which allows for continuous (Power Doppler) ultrasonography and assessment of perfusion dynamics in skeletal muscle during exercise. The reliability of the RPA amplitudes and kinetics ranges from poor to good, while the reliability of the RPA increase in submaximal cycling (ICC = 0.8, CV = 18%) is promising for non-invasive clinical assessment of the muscle perfusion response to daily exercise.
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Affiliation(s)
- H M Heres
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - T Schoots
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - B C Y Tchang
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M C M Rutten
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - H M C Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - F N van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R G P Lopata
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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3D Power Doppler vascular indices as a novel technique in assessing the outcome of minimally invasive techniques in uterine fibroids treatment. MENOPAUSE REVIEW 2018; 16:118-121. [PMID: 29483852 PMCID: PMC5824680 DOI: 10.5114/pm.2017.72755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
Uterine fibroids are considered to be the most frequent female benign tumours. The most common reported symptoms of fibroids are heavy menstrual bleeding and painful menstruation, pelvic pain, urinary problems, constipation, as well as infertility and recurrent pregnancy loss. The mainstay of fibroid treatment is surgery, but nowadays minimally-invasive techniques are growing in popularity. Vascularity of fibroids may play a role in the outcome of these techniques, which is why it is important to find an objective, reproducible technique to measure the vascularization before and after the procedure. The 3D Power Doppler vascular indices (3DPDVI) allow objective assessment of vascularization in the entire volume of the tumour. Initially this technique was mostly used in experimental imaging phantoms, but recently many studies focus on the clinical utility of this technique. Power Doppler allows to obtain information on vascularity in the area of interest, while 3DPDVI can be objectively calculated by the Virtual Organ Computer-aided AnaLysis (VOCAL™) software. 3DPDVI showed high reproducibility in most of the studies. This technique has an important role in monitoring the outcome of minimally invasive procedures in fibroid treatment, because they affect vascularity of the tumours. Although there are some limitations of 3DPDVI, it seems that their application may be an effective tool in objective assessment of vascularity of fibroids. However further studies are required to consolidate the usage of 3DPDVI in clinical practice.
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Kyriakopoulos K, Domali E, Stavrou S, Rodolakis A, Loutradis D, Drakakis P. Recurrent benign leiomyomas after total abdominal hysterectomy. Rich or poor estrogenic environment may lead to their recurrence? Int J Surg Case Rep 2018; 44:191-193. [PMID: 29550681 PMCID: PMC5927807 DOI: 10.1016/j.ijscr.2018.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Benign metastasizing leiomyomas represent benign lesions consisted by leiomatosous tissue and could be observed in positions away from their usual localization, the human uterus. They commonly affect women that have undergone total hysterectomy. Approximately 100 similar cases have been reported in the literature, so the case we present is rare and reviewing the literature and needs to be reported. PRESENTATION OF CASE We report a case of a 55 year old Greek woman, gravida five and para three, who attended our unit 3 years ago complaining of occasionally lower abdominal pain and irritation the last months. Fourteen years ago she underwent abdominal hysterectomy and left salpingo-oophorectomy due to a 13 cm uterine leiomyoma. In the meantime she underwent two surgical procedures for recurrent benign leiomyomas. DISCUSSION When patient was admitted at this time, clinical examination revealed a palpable mass of 5 cm. The transvaginal ultrasonography revealed 3 masses in the lower pelvis of unknown origin. The patient underwent a new laparotomy revealing three masses of benign leiomyomas with low mitotic activity. CONCLUSION Our case supports the recurrent appearance of leiomyomas in pelvis after total abdominal hysterectomy and is one of few reports in literature where the tumors appear in the same patient both in estrogen rich and estrogen poor environment. Additionally, we show the importance of transvaginal ultrasonography and 3 dimensional power Doppler in the differential diagnosis of pelvic masses. Thus, transvaginal ultrasonography seems to be a pivotal tool for the diagnosis and follow up of these challenging lesions.
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Affiliation(s)
- Konstantinos Kyriakopoulos
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Sofoklis Stavrou
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Peter Drakakis
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Lourou and Vasilisis Sofias Avenue, 11528 Athens, Greece.
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Tanos V, Berry K. Benign and malignant pathology of the uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:12-30. [DOI: 10.1016/j.bpobgyn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
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20
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Wu L, Ferreira A, Stevenson GN, Sanderson J, Mahajan A, Meriki N, Welsh AW. Novel spatial-temporal image correlation derived indices of tissue vascular impedance: A variability study. Australas J Ultrasound Med 2017; 20:115-122. [DOI: 10.1002/ajum.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Linda Wu
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Ana Ferreira
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Gordon N Stevenson
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
| | - Jennifer Sanderson
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
| | - Aditi Mahajan
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Neama Meriki
- Department of Obstetrics & Gynecology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Department of Maternal Fetal Medicine; King Khalid University Hospital; Riyadh Saudi Arabia
| | - Alec W Welsh
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
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Haidar ZA, Papanna R, Sibai BM, Tatevian N, Viteri OA, Vowels PC, Blackwell SC, Moise KJ. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa? Am J Obstet Gynecol 2017; 217:202.e1-202.e13. [PMID: 28400306 DOI: 10.1016/j.ajog.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. OBJECTIVE The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. STUDY DESIGN A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. RESULTS The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index (14.2 ± 3.8) were higher in morbidly adherent placenta (P < .001); (4) area under the receiver-operating characteristic curve for the vascular and vascular flow indices were 0.99 and 0.97, respectively; (5) the vascular index ≥21 predicted morbidly adherent placenta with a sensitivity and a specificity of 95% (95% confidence interval, 88.2-96.9) and 91%, respectively (95% confidence interval, 87.5-92.4), 92% positive predictive value (95% confidence interval, 85.5-94.3), 90% negative predictive value (95% confidence interval, 79.9-95.3), positive likelihood ratio of 10.55 (95% confidence interval, 7.06-12.75), and negative likelihood ratio of 0.05 (95% confidence interval, 0.03-0.13); and (6) for the severe morbidly adherent placenta, 2-dimensional ultrasound had a sensitivity of 33.3% (95% confidence interval, 11.3-64.6), a specificity of 81.8% (95% confidence interval, 47.8-96.8), a positive predictive value of 66.7% (95% confidence interval, 24.1-94.1), a negative predictive value of 52.9% (95% confidence interval, 28.5-76.1), a positive likelihood ratio of 1.83 (95% confidence interval, 0.41-8.11), and a negative likelihood ratio of 0.81 (95% confidence interval, 0.52-1.26). A vascular index ≥31 predicted the diagnosis of a severe morbidly adherent placenta with a 100% sensitivity (95% confidence interval, 72-100), a 90% specificity (95% confidence interval, 81.7-93.8), an 88% positive predictive value (95% confidence interval, 55.0-91.3), a 100% negative predictive value (95% confidence interval, 90.9-100), a positive likelihood ratio of 10.0 (95% confidence interval, 3.93-16.13), and a negative likelihood ratio of 0 (95% confidence interval, 0-0.34). Intrarater and interrater agreements were 94% (P < .001) and 93% (P < .001), respectively. CONCLUSION The vascular index accurately predicts the morbidly adherent placenta in patients with placenta previa. In addition, 3-dimensional power Doppler vascular and vascular flow indices were more predictive of severe cases of morbidly adherent placenta compared with 2-dimensional ultrasound. This objective technique may limit the variations in diagnosing morbidly adherent placenta because of the subjectivity of 2-dimensional ultrasound interpretations.
