3D Power Doppler Angiography Research Articles

Evaluation of fetal cerebral blood flow perfusion using power doppler ultrasound angiography (3D-PDA) in growth-restricted fetuses

Background: Fetal growth restriction is a common complication of pregnancy and, in severe cases, is associated with elevated rates of perinatal mortality, neonatal morbidity, and poor neurodevelopmental outcomes. Aim of the work: The main purpose of our study was to explore the potential of 3D Power Doppler Angiography to evaluate the cerebral circulation in growth restricted fetuses in pregnant women. Patients and Methods: This was a prospective cohort study; the study including 100 patients were recruited in this study and divided in to two groups, group (A) High risk group including 50 pregnant patients with IUGR and hypertension of pregnancy and group (B) control group including 50 pregnant without risk factors, The study was conducted in Al Azhar university hospital. Results: The mother age in high risk group ranged from 23 to 38 years with mean ±SD= 30.24± 5.15 years while the in control group the mother age ranged from 22 to 38 years with mean ±SD= 29.74± 4.59 years with no statistical significant difference between the two groups.

Assessment of uteroplacental vascularisation in early first-trimester pregnancy with contrast-enhanced ultrasound and 3D power Doppler angiography: protocol for a prospective, cross-sectional, multicentre and non-randomised open study (“HOPE Study”)

IntroductionKnowledge about the mechanisms leading to the establishment of uteroplacental vascularisation is inadequate, and some of what has been thought to be known for decades has recently been challenged by...

Endometrial Volume, and Sub-Endometrial Blood Flow Indices as Predictors of ICSI Success

Objective: This study designed to evaluate the endometrial volume, and the sub-endometrial flow indices as predictors of ICSI success.Study Design: Fifty infertile women included in this study, and received long pituitary downregulation protocol followed by hMG controlled hyperstimulation until ≥ 3 ovarian follicles 18-20 mm in diameter detected. Ovulation triggered by hCG, followed by oocytes retrieval 34-36 hours after hCG trigger. Day 2 or 3 embryo transfers done for all studied women, followed by quantitative β-hCG 14 days after the embryo transfers, and transvaginal sonography to diagnose clinical pregnancy. Studied women evaluated by the 3D ultrasound, and 3D power Doppler angiography at the day of the embryo transfers to assess the endometrial volume, and the sub-endometrial flow indices as predictors of the ICSI success.Results: The endometrial volume, sub-endometrial vascularization index, flow index, and vascularization flow index were higher in successful ICSI compared to unsuccessful ICSI group, but the difference was not significant. The ROC analysis showed that the endometrial volume and the 3D power Doppler angiography parameters (vascularization index, flow index, and vascularization flow index indices) were not conclusive for prediction of successful clinical pregnancy after the current ICSI trials.Conclusion: The endometrial volume and the 3D power Doppler angiography indices were not predictive for the clinical pregnancy after the current ICSI trials.

Three-Dimensional Power Doppler Angiography Improves the Diagnostic Accuracy for Malignant Uterine Body Tumor Prediction

Uterine sarcoma comprises 3–5% of all malignancies of uterine body, with a worldwide annual occurrence rate of 1.55–1.95 per 100,000 population. The advance of resolution of gray-scale ultrasonography improves its utility in the diagnosis of lesions of the uterine corpus. However, its sensitivity and specificity were poor in the diagnosis of malignant uterine body masses. Power Doppler angiography can analyze the vascular pattern of the uterine corpus lesions and further improves the diagnostic rate. With the advance of computerized imaging processing, three-dimensional (3D) power Doppler angiography was available to assist the decision making for a huge or a rapid growth uterine body lesion. Our study design was proved by institutional review board. We launched a retrospective chart review. We reviewed chart from 2002 to 2014 in a tertiary medical center in the north Taiwan to collect patient who received 3D power Doppler angiography for uterine body tumors. Reports of 3D power Doppler angiography and pathology reports were analyzed. Sensitive, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. Characters of 3D power Doppler angiography and its relationship with malignant uterine masses were also analyzed. There were 639 cases received 3D power Doppler angiography for uterine body tumors in 2002-2014. The initial reports were 285 cases had benign uterine body lesions and 101 cases had malignant uterine body lesions. 392 cases received operation such as hysterectomy or myomectomy for the uterine mass. Pathology reports showed 327 cases of benign lesions and 54 cases of malignant lesions. The sensitivity of our 3D power Doppler angiography for malignant uterine body lesions was 75.4% and specificity was 83.2%. Prevalence of malignant lesions in our study group was 15.9%. Positive predictive value was 46% and negative predictive value was 94.7% in our study group. Finally, positive likelihood ratio was 4.4 and negative likelihood ratio was 0.3. 3D power Doppler angiography is a useful tool in the screening of malignant uterine body tumors. It can exclude the patient with lower risk for malignant uterine body masses.

