3D Power Doppler Angiography Research Articles

OP10.08: Evaluation of the reliability of data acquisition for 3D ultrasound and power Doppler angiography of the whole placenta at 12 and 20 weeks gestation

Objectives: 3D power Doppler angiography (3DPD) is used to quantify the vascularity of an organ. Analysis of a stored dataset can be reliable but few studies have considered the reliability of data acquisition. Our aim was to investigate the intraand interobserver reproducibility of serial acquisition of 3DPD data of the whole placenta from women at 12 and 20 weeks gestation. We hypothesised a high level of agreement would exist. Methods: 20 low risk women with an uncomplicated, viable singleton pregnancy were scanned (Voluson 730 Expert) at two gestational age groups: 12+0 to 13+6 and 19+0 to 21+6 weeks. 3DPD whole placental datasets were acquired by two observers: the 1st made two acquisitions and the 2nd a single acquisition resulting in 3 datasets per patient and 120 overall. These were analysed by a single observer who used VOCAL (A plane, 9 degree steps) to define the VI, FI and VFI. The reliability of these measurements was assessed by intraclass correlation coefficients (ICC + 95% CI) and Bland-Altman plots. The presence of systematic bias within and between observers was also analysed. Results: Mean BMI was 24 (SD 5) in each group. Interobserver ICC was highest for the VI 0.81 (0.59–0.92) and VFI 0.76 (0.48–0.90). ICC for FI showed only moderate correlation at 0.55 (0.18–0.79). Bland Altman plots showed the FI to be the most reliable vascular index however at ±15% (expressed as a % of the mean) and ±17% at 12 weeks and ±9% and ±10% at 20 weeks for intraobserver and interobserver differences respectively. Intraand inter-observer differences were greater for VI at ±40% and ±70% respectively at 20 weeks. There was no bias between datasets. Conclusions: This study demonstrates that 3D can be used to reliably acquire power Doppler data from the whole placenta at 12 and 20 weeks gestation. Previous studies had only addressed the reliability of data analysis. Prospective studies are now required to identify if 3DPD is sensitive enough to identify patients with early-onset placental dysfunction.

OP39.03: A new proposal of sonobiopsy of fetal brain using 3D power Doppler angiography (VOCAL) in normal and growth restricted fetuses

OP39.03: A new proposal of sonobiopsy of fetal brain using 3D power Doppler angiography (VOCAL) in normal and growth restricted fetuses

OP10.01: In vitro perfusion of placental lobules to investigate a relationship between erythrocyte concentration and quantitative 3D power Doppler angiography

OP10.01: In vitro perfusion of placental lobules to investigate a relationship between erythrocyte concentration and quantitative 3D power Doppler angiography

Endometrial/subendometrial blood flow indexes measured by 3D power Doppler angiography and inherited thrombophilia and in vitro fertilization outcome

OBJECTIVE: Endometrial and subendometrial blood flow is involved in embryo implantation.We have investigated the role of inherited thrombophilia in impairing endometrial and subendometrial blood flows during IVF. DESIGN: Prospective, nonrandomized clinical study. MATERIALS AND METHODS: 85 thrombophilic and 50 non-thrombophilic women were included and tested for inherited thrombophilia,including:FV Leiden,MTHFR–CT/-AC, PAI1,HPA1,FII,FXIII, FBG,APOE, PROTEIN C,PROTEIN S.Serial 3D ultrasound scans and power Doppler angiography (PDA) were performed during controlled ovarian hyperstimulation (COH) to measure endometrial and subendometrial blood flow transvaginally monitored by a GE 730Voluson machine.The stored volumes were off line analyzed considering as region of interest the 2mm uterine tissue surrounding endometrium.Endometrial pattern,thickness ,and volume,and PDA indexes of vascularization were calculated on the day of HCG administartion.These measurements were related to embryo implantation.COH was induced by long or short protocol + rFSH.Statistical analysis was performed using the SPSS® software package(SPSS Inc., Chicago, Il, USA). RESULTS: Women affected by inherited thrombophilia showed a marked reduction in vascularization flow indexes compared to the normal ones. In the non-thrombophilic group the all PDA parameters were statistically significantly higher. The number of high grade transferred embryos did not affected implantation/pregnancy rates.Blood flow restrictions appeared to be mostly related to some mutations.Homozigous state worsened the situation.In such women we obtained a very low implantation rate 15% vs 32.8%. CONCLUSION: Endometrial and subendometrial blood flow by 3D power Doppler is a useful tool to evaluate angiogenesis during COH and has been related to IVF outcome.To the best of our knowledge this is the first report regarding inherited thrombophilia and endometrial and subendometrial blood flow indexes.Endometrial and subendometrial blood flow seems to be related to implantation/pregnancy rates.