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Esin S, Yirci B, Yalvac S, Kandemir O. Use of translabial three-dimensional power Doppler ultrasound for cervical assessment before labor induction. J Perinat Med 2017; 45:559-564. [PMID: 27977408 DOI: 10.1515/jpm-2016-0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare translabial three-dimensional (3D) power Doppler ultrasound with Bishop score and transvaginal ultrasound measurements for cervical assessment before induction of labor with dinoprostone or cervical ripening balloon. MATERIALS AND METHODS Translabial cervical volume and length, vascularization indices and transvaginal cervical length were measured. Results were compared among women who had vaginal delivery at 24 h or less and more than 24 h after the insertion of the dinoprostone vaginal insert or cervical ripening balloon and among women who had vaginal delivery and cesarean delivery for failure to go into labor or failure to progress. RESULTS There was no correlation between the time to delivery after a ripening agent was applied and translabial cervical volume, translabial cervical length, vascularization index (VI), flow index (FI), vascularization flow index (VFI), transvaginal cervical length and Bishop scores. The ultrasonographic measurements were no different among women who had vaginal delivery at 24 h or less and more than 24 h and among women who had vaginal delivery and cesarean delivery for failure to go into labor or failure to progress. CONCLUSION In this study, we failed to demonstrate the superiority of translabial 3D ultrasonography over Bishop score and transvaginal ultrasonography for predicting the success of induction of labor.
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Collins SL, Welsh AW, Impey L, Noble JA, Stevenson GN. 3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby. PLoS One 2017; 12:e0178675. [PMID: 28570600 PMCID: PMC5453560 DOI: 10.1371/journal.pone.0178675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To undertake an observational study to see whether first trimester placental vascularity, measured with a standardized power Doppler index: 3D-FMBV, is different in pregnancies which either develop pre-eclampsia or lead to term, normotensive small for gestational age (SGA) babies. METHODS Women were scanned between 11 and 13+6 weeks. The placental volume (sPlaV) was estimated using our previously validated semi-automated tool. Estimates of 3D-FMBV were generated from the raw power Doppler signal for the whole utero-placental interface, UPI (FMBV-UPI) and 5mm into the placenta (FMBV-IVS). Differences in the placental volume and FMBV for pregnancies developing pre-eclampsia and resulting in term, normotensive SGA babies were compared with term, normotensive, appropriate for gestational age (AGA), controls. RESULTS Results were available for 143 women. The placental volume (sPlaV) was reduced in both pre-eclampsia (p = 0.007) and term, normotensive SGA (p = 0.001) when compared with term normotensive AGA controls. 3D-FMBV estimates were significantly lower for pregnancies developing pre-eclampsia (FMBV-UPI, p = 0.03, FMBV-IVS, p = 0.01) but not for the normotensive SGA pregnancies (FMBV-UPI, p = 0.16, FMBV-IVS, p = 0.27). CONCLUSION Pregnancies destined to develop pre-eclampsia are more likely to have small placentas with significantly reduced vascularity at 11-13 weeks. Those pregnancies which were normotensive throughout but resulted in an SGA baby delivered at term, had significantly smaller placentas but with similar vascularity to normotensive AGA pregnancies.
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Affiliation(s)
- Sally L. Collins
- The Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail:
| | - Alec W. Welsh
- School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Lawrence Impey
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - J. Alison Noble
- The Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Gordon N. Stevenson
- School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
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Saravelos SH, Jayaprakasan K, Ojha K, Li TC. Assessment of the uterus with three-dimensional ultrasound in women undergoing ART. Hum Reprod Update 2017; 23:188-210. [PMID: 28007752 DOI: 10.1093/humupd/dmw040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A detailed assessment of the uterus forms a pivotal part of the ART treatment process. The emergence of three-dimensional ultrasound (3D US) has provided clinicians with a highly powerful tool in this respect. Assessments with 3D US range from the reconstruction of anatomical planes elusive to conventional US, to the objective measurement of anatomical volumes and vascularization parameters. However, despite the ever increasing number of publications emerging in the literature, the question of which aspects of 3D US are of most clinical value remains a topic of debate. OBJECTIVE AND RATIONALE The objective of this review is to dissect which aspects of the 3D US assessment of the uterus are supported by a strong level of evidence to date, and should therefore be incorporated into current routine clinical practice. SEARCH METHODS We conducted a systematic search of the PubMed database up to May 2016, using a combination of text words and Medical Subject Headings (MeSH) pertaining to the 3D US assessment of the uterus. All articles published in the English language were screened to ascertain relevance to women of reproductive age; further citations were retrieved through manual reference list searching. OUTCOMES A multitude of predominantly observational studies were identified, which concerned a vast variety of 3D US uterine assessments. All articles unequivocally praised the non-invasive, cost-effective, highly acceptable and objective nature of 3D US. Studies regarding the value of assessing the endometrial volume and vascularization prior to embryo transfer appeared conflicting and inconsistent. Studies regarding the imaging of uterine pathology and identification of intratubal and intrauterine devices consistently reported high rates of diagnostic accuracy. A recent RCT did not show an improvement in clinical outcomes when comparing 3D versus 2D US during embryo transfer. However, preliminary studies suggested that 3D US is superior in determining the site of implantation, particularly in ambiguous cases such as interstitial and angular pregnancies. Finally, pilot studies have suggested that the further integration of 3D and possibly 4D US with surgical interventions of the uterus may be a promising prospect. WIDER IMPLICATIONS 3D US may prove to be an invaluable tool in the assessment of the uterus within the context of ART. Currently, the aim should be to highlight the aspects of 3D US that are most evidence-based and valuable for patients, and to incorporate these into routine clinical practice.