Three dimensional transvaginal sonography and power Doppler angiography in the differentiation between endometrial hyperplasia and endometrial carcinoma in postmenopausal women with abnormal uterine bleeding

ObjectiveThe aim of this study was to evaluate the accuracy of 3D transvaginal sonography and power Doppler in the differentiation between endometrial hyperplasia and endometrial carcinoma. Patients and methodsForty-two women suffering from abnormal uterine bleeding (AUB) were examined by 3D TV sonography and power Doppler angiography and all the sonographic findings and Doppler indices were recorded and evaluated.Lesions were then classified as benign or malignant according to imaging findings and the results were then correlated with histopathology results. ResultsSignificant improvement of the sensitivity and specificity was found in differentiating between endometrial hyperplasia and endometrial carcinoma when we combined the imaging findings of 3DTV sonography and the indices of power Doppler. ConclusionAdding power Doppler to 3D TV sonography has added value in the differentiation between endometrial carcinoma and hyperplasia.

Reproducibility of a method to evaluate the pelvic floor in normal pregnancy and puerperium using 3D ultrasound and 3D-Power Doppler angiography to assess endopelvic vascularization

Introduction and hypothesis: We tested inter/intra-observer reproducibility of ten different three-D ultrasound (3D-US) pelvic floor variables and endopelvic vascularization using 3D-power Doppler angiography (3D-PDA) as a reliable method to assess pelvic floor status during pregnancy and puerperium. We hypothesized that the method would show good reproducibility. Materials and methods: A prospective study was conducted in two university hospitals, with 162 nulliparous pregnant women evaluated at weeks 12, 28 and 36, and at 48 hours postpartum and three months post-delivery. At each visit, we performed transperineal 3D-US and 3D-PDA of the pelvic floor. Images corresponding to 30 cases were electronically sent between the 2 observers to test the reproducibility of the results. Results: Correlation coefficients > 0.70 for all 10 variables were obtained. Intra-observer reproducibility for each observer was very good, with intra-class correlation coefficients > 0.86. Inter-observer reproducibility of urethral sphincter volume and vascularization, 3D-PDA, VI, FI and VFI measured by VOCAL technique with automatic threshold mode showed good correlation (ICC > 0.80), considered sufficiently high to be clinically applicable. Conclusions: The present study showed good reproducibility and high inter- and intra-observer correlation coefficients for all the variables used to assess the pelvic floor during normal pregnancy and puerperium, including vaginal anterior wall anchors (AWA) as new biometric measures. This makes them reliable parameters for diagnosis and monitoring of pelvic floor disorders in normal pregnancies. We found that use of the VOCAL technique with automatic threshold mode for measurements was superior to the manual mode due to its accuracy and shorter time requirement.

