Abstract
Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.
Highlights
Two- and three-dimensional ultrasounds (2D US and 3D US, respectively) have been well adopted for structural and functional assessments of the fetus, the umbilical cord and placenta, and the cervix during pregnancy [1]
Color Doppler (CD), power Doppler (PD), and high-definition flow (HDF) display flow data superimposed on a B-mode image
307 were found to address our objectives. Those studies had a broad range of study methodologies, indications, and technical perspectives of prenatal 3D power Doppler (3D PD)
Summary
Two- and three-dimensional ultrasounds (2D US and 3D US, respectively) have been well adopted for structural and functional assessments of the fetus, the umbilical cord and placenta, and the cervix during pregnancy [1]. Tomographic ultrasound imaging is useful for the 3D US display of the fetal brain. Color Doppler (CD), power Doppler (PD), and high-definition flow (HDF) display flow data superimposed on a B-mode image. They are less accurate than angiography because (1) CD and PD exaggerate the size of vessels, and (2) Doppler flow detection is obscured by the grey-scale signal of the overlying tissue [3]. Computed tomographic angiography and magnetic resonance angiography can reconstruct the courses of vessels in three orthogonal planes. The motion artifacts that are universally found in computerized tomography and magnetic resonance images of smaller vessels limit their use during the first trimester of pregnancy [5,6]
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