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Affiliation(s)
- Sotirios H Saravelos
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Kannamannadiar Jayaprakasan
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Kamal Ojha
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
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Evaluation of the predictive value of placental vascularisation indices derived from 3-Dimensional power Doppler whole placental volume scanning for prediction of pre-eclampsia: A systematic review and meta-analysis. Placenta 2017; 51:89-97. [DOI: 10.1016/j.placenta.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/13/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
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Guerriero S, Saba L, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Sedda F, Peddes C, Fabbri P, Pilla F, Zajicek M, Giuseppina P, Melis GB. Past, present and future ultrasonographic techniques for analyzing ovarian masses. ACTA ACUST UNITED AC 2016; 11:369-83. [PMID: 26102474 DOI: 10.2217/whe.15.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography is today the method of choice for distinguishing between benign and malignant adnexal pathologies. Using pattern recognition several types of tumors can be recognized according to their characteristic appearance on gray-scale imaging. Color Doppler imaging should be used only to perform a semiquantitative color score or evaluate the flow location. International Ovarian Tumor Analysis group had standardized definitions characterizing adnexal masses and suggested the use of 'simple rules' in premenopausal women. Recently, the use of 3D vascular indices has been proposed but its potential use in clinical practice is debated. Also computerized aided diagnosis algorithms showed encouraging results to be confirmed in the future.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics & Gynecology, University of Navarra, Pamplona, Spain
| | | | - Silvia Ajossa
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Maura Perniciano
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Cristina Peddes
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Paola Fabbri
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Pilla
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Michal Zajicek
- Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Parodo Giuseppina
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
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Sonographic evaluation of polycystic ovaries. Best Pract Res Clin Obstet Gynaecol 2016; 37:25-37. [PMID: 27118252 DOI: 10.1016/j.bpobgyn.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
The morphological features of the ovaries in women with polycystic ovary syndrome (PCOS) have been well described by ultrasound imaging technology. These include enlarged ovary size, multiple small follicles of similar size, increased ovarian stromal volume and echogenicity, peripheral distribution of the follicles, and higher stromal blood flow. Ultrasound identification of the presence of polycystic ovarian morphology (PCOM) has been recognized as a component of PCOS diagnosis. With the advance of ultrasound technology, new definition has been proposed recently. There is, however, a paucity of data for the ovarian morphology in normal and PCOS adolescents. Magnetic resonance imaging has the potential to be an alternative imaging modality for diagnosing PCOM in adolescence.
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Can Three-dimensional (3D) power Doppler and uterine artery Doppler differentiate between fibroids and adenomyomas? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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29
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3D power Doppler ultrasound characteristics of the corpus luteum and early pregnancy outcome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 389] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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Characteristics of Three-Dimensional Power Doppler in Gestational Trophoblastic Disease. DISEASE MARKERS 2015; 2015:917687. [PMID: 26257463 PMCID: PMC4519557 DOI: 10.1155/2015/917687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022]
Abstract
Purpose. In the present study, the three-dimensional power Doppler was used as a quantitative method to evaluate its reliability in detecting and assessing of gestational trophoblastic disease (GTD). Methods. 52 GTD patients who received diagnosis and treatment at the first affiliated hospitals of Xi'an Jiaotong University in China between 2011 and 2013 were evaluated using Voluson E8 (GE Medical System). Demographic information, pathological characteristics, clinical history, sonographic images, and related indices (resistance index, vascularization index, and flow and vascularization index) were evaluated. Result. Three-dimension power Doppler indicated that there were significant differences in the resistance index, vascularization index, flow index, and vascularization-flow index between the healthy individuals and each subgroup of patients (P < 0.01). Further, in combining invasive hydatidiform mole and choriocarcinoma groups, there was a significant difference between hydatidiform mole and the combined malignant group (P < 0.01). And the abnormal sonographic and power Doppler findings in GTD were resolved when chemotherapy was done successfully. Conclusion. Combined with the clinical features, sonography and three-dimension power Doppler imaging were helpful in diagnosing GTD as a noninvasive method, distinguishing the invasive nature of disease, detecting the recurrence of the disease, and assessing the effectiveness of the chemotherapy.