Three-dimensional ultrasound of the female pelvic floor and 3D-power doppler angiography to assess endopelvic vascularization in pregnancy and puerperium

Introduction and hypothesis: We studied ten different three-dimensional ultrasound (3D-US) and three-dimensional Power-Doppler angiography (3D-PDA) variables to assess female pelvic floor status and endopelvic vascularization. We hypothesize that 3D-US is a reliable method to determine and evaluate changes occurring in the pelvic floor during normal pregnancy and puerperium, and can be used by any urogynecology specialist with US-imaging experience. We aimed to validate this method for clinical application. Materials and methods: We performed a prospective study of 162 nulliparous pregnant women evaluated at weeks 12, 28 and 36, and at 48 hours postpartum and three months post-delivery. At each of the five visits, we performed transperineal 3D-US of the pelvic floor and 3D-PDA to assess periurethral vascularization. Results: Quantification of the vaginal anterior vaginal wall anchors (AWA) is an anthropometric parameter sensitive to changes in pregnancy and puerperium. Significant differences in AWA were observed according to delivery mode, being lower in vaginal deliveries than cesarean sections and even lower in prolonged labor deliveries and those in which episiotomy was performed. Posterior uretrovesical angle (UVA) increased during pregnancy, partially recovering after delivery although less so in those with epidural analgesia. Urethral sphincter volume (USV) decreased significantly during labor and postpartum. Periurethral vascularization increased during pregnancy and decreased significantly after delivery. Levator hiatus area (LHA) increased during pregnancy and decreased after delivery. Patients who received epidural analgesia and oxytocin showed better LHA recovery. Prolonged labor and greater fetal head circumference increased LHA. The anorectal angle (ARA) increased during pregnancy and decreased postpartum. Conclusion: All 3D-US variables and their changes during pregnancy, childbirth and the postpartum period are measurable using the Virtual Computer-Aided Analysis (VOCAL method) with automatic threshold, which is more reliable and faster for measuring USV. AWA as an important new biometric parameter should be included in the study of the pelvic floor.

Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses.

To evaluate the contribution of three-dimensional (3D) power Doppler angiography (3D-PDA) to the differential diagnosis of adnexal masses. This was a prospective study in women diagnosed with a persistent adnexal mass and subsequently scheduled for surgery in a tertiary university hospital. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol, with transabdominal ultrasound being performed in some cases. First, morphological evaluation of the mass was performed using gray-scale 'pattern recognition' (first step). Lesions diagnosed as having a benign pattern were considered as being at low risk of malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as being at high risk of malignancy. In both cases no further test was performed and a decision regarding clinical management, either for follow-up or surgery, was taken. Tumors with solid components but without signs of ascites or carcinomatosis were considered as being at intermediate risk of malignancy. These lesions were assessed by two-dimensional (2D) PDA to evaluate tumor vascularity (color score) (second step). Solid tumors with a color score of 1 or 2 were considered as benign and no further test was performed, while tumors with a color score of 2, 3 or 4 within solid components or a color score of 3 or 4 in the case of a solid tumor were considered as malignant. The latter group underwent 3D-PDA assessment (third step). Vascularization index (VI) was calculated in a 1-mL sphere of the most vascularized area of the tumor. When a VI ≥ 24.015% was found, the tumor was considered as malignant. All masses were removed surgically and definitive histological diagnosis was used as the gold standard. Sensitivity and specificity for each strategy were calculated and compared. In the case of bilateral tumors, only the more suspicious one was used for analysis. A total of 367 adnexal masses diagnosed in 367 women (mean age, 46.5 (range, 18-80) years) were evaluated during the study period. Of these, 86 masses were malignant and 281 were benign. The sensitivity and specificity for each assessment strategy were as follows: one-step, 97.7% and 78.6%; two-step, 94.2% and 97.9% (P < 0.001 for specificity when compared with that of one-step); three-step, 90.7% and 98.9% (not statistically significant when compared with that of two-step). The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.

