3D Power Doppler Ultrasonography Research Articles

Changes of placental three-dimensional power Doppler ultrasonography in third trimester among hypertensive disorders complicating pregnancy and its predictive value for pregnant outcomes.

Hypertensive disorders complicating pregnancy (HDCP) represent a systemic condition specific to pregnant women. Three-dimensional (3D) power Doppler ultrasonography is a technique that utilizes erythrocyte density, scattered intensity, or energy distribution in the bloodstream for imaging purposes. This study aimed to compare the changes in 3D power Doppler ultrasonography parameters in late pregnancy between patients with HDCP and those without HDCP, and to evaluate the predictive value of these parameters for pregnancy outcomes in patients with HDCP. The study included 160 pregnant women diagnosed with HDCP and 100 pregnant women without HDCP, who served as the control group. 3D power Doppler ultrasonography was performed, and the values of the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured. In the HDCP group, the VI, FI, and VFI were all lower than those observed in patients without HDCP. In HDCP patients with positive outcomes, these three parameters were higher than those recorded in patients with negative outcomes. The area under the predicted curve (AUC) for VI, FI, VFI, and the combination of these three parameters were 0.69, 0.63, 0.66, and 0.75, respectively. The parameters of 3D power Doppler ultrasonography can reflect the perfusion status of the placenta and predict the outcome of pregnancy in patients with HDCP. By monitoring these relevant hemodynamic parameters, valuable information can be provided for the clinical diagnosis, objective evaluation, and treatment of HDCP.

Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency-A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society.

This review aims to provide a functional, metabolic view of the pathogenesis of benign thyroid disease. Here, we summarize the features of our previous publications on the “WOMED model of benign thyroid disease”. As of 2021, the current state of art indicates that the basic alteration in benign thyroid disease is a metabolic switch to glycolysis, which can be recognized using 3D-power Doppler ultrasound. A specific perfusion pattern showing enlarged vessels can be found using this technology. This switch originates from an altered function of Complex I due to acquired coenzyme Q10 deficiency, which leads to a glycolytic state of metabolism together with increased angiogenesis. Implementing a combined supplementation strategy that includes magnesium, selenium, and CoQ10, the morphological and perfusion changes of the thyroid can be reverted, i.e., the metabolic state returns to oxidative phosphorylation. Normalization of iron levels when ferritin is lower than 50 ng/mL is also imperative. We propose that a modern investigation of probable thyroid disease requires the use of 3D-power Doppler sonography to recognize the true metabolic situation of the gland. Blood levels of magnesium, selenium, CoQ10, and ferritin should be monitored. Thyroid function tests are complementary so that hypo- or hyperthyroidism can be recognized. Single TSH determinations do not reflect the glycolytic state.

Evaluation of neonatal cerebral perfusion using three-dimensional power Doppler ultrasound volumes.

Despite improvement in preterm survival, neurological morbidity remains high. 3D fractional moving blood volume (3D-FMBV) quantifies neonatal cerebral perfusion by calculating a standardised measure of the amount of moving blood in a region of interest and correlates with tissue perfusion in animal studies. However, its feasibility and reproducibility are yet to be assessed in newborn infants. Fractional moving blood volume analysis was performed on three-dimensional power Doppler ultrasound (PD-US) volumes from a cohort of preterm infants recruited in 2015 from the Royal Hospital for Women Neonatal Intensive Care Unit. The volumes were acquired by two sonographers and analysed by two different observers. The 3D-FMBV algorithm was applied to calculate an estimate for perfusion. Reproducibility and agreement were assessed using intra-class correlation coefficients (ICC) and Bland-Altman plots. All 3D PD-US volumes were analysed successfully. Intra-observer reliability was excellent with an ICC of 0.907 (95% CI 0.751-0.968) and 0.906 (95% CI 0.741-0.967) for two independent observers respectively. The inter-observer reliability of the entire technique was good with an ICC of 0.752 (CI: 0.404-0.909). We have successfully shown the feasibility and reliability of applying the 3D-FMBV technique to the neonatal brain in a healthy preterm population.