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Hannaford KE, Tuuli M, Goetzinger KR, Odibo L, Cahill AG, Macones G, Odibo AO. First-trimester 3-dimensional power Doppler placental vascularization indices from the whole placenta versus the placental bed to predict preeclampsia: does pregnancy-associated plasma protein a or uterine artery Doppler sonography help? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:965-970. [PMID: 26014314 DOI: 10.7863/ultra.34.6.965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the use of vascular indices derived from the whole placenta to those from the placental bed only for predicting preeclampsia and to determine whether the addition of pregnancy-associated plasma protein A (PAPP-A) and mean uterine artery Doppler values improves prediction. METHODS We conducted a secondary analysis of a prospective cohort of women with singletons between 11 and 14 weeks' gestation undergoing sonography for aneuploidy screening. Placental vascularization indices from the whole placenta versus the placental bed were combined with first-trimester maternal serum PAPP-A levels, mean uterine artery Doppler values, or the combination of both to predict the development of preeclampsia or early preeclampsia (delivery <34 weeks). The predictive ability of each vascular index was calculated by using areas under receiver operating characteristic curves. The sensitivity of the model for predicting preeclampsia and early preeclampsia at fixed false-positive rates of 10% and 20% was calculated. RESULTS Of 570 women, 48 (8.4%) had preeclampsia, and 10 (1.7%) had early preeclampsia. The area under the curve and sensitivity values for the prediction of preeclampsia or early preeclampsia were not different when evaluating the whole placenta versus the placental bed. Additionally, there was no significant improvement when adding PAPP-A, uterine artery Doppler values, or both. The variables in the model were more sensitive for the prediction of early preeclampsia than preeclampsia. CONCLUSIONS Although placental bed vascular indices are modestly predictive of preeclampsia, the addition of PAPP-A and uterine artery Doppler values to vascularization indices in the whole placenta or the placental bed did not significantly improve their predictive ability.
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Affiliation(s)
- Karen E Hannaford
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
| | - Methodius Tuuli
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA
| | | | - Linda Odibo
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA
| | - George Macones
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA
| | - Anthony O Odibo
- Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA
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Dueholm M, Christensen JW, Rydbjerg S, Hansen ES, Ørtoft G. Two- and three-dimensional transvaginal ultrasound with power Doppler angiography and gel infusion sonography for diagnosis of endometrial malignancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:734-743. [PMID: 24862861 DOI: 10.1002/uog.13421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 05/14/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate the diagnostic efficiency of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasonography, power Doppler angiography (PDA) and gel infusion sonography (GIS) at offline analysis for recognition of malignant endometrium compared with real-time evaluation during scanning, and to determine optimal image parameters at 3D analysis. METHODS One hundred and sixty-nine consecutive women with postmenopausal bleeding and endometrial thickness ≥ 5 mm underwent systematic evaluation of endometrial pattern on 2D imaging, and 2D videoclips and 3D volumes were later analyzed offline. Histopathological findings at hysteroscopy or hysterectomy were used as the reference standard. The efficiency of the different techniques for diagnosis of malignancy was calculated and compared. 3D image parameters, endometrial volume and 3D vascular indices were assessed. Optimal 3D image parameters were transformed by logistic regression into a risk of endometrial cancer (REC) score, including scores for body mass index, endometrial thickness and endometrial morphology at gray-scale and PDA and GIS. RESULTS Offline 2D and 3D analysis were equivalent, but had lower diagnostic performance compared with real-time evaluation during scanning. Their diagnostic performance was not markedly improved by the addition of PDA or GIS, but their efficiency was comparable with that of real-time 2D-GIS in offline examinations of good image quality. On logistic regression, the 3D parameters from the REC-score system had the highest diagnostic efficiency. The area under the curve of the REC-score system at 3D-GIS (0.89) was not improved by inclusion of vascular indices or endometrial volume calculations. CONCLUSION Real-time evaluation during scanning is most efficient, but offline 2D and 3D analysis is useful for prediction of endometrial cancer when good image quality can be obtained. The diagnostic efficiency at 3D analysis may be improved by use of REC-scoring systems, without the need for calculation of vascular indices or endometrial volume. The optimal imaging modality appears to be real-time 2D-GIS.
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Affiliation(s)
- M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - J W Christensen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - S Rydbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - E S Hansen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - G Ørtoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Pálsdóttir K, Fischerova D, Franchi D, Testa A, Di Legge A, Epstein E. Preoperative prediction of lymph node metastasis and deep stromal invasion in women with invasive cervical cancer: prospective multicenter study using 2D and 3D ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:470-475. [PMID: 25092154 DOI: 10.1002/uog.14643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine how various objective two-dimensional (2D) and three-dimensional (3D) ultrasound parameters allow prediction of deep stromal tumor invasion and lymph node involvement, in comparison to subjective ultrasound assessment, in women scheduled for surgery for cervical cancer. METHODS This was a prospective multicenter trial including 104 women with cervical cancer at FIGO Stages IA2-IIB, verified histologically. Patients scheduled for surgery underwent a preoperative ultrasound examination. The value of various 2D (size, color score) and 3D (volume, vascular indices) ultrasound parameters was compared to that of subjective assessment in the prediction of deep stromal tumor invasion and lymph node involvement. Histology obtained from radical hysterectomy or trachelectomy and pelvic lymphadenectomy was considered as the gold standard for assessment. RESULTS All women underwent pelvic lymphadenectomy, with 99 (95%) undergoing subsequent radical surgery; five underwent only pelvic lymphadenectomy because of the presence of a positive sentinel lymph node. Women with deep stromal invasion or lymph node involvement had significantly larger tumors (diameter and volume) but there was no correlation with vascular indices measured on 3D ultrasound. Subjective evaluation was superior (AUC, 0.93; sensitivity, 90.5%; specificity, 97.2%) in the prediction of deep stromal invasion when compared to any objective measurement technique, with maximal tumor diameter at 20.5-mm cut-off (AUC, 0.83; sensitivity, 90.5%; specificity, 61.1%) and 3D tumor volume at 9.1-mm(3) cut-off (AUC, 0.85; sensitivity, 79.4%; specificity, 83.3%) providing the best performance among the objective parameters. Both subjective assessment and objective measurements were poorly predictive of lymph node involvement. CONCLUSIONS In women with cervical cancer, subjective ultrasound evaluation allowed better prediction of deep stromal invasion than did objective measurements; however, neither subjective evaluation nor objective parameters were adequate to predict lymph node involvement. 3D vascular indices were ineffective in the prediction of advanced stages of the disease.