Assessment of endometrial and subendometrial blood flow in women undergoing frozen embryo transfer cycles

This study evaluated whether 3D power Doppler (3DPD) indices from endometrium and subendometrium can identify increases in endometrial volume/vascularity induced by exogenous oestradiol and subsequent introduction of progestogens in women undergoing frozen–thawed embryo transfer (FET). Oral oestradiol was administered at increasing doses after down-regulation to prepare the endometrium and progestogens were used for luteal support. 3DPD data sets were acquired at down-regulation, on days 5, 10 and 15 of oestradiol administration and at the time of FET. Endometrial thickness was measured using the multiplanar method and endometrial volume and blood flow from the endometrium and subendometrium were estimated using virtual organ computer-aided analysis and shell-imaging. This study evaluated 45 women at least once: 19 achieved clinical pregnancy (CP); 21 were evaluated at down-regulation (eight CP), 26 at day 5 (10 CP), 31 at day 10 (12 CP), 31 at day 15 (13 CP) and 16 at FET (seven CP). Changes were observed in all parameters between the examinations; however, differences between women who achieved CP and those who did not were not significant. 3DPD angiography is not a sufficiently sensitive tool to predict the outcome of FET.We evaluate whether 3D ultrasound using power Doppler (3DPD) indices from endometrium and subendometrium can identify predictable increases in endometrial volume and vascularity induced by serial increments in exogenous oestradiol and the subsequent introduction of progestogens in women undergoing frozen–thawed embryo transfer (FET) using hormone replacement therapy to prepare the endometrium. Oral oestradiol was administered at increasing doses after down-regulation to prepare the endometrium and progestogens were used for luteal support. 3DPD data sets of the uterus were acquired at down-regulation, on days 5, 10, and 15 of oestradiol administration, and at the time of FET. Endometrial thickness was measured. Endometrial volume and blood flow from the endometrium and subendometrium were measured using virtual organ computer-aided analysis (VOCAL) and shell imaging. This study evaluated 45 women at least once: 19 achieved clinical pregnancy (CP); 21 were evaluated at down-regulation (eight CP), 26 at day 5 (10 CP), 31 at day 10 (12 CP), 31 at day 15 (13 CP) and 16 at FET (seven CP). Changes were observed in all the parameters between the examinations; however, differences between women who achieved CP and those who did not were not significant, suggesting that quantitative 3D power Doppler angiography is not a sufficiently sensitive tool to predict the outcome of FET treatment.

Ovarian vascularization analyzed by 3D power Doppler angiography ultrasound predicts the number of mature oocytes in poor responder patients

To evaluate the predictive ability of Doppler Angiography (3D-PDA) performed the day of hCG administration in the number of mature oocytes collected. Prospective clinical trial. We include for the study a group of very low responders stimulated for IVF in our institution from Janury 2012 and April 2013. All patients fulfilled Bolonia Criteria and received conventional controlled ovarian stimulation with standard dose of gonadotropins (300 UI/day) using agonist down regulation or antagonist protocol. Ultrasound exploration was performed the day of hCG triggering. Virtual organ computer-aided analysis (VOCAL) was used to calculate volume of interest (ovary), after that, angiopower Doppler signal within this volume was quantified. Ovarian vascularity was measured by 3D-PDA indexes (vascularization index (VI), flow index (FI), and vascularization flow index (VFI)). Univariate analysis was performed by a Spearman correlation establishing potential confounders. We performed a multiple linear regression adjusting for confounding variables. 33 patients were included. The median age was 37,23 (SD 1,6). An average of 3,64(SD = 1.97) oocytes and 2.61(SD = 2.13) mature oocytes were obtained. No predictive relationship was established between the number of oocytes and ovarian vascularization. Number of mature oocytes retrieved was significantly correlated to 3D-PD indexes.(VI: r = 0.876, r (2) = 0.751, FI: r = 0.854, r (2) = 0.711; VFI, r = 0.878, r (2) = 0.756). This corelation was significant regardless the number of dominant follicles. Ovarian vascularization analyzed by 3D-PDA is a useful tool to predict the number of mature oocytes that we can retrieve in poor responder patients. The decision to cancel or go ahead with the oocyte collection depends on the number of mature eggs expected in patients with a very low ovarian response to stimulation and 3D-PDA could be a helping biomarker in the decision making process.