The Influence of Hyperoxygenation on Fetal Brain Vascularity Measured Using 3D Power Doppler Ultrasound and the Index “Fractional Moving Blood Volume”

Introduction: Maternal hyperoxygenation effects on fetal cerebral hemodynamics are largely unknown. This study aimed to determine efficacy and reliability of a validated power Doppler ultrasound (US) index, fractional moving blood volume (FMBV), at measuring fetal cerebral vasculature changes during maternal hyperoxia. Methods: The fetal cerebral effects of 10 min of hyperoxygenation at 2 flow rates (52%/60% FiO₂) were evaluated in women in their third trimester of pregnancy. 2D-US and 3D-US in a transverse plane were performed before, during, and following maternal hyperoxygenation with FMBV estimation performed offline. Results: Forty-five cases provided data for analysis. Mean intraobserver ICCs were 0.89 (3D-FMBV) and 0.84 (2D-FMBV). A significant difference in vascularity before and during and before and after 60% hyperoxia was observed (p < 0.05), whereas no significant differences were found at 52% hyperoxia (p > 0.05). Significant differences in vascularity were found between 2D-FMBV and 3D-FMBV (p < 0.01). Conclusion: Measurement of fetal cerebral vascularity by 3D-FMBV and 2D-FMBV was highly reproducible. The differing cerebral vascular changes seen with 60% but not 52% FiO₂ suggest a possible “threshold effect” that may have influenced prior studies. Further studies are needed to assess cerebral effects of maternal hyperoxygenation on compromised fetuses.

Анализ морфофункционального состояния яичников при различных клинических формах преждевременной недостаточности яичников с использованием энергетической допплерометрии в режиме 2D/3D

Анализ морфофункционального состояния яичников при различных клинических формах преждевременной недостаточности яичников с использованием энергетической допплерометрии в режиме 2D/3D

The Expression of VEGF and CD31 in Endometrial Lesions and Its Associations with Blood Flow Parameters of Transvaginal 3D Power Doppler Ultrasonography: A Preliminary Study.

AimTo investigate the association of the blood flow parameters measured by transvaginal three-dimensional power Doppler ultrasound and the angiogenesis of endometrial cancer.Material and MethodsThe expressions of vascular endothelial growth factor (VEGF) and CD31 in benign and malignant endometrial lesions, and in malignant lesions with different clinical and pathological features were analyzed. The correlations of the blood flow parameters (vascularization index [VI], blood flow index [FI], and vascularization-blood flow index [VFI]) of transvaginal 3D power Doppler ultrasound, and VEGF expressions, microvessel density (MVD) were also evaluated.ResultsThe VEGF-positive rates and the MVD values in benign and malignant endometrial lesions were significantly different (both P<0.001). The differences of VEGF-positive rates (P < 0.001) and MVD values (P = 0.021) between type I and type II lesions of endometrial cancer were statistically significant. There was no significant difference in the VEGF-positive rate and MVD value between stage IA and IB (P=0.443, P=0.311). The difference of VEGF expression and MVD in stage IA, stage IB and stage II and above was statistically significant (P=0.003, P=0.017). The VEGF-positive rate and MVD value were not significantly different in IAG1 and IAG2 lesions of endometrioid adenocarcinoma (P=0.709, P=0.792). There was no significant correlation between VI, FI, VFI and VEGF expression and MVD in endometrial cancer.ConclusionThe VEGF-positive rates and MVD values were relatively high in malignant endometrial lesions, type II and stage II and above lesions of type I endometrial cancer, indicating that the angiogenesis of endometrial cancer tissues might play a crucial role in the tumor classification, and pelvic metastasis.

Three-dimensional power Doppler ultrasonography indicates that increased placental blood perfusion during the third trimester is associated with the risk of macrosomia at birth.