Changes in perifollicular vascularity after administration of human chorionic gonadotropin measured by quantitative three-dimensional power Doppler ultrasound

To determine the perifollicular vascular network and blood flow changes of the dominant preovulatory follicle using quantitative three-dimensional (3D) power Doppler analysis. A total of 21 cycles were studied in spontaneously ovulating women who underwent folliculometry and 3D power Doppler angiography of perifollicular blood flow of the dominant preovulatory follicle on the day of human chorionic gonadotropin (hCG) administration and 24 h after it. At 24 h after the administration of hCG, increases were found in the area inside the biggest follicular circumference (8.48 +/- 1.73 cm(2) vs. 9.30 +/- 1.64 cm(2)), in the percentage of vessel volume inside the perifollicular capsule (3.58 +/- 3.65% vs. 7.76 +/- 10.13%) and in total perifollicular blood volume (931.33 +/- 1084.60 vs. 3486.00 +/- 7272.34). Moreover, the rearrangement in blood volume distribution resulted in equalization of the contribution of each feeding vessel to total perifollicular blood flow. A more uniform vascular network resulting in decreased dominance of a single feeding vessel in total inflow was found (50.50 +/- 28.18% vs. 29.05 +/- 14.14%). After the administration of hCG there was a visible increase in perifollicular capillary network volume, relative volume of blood, and balancing of blood inflow of each feeding vessel of the perifollicular circulation.

Does sphere volume affect the performance of three‐dimensional power Doppler virtual vascular sampling for predicting malignancy in vascularized solid or cystic‐solid adnexal masses?

To assess whether, when using spherical sampling with Virtual Organ Computer-Aided Analysis (VOCAL) for calculating three-dimensional (3D) power Doppler angiography (PDA) indices, the sphere volume affects performance in the prediction of malignancy in vascularized cystic-solid or solid adnexal masses. One hundred and thirty-eight women (mean +/- SD age, 51.8 +/- 14.1 years) diagnosed as having vascularized cystic-solid or solid adnexal masses on B-mode and two-dimensional (2D) power Doppler ultrasound were evaluated by 3D-PDA prior to surgery. Five women had bilateral masses, giving a total number of 143 masses analyzed. Vascularization was assessed using VOCAL software. 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from the most vascularized area within papillary projections and solid areas were calculated automatically using spherical sampling. Five different volumes of sphere were used (1 cm(3), 2 cm(3), 3 cm(3), 4 cm(3) and 5 cm(3)) in each case. A definitive histological diagnosis was obtained in each case after surgical tumor removal. One hundred and seventeen (82%) masses were malignant and 26 (18%) were benign. Morphological evaluation revealed 34 (24%) unilocular solid masses, 49 (34%) multilocular solid masses and 60 (42%) mostly solid masses. The 1-cm(3) sphere could be used in 100% of the cases, the 2-cm(3) sphere could be used in 98.2% of the cases and the 3-5-cm(3) spheres could be used in 97.2% of the cases. The median VI, FI and VFI for all sphere volumes were significantly higher in malignant compared with non-malignant tumors. Receiver-operating characteristics curve analysis showed that VI and VFI, independently of sphere volume, were better predictors of malignancy than was FI. The best cut-off values for the 3D-PDA indices differed depending on sphere volume. VI was significantly more specific than were VFI and FI. Sphere volume does not affect the performance of 3D-PDA. We recommend the use of different cut-off values for 3D-PDA indices for discriminating between benign and malignant adnexal masses, depending on the sphere volume used. Use of VI is preferable due to its higher specificity.