Three‐dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding

The aim of this study was to evaluate the efficacy of 3D power Doppler angiography (3D-PDA) for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding (PMB). One-hundred and fifty women with PMB and an endometrial thickness (ET) of ≥4 mm on 2D sonography were assessed by 3D-PDA before endometrial sampling to obtain definitive histological diagnosis of endometrial pathology. Endometrial volume (EV), vascularity index (VI), flow index (FI) and vascularity-flow index (VFI) were calculated by computer-aided analysis. Of the 150 women, 114 (76%) had benign endometrial lesions and 36 (24%) had endometrial carcinoma. Patients with endometrial carcinoma had significantly thicker endometrium (15.8 ± 7.7 vs 9.9 ± 5.9 mm; P < 0.001), larger EV (9.1 ± 4.7 vs 2.6 ± 3.5 mL, P < 0.001) and higher 3D-PDA indices (P < 0.001) than patients with benign endometrial lesions. The best variable for distinguishing between benign and malignant endometrium was VI, with an area under the receiver operating characteristic curve (AUC) of 0.86. In contrast, the ET had an AUC of only 0.62. The best-fit logistic regression model for the diagnosis malignancy contained only VI as an independent factor (P = 0.002). 3D-PDA measurements may be useful for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding.

Three-Dimensional Angioultrasonography for the Prediction of Malignancy in Ovarian Masses

Objective: To determine the efficacy of the angiographic indexes of 3D power Doppler angiography (3D-PDA) for the diagnosis of malignancy in complex ovarian masses. Methods: A prospective, observational study of 72 patients with complex adnexal mass. Results: In the morphological study, 3D ultrasound showed sensitivity, specificity, PPV, NPV, PLHR and NLHR of 84.6%, 81.9%, 85.1%, 81.8%, 4.65 and 0.19. No differences in vascular indexes (VI, FI, VFI) between malignant and benign masses were found: VI 5.38 (CI 95% 3.06-7.7) vs. 6.29 (CI 95% 4.41-8.17) (p = 0.53); FI 29.6 (CI 95% 25.17-34.08) vs. 33.8 (CI 95% 30.03-37.3) (p = 0.15); VFI 1.68 (CI 95% 0.94-2.42) vs. 2.37 (CI 95% 1.49-3.25) (p = 0.24). When analysed according to different stages, VI was higher in patients with more advanced stages of disease; 4.34 (95% CI 2.21-6.47) vs. 7.38 (95% CI 4.7-10.06) (p = 0.11). FI was significantly lower in patients with early stages of disease; FI 29.07 (95% CI 21.49-36.68) vs. 36.46 (95% CI 32.31-40.62) (p = 0.04). For VFI, differences were not significant, although there was a strong trend; VFI 1.47 (95% CI 0.67-2.28) vs. 2.86 (95% CI 1.57-4.16) (p = 0.11). 3D-PDA indexes were significantly higher in patients with positive adenopathies. Conclusion: 3D-PDA values increase progressively, but not significantly, with the stage of the disease.

OP33.08: Evaluation of fetal cerebral blood perfusion using power Doppler ultrasound angiography (3D‐PDA) in normal and growth‐restricted fetuses (IUGR)

The aim of the present study was to explore the possible use of 3D Power Doppler Angiography (3D PDA) using VOCALTM software (GE Healthcare, USA) assessing different fetal cerebral regions in normal and growth restricted fetuses (IUGR). 77 AGA and 55 IUGR (24–36 ws gestation). IUGR were divided in 3 groups: group 1 (n = 28): Late onset IUGR (> 34 ws) with normal bidimensional Doppler flow analysis, group 2 (n = 11): early onset IUGR (< 34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), normal middle cerebral artery (MCA) PI and normal ductus venosus (DV) PI, group 3 (n = 16): early onset IUGR (< 34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), abnormal MCA PI and pathological DV PI. Two regions of interest (ROI) were defined within the fetal brain. The first ROI (zone 1) is anterior respect the cavum septi pellucidi (CSP). The second ROI (zone 2) is obtained tracing a contour between the temporal bones as wide as the CSP. 3D-PDA vascular indexes (VI = vascularization, FI = flow, VFI = vascularization and flow) were determined in both areas for both AGA and IUGR fetuses by one operator. VFI values demonstrated increased blood flow in frontal zone compared to control group (AGA) in “early onset IUGR” (in both groups 2–3 with and without abnormal 2D MCA findings). VI and VFI values demonstrated increased blood flow in frontal zone and decreased blood flow in temporal zone compared to control group (AGA) in “late onset IUGR” with preferential increment in bloody supply to the frontal region to protect general cognitive functions. 3DPDA analysis could be considered a valid method to identify earlier vascular redistribution in IUGR fetuses comparing to 2D velocimetry. 3DPDA could become an additional parameter to adjust the monitoring intervals in the evaluation of high risk fetuses.