To investigate the association between placental blood perfusion and the occurrence of macrosomia at birth. This was a prospective cohort study including women with singleton pregnancies that aimed to measure placental blood perfusion using three-dimensional (3D) power Doppler ultrasonography in the second and third trimester. We acquired three indices of placental blood flow, including vascularization index (VI), flow index (FI), vascularization flow index (VFI), along with routine two-dimensional (2D) biometric measurements, including abdominal circumference (AC) and estimated fetal weight (EFW). Pregnancy outcomes were divided into two groups: newborns with a normal birth weight and those with macrosomia. We then compared all of the recorded variables between these two groups. We also determined the predictive efficiency of each variable using receiver-operating characteristic (ROC) curves. The placental 3D power Doppler indices, including VI and FI, were significantly higher in the third trimester of pregnancies developing macrosomia, but not during the second trimester, as compared to those with a normal birth weight. ROC curves analysis for third-trimester VI and FI suggested a slight ability to predict macrosomia; this was also the case for AC and EFW. Interestingly, VI showed high sensitivity and low specificity, while FI showed low sensitivity and high specificity; this was also the case for AC and EFW. Three-dimensional power Doppler ultrasound indices were significantly higher during the third-trimester for pregnancies developing macrosomia. However, these indices had only moderate ability to predict macrosomia.

Relationship between 3D Power Doppler Ultrasound and Serum MMP-2 and Ang-2 Levels in Pregnant Women with Preeclampsia.

To explore the relationship between 3D power Doppler ultrasound (3D-PDU) and serum MMP-2 and Ang-2 levels in pregnant women with preeclampsia (PE). Comparative analytical study. The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, China, from October 2017 to January 2020. One hundred and thirty-four pregnant women with PE were selected as the research subjects, with 67 cases in mild group and 67 cases in severe group. Sixty-seven healthy primigravidas were selected as normal control group. Serum MMP-2 and Ang-2 were detected. All subjects underwent prenatal 3D-PDU examination, and VI, FI and VFI were measured. Compared to normal control group, serum MMP-2 and Ang-2 levels of mild group and severe group decreased successively (all p <0.001); VI, FI, and VFI of mild group and severe group decreased successively (both p <0.001). Pearson correlation analysis showed that serum MMP-2 in pregnant women with PE was positively correlated with VI, FI, VFI (r = 0.940, p <0.001, r = 0.938, p <0.001, and r = 0.921, p <0.001, respectively); and serum Ang-2 was positively correlated with VI, FI, VFI (r = 0.958, p <0.001; r = 0.960; p <0.001; r = 0.945, p <0.001, respectively). 3D-PDU has a certain application value in the diagnosis of pregnant women with PE, variation tendency of VI, FI and VFI detected by 3D-PDU is closely associated with serum MMP-2 and Ang-2 levels. Key Words: Preeclampsia, Pregnant women, MMP-2, Ang-2, 3D power Doppler ultrasound (3D-PDU).

The Use of Doppler Ultrasound to Assess the Blood Flow of Pedicled Vascularized Bone Grafting for Scaphoid Nonunions.

Objectives This study aims to assess the blood flow and the vascularity pattern across the newly bridged vascularized bone grafts for scaphoid nonunions using three-dimensional (3D) high frequency power Doppler ultrasonography and its role in the union. Materials and Methods A total of 26 patients with scaphoid nonunions were operated with 1,2-intercompartmental supraretinacular artery (ICSRA) graft. CT scan and 3D high frequency power Doppler ultrasonography were performed in all patients between 12 and 18 weeks, and its results were analyzed. Results Doppler ultrasonography confirmed the pulsatile flow and vascularity across the pedicle and vascularized bone graft incorporation into the scaphoid nonunion site. Conclusions 3D high frequency power Doppler ultrasonography is a simple, noninvasive, nonradiation, reproducible, and well-reliable diagnostic modality in assessing the blood flow and vascularity of the bone grafts used for scaphoid nonunions. Level of Evidence This is a Level IV study.