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Affiliation(s)
- K Pálsdóttir
- Department of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Can 3D power Doppler identify levator ani vascularization at its pubic insertion? Int Urogynecol J 2015; 26:1327-32. [PMID: 25822029 DOI: 10.1007/s00192-015-2689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The levator ani is the most important muscle in the pelvic floor. This pilot study using 3D power Doppler aimed to identify normal vascularization of the puborectalis/pubovisceralis muscle at its insertion in nulliparous and premenopausal women. METHODS Forty nulliparous and premenopausal women were evaluated at the Gynecological Unit of a tertiary hospital. All women underwent a translabial ultrasound (US) with 3D power Doppler. Pubic insertion of the puborectalis/pubovisceralis muscle was assessed in the axial plane, and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated bilaterally. Volumes were analyzed offline by two independent observers, and interobserver agreement and correlation between variables was calculated. RESULTS A high, statistically significant, correlation was found between the three US indices on each side (p < 0.005). No correlation was found between the US index and either of the demographic parameters of body mass index [(BMI), p > 0.241], or age (p > 0.398). The degree of correlation between the same index on the different sides was not statistically significant. CONCLUSION Puborectalis/pubovisceralis muscle vascularization at its insertion can be identified using 3D Doppler US, but values differ substantially from those of the contralateral side.
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Andescavage NN, DuPlessis A, Limperopoulos C. Advanced MR imaging of the placenta: Exploring the in utero placenta-brain connection. Semin Perinatol 2015; 39:113-23. [PMID: 25765905 PMCID: PMC4409865 DOI: 10.1053/j.semperi.2015.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The placenta is a vital organ necessary for the healthy neurodevelopment of the fetus. Despite the known associations between placental dysfunction and neurologic impairment, there is a paucity of tools available to reliably assess in vivo placental health and function. Existing clinical tools for placental assessment remain insensitive in predicting and evaluating placental well-being. Advanced MRI techniques hold significant promise for the dynamic, non-invasive, real-time assessment of placental health and identification of early placental-based disorders. In this review, we summarize the available clinical tools for placental assessment, including ultrasound, Doppler, and conventional MRI. We then explore the emerging role of advanced placental MR imaging techniques for supporting the developing fetus and appraise the strengths and limitations of quantitative MRI in identifying early markers of placental dysfunction for improved pregnancy monitoring and fetal outcomes.
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Affiliation(s)
- Nickie Niforatos Andescavage
- Division of Neonatology, Children’s National Health System, 111
Michigan Ave. NW, Washington, DC 20010,Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Adre DuPlessis
- Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Diagnostic Imaging & Radiology, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Catherine Limperopoulos
- Division of Neonatology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037; Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037.
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Moncayo R, Moncayo H. The WOMED model of benign thyroid disease: Acquired magnesium deficiency due to physical and psychological stressors relates to dysfunction of oxidative phosphorylation. BBA CLINICAL 2014; 3:44-64. [PMID: 26675817 PMCID: PMC4661500 DOI: 10.1016/j.bbacli.2014.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to discern whether a relation between biochemical parameters, sonography and musculoskeletal data exists in cases of hyperthyroidism and whether they are modifiable through supplementation with selenomethionine and magnesium citrate as well as by acupuncture and manual medicine methods. RESULTS A direct correlation between whole blood selenium and serum magnesium was found in subjects without thyroid disease and in menopausal women while it was reversed in cases of thyroid diseases as well as in patients with depression, infection, and in infertile women. Vascularization indices were elevated in cases of newly diagnosed benign thyroid diseases. Musculoskeletal changes i.e. lateral tension and idiopathic moving toes, as well as situations of physical and psychological stress and minor trauma and infection led to an increase of vascularization. Magnesium levels correlated negatively with these two conditions. The supplementation brought a reduction of the vascularization indices and reduced the incidence of idiopathic moving toes. Treatment of lateral tension required manual medicine methods and acupuncture (gastrocnemius). A small subgroup of patients showed a further reduction of hyper-vascularization after receiving coenzyme Q10. CONCLUSIONS We interpret the elevated thyroid vascularization and low magnesium levels as signs of an inflammatory process related to the musculoskeletal changes. Improvement of thyroid function and morphology can be achieved after correcting the influence of stressors together with the supplementation regime. We hypothesize that the central biochemical event in thyroid disease is that of an acquired, altered mitochondrial function due to deficiency of magnesium, selenium, and coenzyme Q10.
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Affiliation(s)
- Roy Moncayo
- WOMED, Karl-Kapferer-Strasse 5, AT-6020 Innsbruck, Austria
| | - Helga Moncayo
- WOMED, Karl-Kapferer-Strasse 5, AT-6020 Innsbruck, Austria
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Fang SW, Ou CY, Tsai CC, Fu HC, Cheng HH, Cheng BH, Chang MS, Hsu TY. Second-trimester placental volume and vascular indices in the prediction of small-for-gestational-age neonates. Fetal Diagn Ther 2014; 37:123-8. [PMID: 25359105 DOI: 10.1159/000365148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the ability of second-trimester placental volume and vascular indices to predict small-for-gestational-age (SGA) birth weight pregnancies. MATERIAL AND METHODS Women with singleton pregnancies were prospectively evaluated at 17-20 weeks of gestation. Second-trimester placental volume and vascular indices were obtained and calculated using volume organ computer-aided analysis and three-dimensional (3D) power Doppler ultrasound. Participants were followed until delivery and their medical records were reviewed, including maternal age, parity and pregestational body weight and body height, as well as the gestational age, birth weight and gender of the fetus. RESULTS Of the 163 women with complete follow-up, 20 gave birth to SGA and 143 to appropriate-for-gestational-age (AGA) neonates. The mean second-trimester placental volume was significantly lower in the SGA than in the AGA group (170.6 ± 49.8 vs. 213.5 ± 75.8 cm(3), p = 0.015). None of the vascular indices, including the vascularization index, flow index and vascularization flow index, differed significantly between the two groups. We also found that the optimum cutoff for placental volume at a gestational age of 17-18 weeks was 189.7 cm(3). DISCUSSION Second-trimester placental volume was positively correlated with neonatal birth weight. Second-trimester placental volume measured on 3D ultrasound may be predictive of SGA neonates.