OP33.09: The effect of maternal vitamin D concentration on fetal bone

Objectives: The aim of the present study was to explore the possible use of 3D Power Doppler Angiography (3D PDA) using VOCALTM software (GE Healthcare, USA) assessing different fetal cerebral regions in normal and growth restricted fetuses (IUGR). Methods: 77 AGA and 55 IUGR (24–36 ws gestation). IUGR were divided in 3 groups: group 1 (n = 28): Late onset IUGR (>34 ws) with normal bidimensional Doppler flow analysis, group 2 (n = 11): early onset IUGR (<34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), normal middle cerebral artery (MCA) PI and normal ductus venosus (DV) PI, group 3 (n = 16): early onset IUGR (<34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), abnormal MCA PI and pathological DV PI. Two regions of interest (ROI) were defined within the fetal brain. The first ROI (zone 1) is anterior respect the cavum septi pellucidi (CSP). The second ROI (zone 2) is obtained tracing a contour between the temporal bones as wide as the CSP. 3D-PDA vascular indexes (VI = vascularization, FI = flow, VFI = vascularization and flow) were determined in both areas for both AGA and IUGR fetuses by one operator. Results: VFI values demonstrated increased blood flow in frontal zone compared to control group (AGA) in ‘‘early onset IUGR’’ (in both groups 2–3 with and without abnormal 2D MCA findings). VI and VFI values demonstrated increased blood flow in frontal zone and decreased blood flow in temporal zone compared to control group (AGA) in ‘‘late onset IUGR’’ with preferential increment in bloody supply to the frontal region to protect general cognitive functions. Conclusions: 3DPDA analysis could be considered a valid method to identify earlier vascular redistribution in IUGR fetuses comparing to 2D velocimetry. 3DPDA could become an additional parameter to adjust the monitoring intervals in the evaluation of high risk fetuses.

Quantification of utero-placental vascularization in a rabbit model of IUGR with three-dimensional power Doppler angiography

ObjectivesOur objective was to evaluate the 3D power Doppler angiography (PDA) in terms of feasibility and ability to detect placental hypo-perfusion in an experimental rabbit model of intrauterine growth restriction (IUGR). Study design14 pregnant females were treated with NG-nitro-L-arginine methylester (L-NAME), a nitric oxide synthase inhibitor, from day 24 to day 28 of gestation, to induce an IUGR. Concomitantly, 8 pregnant rabbits were used as controls. On day 28, 3D power Doppler indices were quantified in each utero-placental unit. Morphological examination of the placentas for the control group (n = 4) and the L-NAME group (500 mg/day, n = 4) were performed with immunohistochemical staining to discriminate the fetal capillaries in the labyrinthine area. ResultsA total of 180 live fetuses were obtained, 108 from the L-NAME group and 72 from the control group. G28 fetal weight was significantly lower in the L-NAME group than in the control group (27.40 ± 0.55 g vs 33.14 ± 0.62 g, p < 0.0001). In the L-NAME group the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were significantly lower than in the control group (2.6 [1.4; 6.0] vs 7.6 [3.5; 12.6], p < 0.05; 28.7 [26.5; 31.3] vs 32.9 [28.3; 38.1], p < 0.05; 0.8 [0.4; 1.8] vs 2.5 [1.1; 4.1], p < 0.05, for VI, FI and VFI, respectively). Morphological examinations revealed a substantial disorganization of the placental vascular architecture in the L-NAME group. ConclusionThis experimental study demonstrates that quantitative 3D PDA indices are sensitive enough to detect placental vascular insufficiency in an experimental rabbit model of IUGR.

