MV-Flow and LumiFlow: new Doppler tools for the visualization of fetal blood vessels

Immediate Effect of Electro-acupuncture on Endometrial Blood Flow in Patients with Recurrent Implantation Failure: A Randomized Controlled Trial

OBJECTIVE

To investigate the immediate effects of electro-acupuncture (EA) on endometrial blood flow among recurrent implantation failure (RIF) patients.

METHODS

Eighty RIF patients, enrolled from March 2022 to December 2022, were randomly allocated into either the EA group (40 cases) or the waiting-list (WL) group (40 cases) by using a random number table. The EA group underwent acupuncture at points of Shenting (GV 24), Baihui (GV 4), Benshen (GB 13), bilateral Zigong (EX-CA 1), Huangshu (KI 16), Sanyinjiao (SP 6) and Xuehai (SP10), and electric acupuncture apparatus was connected to EX-CA 1, KI 16, SP 6, and SP 10 with disperse-dense waves at 4/20 Hz frequencies for 30 min after transvaginal ultrasound, while the WL group received no intervention. The primary outcome measured was the endometrial volume blood flow. The secondary outcomes included the bilateral uterine artery index, endometrial volume, endometrial blood flow type, vascular distribution index (VIMV) for endometrial and ovary, clinical pregnancy rate, and embryo implantation rate.

RESULTS

In the EA group, there was a notable decrease in the bilateral pulsatility index and a significant improvement in the endometrial blood flow type post-EA (P<0.05). Both the endometrial blood flow type and VIMV for the endometrium and right ovary were markedly higher in the EA group compared to the WL group post-treatment (P<0.05). Conversely, no significant disparities were observed in vascular index, flow index, vascular blood flow index, uterine arterial blood flow indices, endometrial volume, clinical pregnancy rate and embryo implantation rate between the two groups after treatment (P>0.05). Besides, no adverse events related to EA were observed.

CONCLUSIONS

EA can promptly ameliorate VIMV for the endometrial and right ovary, and endometrial blood flow type. Future randomized controlled trials are warranted to investigate the long-term effects of EA on blood flow of RIF patients and its implications for pregnancy outcomes. (Trial registration No. ChiCTR2200057377).

Visualisation of microvascular flow in benign uterine disorders: a pilot study of a new diagnostic technique

BACKGROUND

Uterine disorders have clear overlapping symptoms and ultrasound discrimination is not always easy. Accurately measuring vascularity is of diagnostic and prognostic value. Power Doppler is limited to imaging only the larger vessels. Assessment of the microvasculature requires advanced machine settings.

OBJECTIVES

In this pilot study, we aimed to test the feasibility of microvascular flow imaging of benign uterine disorders.

MATERIAL AND METHODS

Two experienced gynaecologists (JH, RL) randomly applied power Doppler and MV-flowTM mode during a single day, in ten patients each visiting the outpatient clinic. Images of eight patients were labelled with a diagnosis by the attending physicians and collected as coded data.

MAIN OUTCOME MEASURES

Microvascular flow images of normal uterine architecture including the fallopian tube, and of benign disorders such as fibroids, adenomyosis, endometriosis and uterine niches were collected. For both Doppler techniques, qualitative descriptive evaluation of the vascular architecture and a quantitative vascular index of fibroids were provided. Finally, we evaluated the effect of the cardiac cycle.

RESULTS

All microvascular flow images showed more distinctive vascular structures than visible on power Doppler. Calculating a vascular index for fibroids on 2D MV-flowTM images was easily performed on-site. During the cardiac cycle a higher vascular index (VI 75.2) is obtained in systole as compared with diastole (VI 44.0).

CONCLUSION

Microvascular flow imaging allowed detailed visualisation of the uterine vascular architecture and is easy to use.

WHAT IS NEW?

Microvascular flow imaging may be of added value for diagnosing uterine disorders, as well as for pre- and post-operative assessment of suited surgical techniques. Yet, validation with histology and clinical outcomes is required.

Use of new microcirculation software allows the demonstration of dermis vascularization

AIMS

Current ultrasound (US) Doppler techniques cannot demonstrate the vascularization of the dermis. The purpose of this study was to investigate whether the new Superb Vascular Imaging (SMI) and Microvascular Flow (MV-Flow) techniques improve the detection of normal dermis vessels. SMI and MV-Flow were compared side-by-side to conventional power-Doppler (PD) imaging.

METHODS

By using US, 50 healthy volunteers were evaluated at level of five body areas: forehead, forearm, palm, buttock, and thigh. Two off-site operators evaluated the images to assess the difference between SMI and PD imaging and between MV-Flow and PD imaging in terms of dermis flow amount. A 0-3 scoring system was adopted.