Study of the Vascularity of Uterine Septum Using Three Dimensional Power Doppler Ultrasound

Abstract Background Uterine anomalies are a relatively common congenital abnormality, with uterine septum being the most common. This is even truer in patients with recurrent pregnancy loss, in whom rates of uterine abnormalities may approach 15% to 27%. Historically, the uterine septum has been approached via laparotomy through either a Tompkins or Jones procedure. These successful, but highly morbid, procedures require laparotomy with significant hospital stays, subsequent cesarean delivery, and have carried a high risk of adhesion formation. More recently, this surgery has been supplanted by hysteroscopy or other minimally invasive methodologies. Objective To assess the relation between the vascularity of uterine septum and obstetric performance with Transvaginal 3D Power Doppler Ultrasound. Patients and Methods Early Cancer Detection Unit and Ultrasound and Fetal special care Unit in Ain Shams University Maternity Hospital (ASUMH). Recruitment took place between May 2017 and November 2018. Cross-sectional study. The study included 30 cases of women with uterine septum. Intervention: Transvaginal 3D power Doppler ultrasound was done to all cases with septal volume and vascularity assessment using VOCAL system and Histogram facility. The study included 30 patients with septate uterus, twelve of them suffered from 1ry infertility while the other eighteen suffered from recurrent abortion. Results There was statistical significant difference between the two groups regarding vascularity (VI, FI, and VFI) of septum (P &amp;lt; 0.05). Conclusion The vascularity of septate uterus is variable. The power Doppler indices shows that septate uterus in cases with recurrent abortion is highly vascular while in cases with 1ry infertility shows low vascularity. Highly vascular septum may be a site of implantation which may be a cause of recurrent abortion thus; excision of the septum may help prevent recurrent abortion, while low vascular septum may prevent implantation which may be a cause of infertility thus; incision of the septum may help in treatment of infertility. Correlation with histopathologic features of septum may be required to decide the best management of the septum.

Influence of Ulipristal Acetate in 3D-PW-Doppler parameters of patients with uterine myomas: a prospective observational pilot study

Introduction: uterine fibroids are the most common benign tumors of the female genital tract. They associate a varied symptomatology, from the absence of symptoms to more disabling bleeding or pain [1,2]. There are multiple treatments directed against different targets such as ulipristal acetate which has proven effective in reducing the size of the fibroids and their symptoms [7]. Our preliminary study seeks to find the relationship between ulipristal acetate and angiogenesis of uterine fibroids, by measuring ultrasound vascularization of the fibroid throughout the treatment. Material and Methods: A prospective observational study has been designed, in which 24 patients with symptomatic uterine fibroids have been included and given 4 cycles of Ulipristal Acetate. The size and vascularization of the fibroids were measured at the beginning and end of treatment; as well as on several occasions throughout the follow-up. Myoma vascularization was measured by power doppler 3D ultrasound through different parameters that define the vascularization in a more objective way: Vascularization Index (VI), Flow Rate (FR), Flow Vascularization Index (FVI). Result: A significant reduction in the size of the fibroids has been observed, as well as their vascularization in terms of vascularization indices measured by 3D PW ultrasound. These changes were evident at the end of treatment and were maintained over time. Conclusion: There is a correlation between myoma vascularization and treatment with Ulipristal Acetate. SPRMs may provide effective treatment for women with symptomatic fibroids by two ways: supports selective progesterone receptor modulators and reduced angiogenesis. In addition, the use of vascularization markers of 3DPW ultrasound and the colour map allow us to monitor the response to medical treatment of myomas in a non-invasive and easily reproducible way. Keywords: Ulipristal Acetate; Esmya®; Uterine fibroids; Angiogenesis; 3D Power Doppler Ultrasound

Antidiastole Value of Three-dimensional Ultrasonography and Power Doppler between Uterine Parenchyma Lumps and Endometrial Cancer: A Retrospective Study.