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Affiliation(s)
- Shih-Wen Fang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan, ROC
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The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India 2014; 64:311-6. [PMID: 25368452 DOI: 10.1007/s13224-014-0622-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Uterine cervical cancer is the second most frequent gynecological malignancy worldwide. The assessment of the extent of disease is essential for planning optimal treatment. Imaging techniques are increasingly used in the pre-treatment work-up of cervical cancer. Currently, MRI for local extent of disease evaluation and PET-scan for distant disease assessment are considered as first-line techniques. Notwithstanding, in the last few years, ultrasound has gained attention as an imaging technique for evaluating women with cervical cancer. In this paper, current knowledge about the use of ultrasound for assessing uterine cervical cancer will be reviewed and discussed.
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Stevenson GN, Collins SL, Welsh AW, Impey LW, Noble JA. A technique for the estimation of fractional moving blood volume by using three-dimensional power Doppler US. Radiology 2014; 274:230-7. [PMID: 25117590 DOI: 10.1148/radiol.14132363] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To (a) demonstrate an image-processing method that can automatically measure the power Doppler signal in a three-dimensional ( 3D three-dimensional ) ultrasonographic (US) volume by using the location of organs within the image and (b) compare 3D three-dimensional fractional moving blood volume ( FMBV fractional moving blood volume ) results with commonly used, unstandardized measures of 3D three-dimensional power Doppler by using the human placenta as the organ of interest. MATERIALS AND METHODS This is a retrospective study of scans obtained as part of a prospective study of imaging placental biomarkers with US, performed with ethical approval and written informed consent. One hundred forty-three consecutive female patients were examined by using an image-processing technique. Three-dimensional FMBV fractional moving blood volume was measured on the vasculature from the uteroplacental interface to a depth 5 mm into the placenta by using a normalization volume 10 mm outside the uteroplacental interface and compared against the Virtual Organ Computer-aided AnaLysis ( VOCAL Virtual Organ Computer-aided AnaLysis ; GE Healthcare, Milwaukee, Wis) vascularization flow index ( VFI vascularization flow index ). Intra- and interobserver variability was assessed in a subset of 18 volumes. Wilcoxon signed rank test and intraclass correlation coefficients were used to assess measurement repeatability. RESULTS The mean 3D three-dimensional FMBV fractional moving blood volume value ± standard deviation was 11.78% ± 9.30 (range, 0.012%-44.16%). Mean VFI vascularization flow index was 2.26 ± 0.96 (range, 0.15-6.06). Linear regression of VFI vascularization flow index versus FMBV fractional moving blood volume produced an R(2) value of 0.211 and was significantly different in distribution (P < .001). Intraclass correlation coefficient analysis showed higher FMBV fractional moving blood volume values than VFI vascularization flow index for intra- and interobserver variability; intraobserver values were 0.95 for FMBV fractional moving blood volume (95% confidence interval [ CI confidence interval ]: 0.90, 0.98) versus 0.899 for VFI vascularization flow index (95% CI confidence interval : 0.78, 0.96), and interobserver values were 0.93 for FMBV fractional moving blood volume (95% CI confidence interval : 0.82, 0.97) versus 0.67 for VFI vascularization flow index (95% CI confidence interval : 0.32, 0.86). CONCLUSION The extension of an existing two-dimensional standardized power Doppler measurement into 3D three-dimensional by using an image-processing technique was shown in an in utero placental study. Three-dimensional FMBV fractional moving blood volume and VFI vascularization flow index produced significantly different results. FMBV fractional moving blood volume performed better than VFI vascularization flow index in repeatability studies. Further studies are needed to assess accuracy against a reference standard.
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Affiliation(s)
- Gordon N Stevenson
- From the Institute of Biomedical Engineering, Department of Engineering Science (G.N.S., J.A.N.), and Nuffield Department of Obstetrics and Gynaecology (S.L.C.), University of Oxford, Oxford, England; School of Women's & Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, NSW, Australia (A.W.W.); and Fetal Medicine Unit, John Radcliffe Hospital, Oxford, England (S.L.C., L.W.I.)
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Fetal ovarian cyst: 2- and 3-dimensional ultrasound as a new diagnostic method to rule out ovarian torsion. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Owing to the improvement in obstetric ultrasound imaging, prenatal diagnosis of ovarian masses has increased considerably. Fetal ovarian cysts can be suspected when an ultrasound scan shows intra-abdominal structures in female fetuses in the presence of normal bowel and urinary structures. The most common complication is the adnexal torsion, causing partial or complete strangulation of blood supply via ovarian vessels, leading ovarian ischemia, or necrosis. Current information regarding the treatment of fetal ovarian cysts is based on personal experiences and some case series. The management is controversial, characterized by dissimilar approaches, such as “wait and see”, prenatal or postnatal aspiration, or neonatal surgery. In more than half of the cases, spontaneous regression occurs in the prenatal or postnatal period, probably due to the small size and simple aspect. Large cysts may cause both local effects (adnexal torsion, ovarian autoamputation), and distant effects (intestinal and urinary obstruction, adhesion with adjacent organs, abdominal and thoracic mass effect, pulmonary hypoplasia, hemoperitoneum, ascites, polyhyramniosis). In the absence of accurate guidelines for management, we must start with the development of more accurate methods for diagnosing associated complications such as torsion. This case report describes the role of three-dimensional (3-D) ultrasonography as potential diagnostic method for ruling out adnexal torsion when an ovarian cyst is present.
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Reus AD, Klop-van der Aa J, Rifouna MS, Koning AHJ, Exalto N, van der Spek PJ, Steegers EAP. Early pregnancy placental bed and fetal vascular volume measurements using 3-D virtual reality. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1796-803. [PMID: 24798392 DOI: 10.1016/j.ultrasmedbio.2014.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/27/2014] [Accepted: 02/16/2014] [Indexed: 05/26/2023]
Abstract
In this study, a new 3-D Virtual Reality (3D VR) technique for examining placental and uterine vasculature was investigated. The validity of placental bed vascular volume (PBVV) and fetal vascular volume (FVV) measurements was assessed and associations of PBVV and FVV with embryonic volume, crown-rump length, fetal birth weight and maternal parity were investigated. One hundred thirty-two patients were included in this study, and measurements were performed in 100 patients. Using V-Scope software, 100 3-D Power Doppler data sets of 100 pregnancies at 12 wk of gestation were analyzed with 3D VR in the I-Space Virtual Reality system. Volume measurements were performed with semi-automatic, pre-defined parameters. The inter-observer and intra-observer agreement was excellent with all intra-class correlation coefficients >0.93. PBVVs of multiparous women were significantly larger than the PBVVs of primiparous women (p = 0.008). In this study, no other associations were found. In conclusion, V-Scope offers a reproducible method for measuring PBVV and FVV at 12 wk of gestation, although we are unsure whether the volume measured represents the true volume of the vasculature. Maternal parity influences PBVV.