RESULTS

SMI scored grade 0 in 0% of body areas, grade 1 in 58%, grade 2 in 33%, and grade 3 in 9%. In comparison with SMI, PD scored grade 0 in 38% of body areas, grade 1 in 56%, grade 2 in 6%, and grade 3 in 0%. MV-Flow scored grade 0 in 0% of body areas, grade 1 in 52%, grade 2 in 43%, and grade 3 in 6%. Comparted to MV-Flow, PD scored grade 0 in 53% of body areas, grade 1 in 34%, grade 2 in 13%, and grade 3 in 0%. The difference in terms of sensitivity was statistically significant for all the body areas investigated.

CONCLUSIONS

We found both SMI and MV-Flow to be superior to PD imaging and capable to demonstrate normal vascularization of the dermis.

Microvascular Flow Imaging: A State-of-the-Art Review of Clinical Use and Promise

Vascular imaging with color and power Doppler is a useful tool in the assessment of various disease processes. Assessment of blood flow, from infarction and ischemia to hyperemia, in organs, neoplasms, and vessels, is used in nearly every US investigation. Recent developments in this area are sensitive to small-vessel low velocity flow without use of intravenous contrast agents, known as microvascular flow imaging (MVFI). MVFI is more sensitive in detection of small vessels than color, power, and spectral Doppler, reducing the need for follow-up contrast-enhanced US (CEUS), CT, and MRI, except when arterial and venous wash-in and washout characteristics would be helpful in diagnosis. Varying clinical applications of MVFI are reviewed in adult and pediatric populations, including its technical underpinnings. MVFI shows promise in assessment of several conditions including benign and malignant lesions in the liver and kidney, acute pathologic abnormalities in the gallbladder and testes, and superficial lymph nodes. Future potential of MVFI in different conditions (eg, endovascular repair) is discussed. Finally, clinical cases in which MVFI correlated and potentially obviated additional CEUS, CT, or MRI are shown.

Achados de ressonância magnética de encéfalo neonatal: correlação com fatores de risco pré-natais e ultrassonografia transfontanelar

Resumo Objetivo: Avaliar alterações encontradas nas ressonâncias magnéticas (RMs) encefálicas neonatais, correlacionando com a ultrassonografia transfontanelar (USTF), e descrever os principais fatores de risco encontrados. Materiais e Métodos: Foram avaliados exames de 51 pacientes que realizaram RM utilizando protocolo neonatal durante internação hospitalar, correlacionando com resultados da USTF prévia, sendo utilizada, para minimizar as chances de viés, a última USTF realizada. Os dados foram obtidos de prontuário médico e as imagens foram revisadas por médico radiologista especialista em neuroimagem. Resultados: A população foi composta majoritariamente de recém-nascidos prematuros extremos (21; 41,2%) e de extremo baixo peso (22; 43,1%). Foram encontradas alterações em 16 (31,4%) das USTFs e em 30 (58,8%) das RMs, sendo a hemorragia da matriz germinativa o achado mais frequente. Os valores preditivos positivo e negativo da USTF em relação à RM foram de 87% e 54%, respectivamente. Conclusão: A USTF mostrou-se importante na distinção entre os graus de hemorragia da matriz germinativa leve e moderada (I e II) dos graus acentuados (III e IV), sendo considerada um bom exame de rastreio e acompanhamento, principalmente em pacientes mais graves e com fatores de risco.

Alterations on magnetic resonance imaging of the neonatal brain: correlations with prenatal risk factors and transfontanellar ultrasound findings

Abstract Objective: To describe the alterations seen on magnetic resonance imaging (MRI) of the brain in newborns, correlating those alterations with the transfontanellar ultrasound (TFUS) findings, and to describe the main risk factors identified. Materials and Methods: We evaluated the examinations of 51 patients who were submitted to brain MRI with a neonatal protocol during hospitalization. We evaluated the MRI findings and correlated them with previous TFUS findings, using the last TFUS performed in order to minimize the risk of bias. Data were obtained from medical records, and the images were reviewed by a radiologist specializing in neuroimaging. Results: Of the 51 patients evaluated, 21 (41.2%) were extremely preterm infants and 22 (43.1%) were extremely-low-birth-weight infants. Alterations were seen on 16 (31.4%) of the TFUS examinations and on 30 (58.8%) of the brain MRI scans, the most common finding being germinal matrix hemorrhage. The positive and negative predictive values of TFUS in relation to MRI were 87% and 54%, respectively. Conclusion: Because TFUS proved to be capable of distinguishing mild and moderate (grade I and II) germinal matrix hemorrhage from the severe forms (grades III and IV), it can be considered a good tool for screening and follow-up, especially in infants with severe disease and risk factors.