Assessment of endometrial volume and vascularization using transvaginal 3D power Doppler angiography in women with postmenopausal bleeding

ObjectiveTo compare the usefulness of 3D power Doppler angiography (3D-PDA) and endometrial thickness measurement by 2D Doppler ultrasound in the distinction of benign from malignant disease in postmenopausal women with abnormal uterine bleeding (AUB) and an endometrial thickness greater than 4.5mm. MethodsForty-eight women with AUB and an endometrial thickness greater than 4.5mm on 2D ultrasound underwent 3D-PDA. The endometrium and a 5-mm subendometrial “shell” were evaluated at rotation angles of 9° and 30°. Endometrial volume, vascularity index, flow index, and vascularization flow index were obtained. ResultsThe histologic findings were normal or benign for 38 women (79%) and malignant for 10 (21%). All vascular indices were significantly higher in the group with malignancies except for the vascularization flow index. There were no differences in the values obtained using the 9° or the 30° angle. Receiver-operating characteristics curves were traced for all indices. The vascularity index had the best area under the curve (0.78), 77.8% sensitivity, and 82.6% specificity. The areas under the curve were smaller for the shell than for the endometrium. Conclusion3D-PDA was not found better than 2D ultrasound at distinguishing benign from malignant disease in women with AUB and an endometrial thickness greater than 4.5mm.

OS047. Quantification of placental vascularization in a rabbit model ofIUGR with three-dimensional power doppler angiography

Placental dysfunction is known to be a major cause of pregnancy complications, such as perinatal loss, preeclampsia, and intrauterine growth restriction (IUGR). Inadequate remodeling of the spiral arteries resulting in decreased blood flowto the placenta has been implicated in the pathophysiology of preeclampsia and IUGR. 3D power Doppler angiography (PDA) is a noninvasive and safe way to study blood flow within an organ or region of interest. The aim of this study was to evaluate PDA as a method to quantify placental perfusion in a pharmacological rabbit model of vascular IUGR induced by inhibition of NO synthesis. Our objective was to evaluate the 3D power Doppler angiography (PDA) in terms of feasibility and ability to detect placental hypo-perfusion in an experimental rabbit model of intrauterine growth restriction (IUGR). Fourteen pregnant females were treated with NG-nitro-L-arginine methylester (L-NAME), a nitric oxide synthase inhibitor, from day 24 to day 28 of gestation, to induce an IUGR. Concomitantly, 8 pregnant rabbits were used as controls. On day 28, 3D power Doppler indices were quantified in each uteroplacental unit. A total number of 180 live fetuses were obtained, 180 from the L-NAME group and 72 from the control group. G28 fetal weight was significantly lower in the L-NAME group than in the control group (27.40±0.55g vs 33.14±0.62g,p<0.0001). In the L-Name group the vascularization index (VI) was significantly lower than in the control group (2.6 [1.4;6.0] vs 7.6 [3.5;12.6],p<0.05). Similar results were obtained for the Flow Index (FI) and the Vascularization Flow Index (VFI). The number of fetuses considered as small for gestational age (SGA;weight<10th centile) was significantly higher in the L-NAME group than in the control group (47/108 vs 7/72,p<0.0001). The VI was significantly lower in the SGA group than in the eutrophic group (3.46 [0.46;5.9] vs 7.50 [4.22;10.9] p<0.05). Similar results were obtained for FI and VFI. This experiment study demonstrates that quantitative 3D PDA indices are sensitive enough to detect placental vascular insufficiency in an experimental model of IUGR.