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Affiliation(s)
- Averil D Reus
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Josine Klop-van der Aa
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maria S Rifouna
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Bioinformatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Bioinformatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Dueholm M, Møller C, Rydbjerg S, Hansen ES, Ørtoft G. An ultrasound algorithm for identification of endometrial cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:557-568. [PMID: 24009152 DOI: 10.1002/uog.13205] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 08/27/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To propose a scoring system to predict endometrial cancer using different ultrasound image characteristics at gray-scale, with and without enhancement by gel infusion, and Doppler transvaginal sonography (TVS) and to evaluate intra- and interobserver variability in assessment of these characteristics. METHOD Unenhanced TVS, Doppler examinations and gel infusion sonography (GIS) were performed prospectively in 174 consecutive postmenopausal women with endometrial thickness ≥ 5 mm. The reference standard in all women was hysteroscopy or hysterectomy with pathological evaluation of the malignancy. The presence of various ultrasound pattern characteristics indicative of endometrial malignancy and intra- and interobserver variability in their assessment were evaluated. Multivariate logistic regression was used to correlate image and clinical parameters to presence of endometrial cancer. RESULTS A simple Doppler flow score (which considered only presence of vascularity and not presence of single/double dominant vessel, multiple vessels, large vessels, color splash or densely packed vessels) had an area under the receiver-operating characteristics curve (AUC) of 0.83 in the prediction of endometrial cancer. Models including endometrial thickness, Doppler score and interrupted endomyometrial junction on unenhanced TVS predicted endometrial cancer with an AUC of 0.95 (95% CI, 0.92-0.99) and, with addition of irregular surface on GIS, the AUC was 0.97 (95% CI, 0.94-0.99). A risk of endometrial cancer (REC) scoring system based on body mass index, Doppler score, endometrial thickness and interrupted endomyometrial junction on unenhanced TVS and irregular surface at GIS performed very well at identifying endometrial cancer; at a REC-score of ≥ 4 the sensitivity for detection of endometrial cancer was 91% and specificity was 94%. Observers agreed in 82.3% of cases (kappa, 0.63 (0.48-0.78)) when subjective parameters were analyzed in stored videoclips. CONCLUSION Our observer-dependent proposed scoring system seems to perform well in the prediction of endometrial cancer and should be tested in future studies.
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Affiliation(s)
- M Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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De Diego R, Sabrià J, Vela A, Rodríguez D, Gómez MD. Role of 3-dimensional power Doppler sonography in differentiating pregnant women with threatened preterm labor from those with an asymptomatic short cervix. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:673-679. [PMID: 24658947 DOI: 10.7863/ultra.33.4.673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare cervical volumes and vascularization indices using 3-dimensional power Doppler sonography among singleton pregnancies with threatened preterm labor and an asymptomatic short cervix. METHODS Three hundred asymptomatic healthy pregnant women between 24 and 34.6 gestational weeks were prospectively scanned for cervical length. If cervical length was short, defined as below the 10th percentile for gestational age, the cervical volume and vascularization indices (vascularization index [VI], vascularization-flow index [VFI], and flow index [FI]) were measured. Women receiving any treatment for preterm delivery prevention were excluded. During this period, the same sonographic parameters were measured among patients with threatened preterm labor admitted to our institution during the first 24 hours after admission. Multiple pregnancies and fetal or maternal pathologic conditions, were exclusion criteria. Data on body mass index, maternal age, smoking, parity, family history of preterm birth, mother who was born preterm, and previous preterm birth among the pregnant women were recorded. Sonographic and medical history parameters were compared between the two groups. RESULTS Twenty-nine asymptomatic healthy women (9.6%) had a short cervix. Additionally, 71 pregnancies with threatened preterm labor were scanned. There were no statistically significant differences between the groups in medical history parameters or cervical length. The cervical volume was smaller in threatened preterm cases (12.90 versus 17.168 cm(3); P = .005). The VI and VFI were lower in women with an asymptomatic short cervix (VI, 4.369% versus 15.939%; P < .001; VFI, 1.514 versus 4.878; P < .001). The FI was higher in the short cervix group (33.581 versus 30.311; P = .006). CONCLUSIONS Three-dimensional transvaginal sonography reveals differences in cervical volume and vascularization indices between pregnancies with an asymptomatic short cervix and cases with threatened preterm labor, although cervical length is similar in both groups.
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Affiliation(s)
- Raül De Diego
- Department of Obstetrics and Gynecology, Sant Joan de Déu Hospital, Passeig Sant Joan de Déu 2, 08950 Esplugues, Barcelona, Spain.
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Miyague AH, Raine-Fenning NJ, Pavan TZ, Polanski LT, Baumgarten MN, Nastri CO, Martins WP. Influence of gain adjustment on 3-dimensional power Doppler indices and on spatiotemporal image correlation volumetric pulsatility indices using a flow phantom. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1831-1836. [PMID: 24065264 DOI: 10.7863/ultra.32.10.1831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Spatiotemporal image correlation can be used to acquire 3-dimensional power Doppler information across a single cardiac cycle. Assessment and comparison of the systolic and diastolic components of the data sets allow measurement of the recently introduced "volumetric pulsatility index" (vPI) through algorithms comparable with those used in 2-dimensional Doppler waveform analysis. The vPI could potentially overcome the dependency on certain machine settings, such as power, color gain, pulse repetition frequency, and attenuation, since these factors would affect the power Doppler signal equally throughout the cardiac cycle. The objective of this study was to compare the effect of color gain on the vascularization index (VI), vascularization-flow index (VFI), and vPI using an in vitro flow phantom model. We separated gains into 3 bands: -8 to -1 (no noise), -1 to +5 (low noise), and +5 to +8 (obvious noise). The vPI was determined from the 3-dimensional VI or VFI using the formula vPI = (maximum - minimum)/mean. Using no-noise gains, we observed that although the VI and VFI increased linearly with gain, the vPI was substantially less dependent on this adjustment. The VI and VFI continued to increase linearly with gain, whereas the vPI decreased slightly using low-noise gains. When gain was increased above the lower limit of obvious noise (+5), the VI and VFI increased noticeably, and there were marked reductions in both vPI values. We conclude that the vPI is less affected by changes in color gain than the VI and VFI at no-noise gains.