Sometimes endometrial polyps, submucosal myomas, and endometrial cancer show similar findings under ultrasonography. The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional (3D) power Doppler ultrasonography angiography (PDA) between endometrial cancer and uterine parenchyma lumps. The data of the blood flow indices in 3D-PDA including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps (endometrial polyps and submucosal myomas) were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis (VOCAL) software. The results showed that all the blood flow parameters (VI, FI, VFI) were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps (P<0.001). The area under the curve of ROC of VI, FI, and VFI was 0.98, 0.84, and 0.97, respectively. Thus, the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%. The optimal cutoff value of VI was 4.06%. Our data demonstrated that all of the blood flow signal parameters (including VI, FI, and VFI) in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.

The Diagnostic Value of 3D Power Doppler Ultrasound Combined With VOCAL in the Vascular Distribution of Breast Masses

This study uses a three-dimensional energy Doppler technique combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in order to determine the diagnostic threshold of blood flow index in breast tumors to provide a reference for evaluation and treatment options. We collected 322 solid lesions which had been operated. Each lesion met the definite pathological diagnosis; collected lesions included 262 cases of benign lesions and 60 cases of malignant lesions. All examinations were performed by using GE LOGIQ E9 with VOCAL software. Volume and four distinct vascular indices of gray mean (MG), power mean, ratio (R), and vascular flow index (VFI) were calculated by using the VOCAL software. Sampling and calculation were repeated three times and the mean value was calculated. The average age and power of the malignant group were greater than those of the benign group, ie p < .01 which had significant differences. The gray mean of the malignant group was lower than that of the benign group, ie p > .05 which had no significant differences between benign and malignant groups. The ratio, vascular flow index and volume had significant differences, i.e. p < .01. The area under the receiver operating characteristic curve (AUC) were 0.864, 0.830, 0.800, 0.758, and 0.764 for age, power, ratio, vascular flow index, and volume, respectively. The research indicators were higher than 50% of the curve showing their diagnostic value. The cut-off points of age, power, ratio, vascular flow index, and volume were 37.5, 26.56, 0.031, 0.846, and 1.75, respectively. Their corresponding sensitivity were 93.3%, 75%, 81.7%, 68.3%, 63.3%, and the specificity were 68.7%, 81%, 70.2%, 75.6%, and 81.7%, respectively. Comparison of vascular indices combined with the Breast imaging reporting and data System (BI-RADS) score and simple BI-RADS method, the AUC of power + BI-RADS, ratio + BI-RADS, VFI + BI-RADS, and BI-RADS alone are 0.928, 0.903, 0.895, and 0.796, respectively, which were higher than 50% of the curve. Sensitivity was 81.7%, 80%, 88.3%, 86.7%, and specificity was 88.5%, 85.5%, 77.1%, 69.5%, respectively. The power + BI-RADS method has the highest AUC among these three methods. Quantitative measurement of blood flow and blood vessel distribution in breast tumors by three-dimensional power Doppler ultrasound combined with the VOCAL method is more accurate and sensitive than the traditional two-dimensional ultrasound. And this method has potential promising applications in many current active research areas, such as the studies of random distribution of intratumoral blood vessels or the normalization of tumor blood vessels. Three-dimensional power Doppler ultrasound combined with the VOCAL method provides a new approach to achieving accurate judgments and the method evaluates the curative effect in breast cancer patients.

3D vocal power Doppler sonography for the estimation of tumor volume and vascularization in stage IB1 cervical cancer.