Dynamique de l’index de vascularisation et de flux dans la phase préovulatoire de l’hyperstimulation ovarienne contrôlée. Relation avec le taux de conception

ObjectivesTo study the evolution of subendometrial vascularization flow index (VFI) in controlled ovarian hyperstimulation (COH+IIU) cycles and compare its dynamic changes in pregnant and non pregnant women. Patients and methodsThis is a retrospective study on 61 couples. To determine the profile of IVF just before ovulation, patients had 3D-Power Doppler angiography (3D-PDA) in this precise preovulatory phase. ResultsWe observed a decreasing profile of VFI in 52% (32/61) of the main group cycles, in 45% (14/31) of the subgroup with spontaneous peak of LH (luteinizing hormone), and in 60% (18/30) of the hCG (human chorionic gonadotropin) trigger subgroup. There were ten conceptions, (10/61, 16.4%), including eight (8/32, 30%) that were associated with a decreasing profile of VFI versus two (2/29, 7%) that were associated with an increasing profile (NS). In the detection of LH peak subgroup, we observed five conceptions (5/14, 36%) associated with a decreasing profile versus one conception (1/17, 6%) associated with an increasing profile of VFI (OR: 8.3; confidence interval [CI] 95%: 0.8–444; P=0.06 in favor of a of decreasing VFI profile). In the hCG subgroup, there were three conceptions in the decreasing VFI profile (3/18, 17%) and one conception with increasing VFI (1/12, 17%, P=0.6). Discussion and conclusionIn controlled ovarian hyperstimulation, a decreasing VFI profile is more common compared to an increasing one. Such au profile seems to be associated with a higher conception rate in cycles with spontaneous LH surge.

OP36.09: Changes in amniotic fluid and umbilical cord serum proteomic profiles in fetuses with intrauterine growth restriction and Doppler velicimetry abnormalities

Objectives: The aim of this study is to evaluate three dimensional cerebroplacental ratio (CPR 3D) using 3D power Doppler angiography (3D PDA) in the intrauterine monitoring of the growth restricted fetuses (IUGR). Methods: Cerebroplacental ratio (CPR), the ratio between PI of MCA and PI of umbilical artery (UA), is a better predictor for adverse outcome than a single vessel considered alone. We defined CPR 3DPDA as the ratio between vascular indices of a region of fetal brain (ROI) and the vascular indices of the placenta using 3DPDA methodology. The ROI evaluated were a ‘frontal zone’, sprinkled mainly by anterior cerebral artery, obtained tracing a contour passing through the anterior side of cavum septum pellucido (CSP) surrounding part of temporal and frontal bone. Then a second ROI obtained tracing a contour from temporal bones of the width of CSP included (’temporal zone’) sprinkled by middle cerebral artery MCA. We considered 3DPDA vascular indexes (VI = vascularisation FI = flow, VFI = vascularisation and flow). We enrolled 33 IUGR fetuses and 81 adeguate for gestational age, as control cases (24–38 weeks). IUGR fetuses were divided into 2 groups: group 1, IUGR with normal flussimetry of umbilical artery (UA) and MCA; group 2, IUGR with abnormal UA-PI (mean > 2 SD) and abnormal MCA-PI (PI < 2 SD). We calculated the 2D CPR and the CPR 3D of the frontal and temporal cerebral zones for all vascular indexes. Results: Values of 2D CPR were in accordance with the expected ones. CPR 3D, applying VI and VFI, both in frontal and temporal zone demonstrated a statistically significant different values compared with control cases. Conclusions: CPR 3D can be considered a new parameter: it demonstrates the vascular redistribution in frontal and temporal zones during the ‘brain sparing effect’ in IUGR fetuses also in the group of IUGR fetuses without bidimensional pathological flussimetry.

A comparison of endometrial and subendometrial vascularity assessed by three-dimensional ultrasonography and power Doppler angiography between healthy fertile women and women with unexplained primary recurrent miscarriage

We compared the characteristics of endometrial-subendometrial vascularity 7 days after ovulation of a natural cycle by transvaginal three-dimensional ultrasonography and power Doppler angiography between 88 patients with unexplained recurrent miscarriage and 46 healthy fertile women. Endometrial vascularization index, flow index, and vascularization flow index, as well as subendometrial vascularization index and vascularization flow index, were reduced significantly in the group with unexplained recurrent miscarriage.