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Affiliation(s)
- Andre H Miyague
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes 3900, 8° Andar, Ribeirão Preto, 14049-900 São Paulo-SP, Brazil.,
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Surányi A, Kozinszky Z, Molnár A, Nyári T, Bitó T, Pál A. Placental three-dimensional power Doppler indices in mid-pregnancy and late pregnancy complicated by gestational diabetes mellitus. Prenat Diagn 2013; 33:952-8. [DOI: 10.1002/pd.4172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/23/2013] [Accepted: 05/31/2013] [Indexed: 11/10/2022]
Affiliation(s)
- A. Surányi
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - Z. Kozinszky
- Department of Obstetrics and Gynecology; Blekinge Hospital; Kvinnokliniken, Blekinge Sjukhuset 371 81 Karlskrona Sweden
| | - A. Molnár
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - T. Nyári
- Department of Medical Physics and Informatics; University of Szeged; 9, Korányi fasor H-6720 Szeged Hungary
| | - T. Bitó
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - A. Pál
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
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Ultrasonic strategies to monitor drug delivery. J Drug Deliv Sci Technol 2013. [DOI: 10.1016/s1773-2247(13)50006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Minsart AF, Ntoutoume Sima F, Vandenhoute K, Jani J, Van Pachterbeke C. Does three-dimensional power Doppler ultrasound predict histopathological findings of uterine fibroids? A preliminary study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:714-720. [PMID: 22581621 DOI: 10.1002/uog.11155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To compare three-dimensional (3D) power Doppler sonographic characteristics of fibroids with histopathological parameters. METHODS We evaluated sonographically 73 fibroids before myomectomy or hysterectomy. For each, the total fibroid volume, a shell of 3 mm and a 1-cm(3) spherical sample from the most vascularized area on subjective assessment were captured. 3D power Doppler vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were generated in the acquired volumes. The degree of cellularity, ischemic necrosis and fibrosclerosis, as well as CD31 and Ki-67 staining for vascular density and proliferation index, respectively, were estimated using the surgical sample. Pathological data were considered as dependent variables and ultrasound data as independent variables in multivariable logistic regression models including patients' characteristics. RESULTS A high histological 'cellular activity score', combining hypercellularity, a fibrosclerosis rate < 25% and positive Ki-67 staining, was statistically related in multivariate analyses to high 3D power Doppler VI in spherical samples (odds ratio (OR), 1.1 (95% CI, 1.0-1.3), P < 0.05) and VFI (OR, 1.3 (95% CI, 1.0-1.8), P < 0.05). Positive CD31 staining was statistically related to high 3D power Doppler VI in spherical samples (OR, 1.1 (95% CI, 1.0-1.3), P < 0.05). In contrast, ischemic necrosis was statistically related to low 3D power Doppler VI in the total volume (OR, 0.6 (95% CI, 0.4-1.0), P < 0.05) and VFI (OR, 0.4 (95% CI, 0.1-1.1), P < 0.05). CONCLUSION Vascular density, ischemic necrosis and histological cellular activity score are statistically significantly associated with some 3D power Doppler indices.
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Affiliation(s)
- A-F Minsart
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium.
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Welsh AW, Collins SL, Stevenson GN, Noble JA, Impey L. Inapplicability of fractional moving blood volume technique to standardize Virtual Organ Computer-aided AnaLysis indices for quantified three-dimensional power Doppler. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:688-692. [PMID: 22344971 DOI: 10.1002/uog.11139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine whether the technique of fractional moving blood volume (FMBV) is applicable to Virtual Organ Computer-aided AnaLysis II (VOCAL II™)-based indices to quantify three-dimensional power Doppler ultrasound (3D-PDU) by investigating the effect of gain level on the indices measured at a possible reference point for standardization. METHODS Ten women with singleton pregnancy between 33+3 and 37+5 weeks' gestation were recruited. The optimal position for 3D acquisition of cord insertion into the placenta was identified and static 3D-PDU volumes were acquired using consistent machine configurations. Without moving the probe or the participant changing position, successive 3D volumes were stored at -3, -5, -7 and -9 dB and at the individualized sub-noise gain (SNG) level. Volumes were excluded if flash artifact was present, in which case all five volumes were reacquired. Using 4D View software, the cord insertion was magnified and the smallest sphere possible was used to measure vascularization index (VI), flow index (FI) and vascularization flow index (VFI). The associations between VOCAL indices and gain level were assessed using Pearson's correlation coefficient. RESULTS VOCAL indices for cord insertion correlated poorly with gain level, whether fundamental or relative to SNG level (R(2) = 0.07 and 0.04, respectively). VI was consistently 100% and mean FI and VFI were 99.5 (SD, 0.57), with all values > 97 irrespective of gain level. CONCLUSIONS Whilst previous work has shown that gain correlates well with placental tissue VOCAL indices, the correlation between gain level and VOCAL indices in an area of 100% vascularity at the cord insertion is poor. Regions of 100% vascularity appear to be artificially assigned a value approaching 100% for all VOCAL indices irrespective of gain level. This precludes using the technique of VOCAL indices from large vessels to standardize power Doppler measurements and the FMBV index is therefore not applicable to image analysis using VOCAL.
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Affiliation(s)
- A W Welsh
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
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