OC16.02: Inter-observer reliability of quantitative 3D power Doppler angiography of whole placental vascularity

3D power Doppler angiography (3DPDA) allows quantification of blood flow within the placenta. The aim of this study was to investigate the interobserver reproducibility of quantitative 3DPDA as a tool to assess placental vascularity. Subjects were scanned at 12, 16 and 20 weeks gestations with a Voluson 730 Expert. 3DPD data were acquired from the whole placenta and analysed using VOCAL and 9 degree rotation steps. Each image was analysed by three observers who made two measurements in the transverse (B) plane. Interobserver reliability was assessed by two-way mixed intraclass correlation coefficients (ICCs) and Bland–Altman plots estimated the level of agreement between the observers. 52 low risk women were scanned at varying gestations resulting in 30 subjects at each gestation and 90 datasets in total. The ICC for data analysis demonstrated a high level of measurement reliability at each gestation: ICC 0.871, 0.968 and 0.980 for VI; 0.911, 0.924 and 0.958 for FI; 0.981, 0.959 and 0.977 for VFI at 12, 16 and 20 weeks gestation. Bland–Altman plots showed a progressive reduction in the agreement between the observers with increasing gestation. This study demonstrates that 3DPDA data can be measured by different observers to produce a quantitative analysis of whole placental vasculature. Measurements become less reliable as gestation advances.

P06.17: Practical and clinical uses of 3D power Doppler angiography in the quantitative determination of vascularization in OB/GYN

P06.17: Practical and clinical uses of 3D power Doppler angiography in the quantitative determination of vascularization in OB/GYN

OC16.04: The intra-observer reliability of measurements of whole placental vascularity made using quantitative 3D power Doppler angiography

OC16.04: The intra-observer reliability of measurements of whole placental vascularity made using quantitative 3D power Doppler angiography

OC16.03: Quantifying placental vascularity: evaluating the intraobserver reliability of 3D power Doppler data acquisition and measurement of the whole placenta

3D power Doppler angiography (3DPDA) allows quantification of blood flow within the placenta. The aim of this study was to investigate the interobserver reproducibility of quantitative 3DPDA as a tool to assess placental vascularity. Subjects were scanned at 12, 16 and 20 weeks gestations with a Voluson 730 Expert. 3DPD data were acquired from the whole placenta and analysed using VOCAL and 9 degree rotation steps. Each image was analysed by three observers who made two measurements in the transverse (B) plane. Interobserver reliability was assessed by two-way mixed intraclass correlation coefficients (ICCs) and Bland–Altman plots estimated the level of agreement between the observers. 52 low risk women were scanned at varying gestations resulting in 30 subjects at each gestation and 90 datasets in total. The ICC for data analysis demonstrated a high level of measurement reliability at each gestation: ICC 0.871, 0.968 and 0.980 for VI; 0.911, 0.924 and 0.958 for FI; 0.981, 0.959 and 0.977 for VFI at 12, 16 and 20 weeks gestation. Bland–Altman plots showed a progressive reduction in the agreement between the observers with increasing gestation. This study demonstrates that 3DPDA data can be measured by different observers to produce a quantitative analysis of whole placental vasculature. Measurements become less reliable as gestation advances.

Three‐Dimensional Power Doppler Angiography of Cyclic Ovarian Blood Flow

The purpose of this study was to assess the vascular indices generated by 3-dimensional (3D) power Doppler angiography by evaluating the cyclic changes in the vascularity of normal ovaries, including those that were ovulating, nonovulating, and hormonally suppressed. In this prospective longitudinal observational study, a cohort of premenopausal regularly menstruating women with no known ovarian disease underwent 3D power Doppler imaging every 2 to 3 days for the duration of 1 menstrual cycle. Four indices were generated: vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and mean grayness. Comparisons of vascularity were made between ovulating, nonovulating, and hormonally suppressed ovaries. Normal ranges were established and graphed longitudinally. Eighteen participants (36 ovaries) ages 28 to 45 years underwent an average of 10 examinations, yielding 368 acquired ovarian volumes for analysis. Seven participants used hormonal contraception. The VI, FI, and VFI were closely correlated (Pearson product moment correlation coefficients, 0.52-0.95). The vascular indices of ovulating ovaries were significantly higher than those of nonovulating ovaries (VI, FI, and VFI, all P < .001), with the largest discrepancies during the luteal phase. Hormonally suppressed ovaries had significantly lower vascularity throughout the cycle (VI, P < .002; FI, P < .001; VFI, P < .007). The vascular indices of all groups appeared to drop during the late follicular period and then rise again. The VI would suffice as the principal vascular parameter for 3D power Doppler analysis. Preovulatory scans may be more useful for distinguishing pathologic vascularization. Hormonally suppressed ovaries have significantly lower vascularity throughout the cycle. Normal-appearing ovaries with vascular indices above the normal ranges established by these data may warrant further investigation.

Changes in myometrial ‘perfusion’ during normal labor as visualized by three‐dimensional power Doppler angiography

Myometrial contractions are one of the most important aspects of effective labor. For cells within the myometrium to work efficiently they need to be well oxygenated and this requires an adequate blood supply. This study used quantitative three-dimensional (3D) power Doppler angiography to calculate the percentage change in myometrial blood flow during a relaxation-contraction-relaxation cycle of active labor. Transabdominal 3D power Doppler ultrasound imaging was used to acquire volumetric data during the first stage of spontaneous labor in 20 term, nulliparous women. 3D datasets were acquired during a single cycle of uterine relaxation, contraction and subsequent relaxation for each subject. The resultant datasets were analyzed independently by two investigators on two occasions using Virtual Organ Computer-aided AnaLysis to define a volume of interest within the myometrium; the power Doppler signal within this volume was quantified to provide 3D indices of vascularity: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). The percentage change in these indices, during a uterine contraction, was calculated from the baseline value during the initial uterine relaxation phase (taken as a maximum of 100%). Myometrial blood flow fell significantly during the uterine contraction and returned during the subsequent relaxation phase of the cycle (P < 0.001 for VI and VFI, P = 0.002 for FI). From the initial baseline relaxation value, VI dropped to 43.9%, FI to 85.5% and VFI to 40.8% during uterine contraction, and returned to 86.7%, 98.1% and 89.1%, respectively, during the subsequent relaxation. The intraclass correlation coefficients in blood flow measurements of 0.982-0.999 between the two investigators were indicative of good interobserver reliability. This study confirms that myometrial perfusion, as measured by quantitative 3D power Doppler angiography, significantly falls during uterine contractions, returns during the subsequent relaxation phase, and can be quantified reliably from stored datasets. Further work is now required to establish clinical applicability for this non-invasive investigation.

In Vitro Dual Perfusion of Human Placental Lobules as a Flow Phantom to Investigate the Relationship between Fetoplacental Flow and Quantitative 3D Power Doppler Angiography

Flow phantoms have been used to investigate and quantify three-dimensional power Doppler data but this is the first study to use the in vitro, dual perfused, placental perfusion model. We used this model to investigate and quantify the effect of variation in fetal-side flow rates and attenuation on 3D power Doppler angiography. Perfusion of a placental lobule was commenced within 30min of delivery and experimentation was successful in 8 of the 18 placenta obtained. Fetal and maternal perfusate was modified Earle's bicarbonate buffer which, following equilibration, was supplemented on the fetal side with whole heparinised cord blood. Imaging was performed with a Voluson-i ultrasound machine. A ‘vascular biopsy’ the thickness of the placental lobule was defined and signal quantified within using VOCAL™ (GE Medical Systems, Zipf, Austria). Three vascular indices are generated: vascularisation index (VI) defined as the percentage of power Doppler data within a volume of interest; flow index (FI), the mean signal intensity of the power Doppler information; and vascularisation flow index (VFI), a combination of both factors derived through their multiplication. Attenuation was investigated in this model with the addition of tissue mimic blocks. Our results showed a predictable relationship between flow rates and the vascular indices VI and VFI. However the FI was a less reliable predictor of flow; thus it should be interpreted with caution. The power Doppler signal was markedly affected by attenuation leading to a complete loss of information at a depth of 6cm in the model used. In conclusion this model can be adapted to provide a phantom to analyse and quantify 3D power Doppler signals and demonstrates that vascular indices within a tissue remain related to volume flow. This model provides further evidence that depth dependent attenuation of signal needs to be accounted for in any in vivo work where the probe is not in direct contact with the tissue of interest.

Postpartum Management of Placenta Previa Accreta Left In Situ

Placenta previa accreta may require hysterectomy because of the potential of massive obstetric hemorrhage. Overall, up to 92% of women require blood transfusion when traditional surgical management is used. 1 Hysterectomy may not be sought as a viable option for women requesting to preserve future fertility. Conservative management by leaving the placenta in utero and administration of methotrexate has been described in the literature. With the use of conservative management, the overall transfusion rate may be lowered substantially but still may be as high as 80%. 1 The problem faced at the conclusion of such management is when to proceed with removal of the placenta. This case report illustrates a new and objective way to determine when it is safest to surgically remove the placental tissue without the risk of excess bleeding in hopes of preserving reproductive function. The means to achieve this goal was the use of 3-dimensional (3D) power Doppler angiography to follow the receding blood vessels to the placenta by quantifying its amount of vascularization.

OP06.04: Myometrial vascularization assessed by 3D power Doppler angiography in women with primary dysmenorrhea

OP06.04: Myometrial vascularization assessed by 3D power Doppler angiography in women with primary dysmenorrhea

OC074: Embryo implantation rate is related to endometrial and subendometrial vascularization measured by 3D ultrasound and power Doppler angiography

OC074: Embryo implantation rate is related to endometrial and subendometrial vascularization measured by 3D ultrasound and power Doppler angiography

OC069: Can quantitative 3D power Doppler angiography be used to predict poor response and ovarian hyperstimulation syndrome during assisted reproduction treatment?

OC069: Can quantitative 3D power Doppler angiography be used to predict poor response and ovarian hyperstimulation syndrome during assisted reproduction treatment?

OP17.05: Spherical virtual tissue sampling with different size samples in 3D power Doppler angiography for evaluation of ovarian cancers

OP17.05: Spherical virtual tissue sampling with different size samples in 3D power Doppler angiography for evaluation of ovarian cancers

Three-Dimensional Power Doppler Assessment of Uterine Vascularization in Women With Primary Dysmenorrhea

The aim of this study was to assess myometrial vascularization with 3-dimensional (3D) power Doppler angiography (PDA) in women with different grades of primary dysmenorrhea at the moment of maximum menstrual pain in an effort to improve the pathophysiologic knowledge of one of the most common gynecologic conditions. This was a cross-sectional study involving 70 voluntary women that studied or worked at the Clinica Universitaria de Navarra between January 2006 and January 2008. All women underwent transvaginal sonographic 3D PDA on the day of maximum pain after the onset of menstruation or during the first 24 to 48 hours of the new cycle if no pain was present. Three groups were defined according to a visual analog scale: no pain to mild dysmenorrhea, moderate dysmenorrhea, and severe dysmenorrhea. Vascularity assessment was done on the basis of 3D vascularity indices: the vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). The mean VI and VFI for the inner 5 mm of the myometrium and the total myometrium were significantly higher in the women with severe dysmenorrhea than in those with no pain to mild dysmenorrhea (P < .05). The VI, FI, and VFI in the women with moderate dysmenorrhea did not differ significantly from those in the women with severe dysmenorrhea. This study evaluated the use of 3D PDA for assessing uterine and specifically myometrial vascularization. Our data indicate that women with severe dysmenorrhea have increased myometrial vascularization during the early menstrual phase compared with women without pain.

Methodological considerations for the correct application of quantitative three‐dimensional power Doppler angiography

Methodological considerations for the correct application of quantitative three‐dimensional power Doppler angiography