To evaluate the tumor's volume and intratumoral vascularization with 3D vocal power Doppler ultrasound in patients with stage 1B1 cervical cancer. This was a prospective study on patients with cervical cancer and stage 1B1 disease, which took place between 2012 and 2015. All women had an initial 2D ultrasound examination for the estimation of the tumor volume. Following this, 3D volumes of the cervix were acquired and were further analyzed using the Virtual Organ Computer Aided Analysis (VOCAL) program. In the selected volume, the vascular pattern (linear or complex vascularization) was also examined. The ultrasonographic findings were compared to the histological ones following surgery. Twenty-seven patients were included. The average cervical tumor volume measured by the 2D ultrasound and 3D VOCAL-PD were 3.14 and 3.08cm3, respectively. Both 2D and 3D VOCAL-PD overestimated the tumor staging. Further analysis showed a statistically significant superiority of 2D ultrasound over 3D VOCAL-PD for tumors equal or smaller than 2.5cm3 with linear vascularity (p < 0.001), while for tumors of larger volume with complex vascularization, a statistically significant superiority of 3D VOCAL-PD was confirmed (p < 0.001). 3-D VOCAL-PD is extremely accurate and superior to 2D ultrasound for the estimation of tumor volume and vascularization when it is more than 2.5cm3 and has a complex vascularization in patients with stage 1B1 cervical cancer.

Logistic regression analysis of combining transvaginal conventional ultrasonography and 3D power Doppler ultrasonography (3D-PDUS) in differential diagnosis of ovarian tumor

Objective To develop a logistic regression model for differential diagnosis of the malignant ovarian tumor by combining transvaginal conventional ultrasonography and 3D power Doppler ultrasound(3D-PDUS) techniques. Methods The transvaginal ultrasonography and 3D-PDUS data were collected from 291 patients with ovarian tumors received clinical pathological diagnosis. According to the pathological resuts, the 291 patients were divided in to benign group(GB) and borderline/malignant group(GM). Univariate and multivariate logistic regression analyses were applied to establish models for predicting malignant tumor. Results ①Within the 291 ovarian tumor patients, 175 (60.14%) were classified as the GB and 116 (39.86%) were considered as the GM, the number for postmenopausal cases and the serum CA125 level in GB group were significantly lower than those in GM group (P<0.001); ②The tansvaginal conventional ultrasound analysis suggested that borderline/malignant tumor often presented as larger volume, more irregular shape, and higher incidence in the blood flow within a solid papillary projection and ascites (P<0.05, compared with GB group); In 3D-PDSU data, the vascularization index (VI) was lower than that in GB group (P<0.001, compared with GM group), but there was no significant difference between GB group and GM group in flow index (FI) and vascularization-flow index (VFI) (P=0.559, 0.454); ③Multivariate logistic regression analysis showed that postmenopausal status, serum CA125 levels, tumor echo, papillary with blood flow, ascites and 3D-PDUS VI parameters were independent risk factors for the progression of borderline/malignant tumor. The ROC curve showed that the established regression model accuracy was 92.0%, sensitivity was 86.2%, specificity was 95.7%, positive predictive value was 92.6% and negative predictive value was 91.7%. Conclusions Combining multi-model transvaginal conventional ultrasound and 3D-PDUS analyses is a useful non-invasive technique for the differential diagnosis of ovarian tumor. Key words: Endosonography; Three-dimensional power Doppler ultrasonography; Ovarian neoplasms; Logistic regression

A Comparative Study on Quantitative Assessment of Blood Flow and Vascularization in Polycystic Ovary Syndrome Patients and Normal Women Using Three-Dimensional Power Doppler Ultrasonography.

To compare the quantitative assessment of blood flow and vascularization of ovaries in polycystic ovary syndrome patients and normal women using three-dimensional power Doppler ultrasonography. This cross-sectional quantitative study was conducted on women of reproductive age group (15-45years) attending Gynaecology OPD AIMSR, Bathinda, Punjab. Thirty women were enrolled in polycystic ovarian syndrome (PCOS) group and 30 healthy women in control group. Women were categorized as polycystic ovary syndrome according to Rotterdam's criteria. The women with PCOS underwent transvaginal USG Doppler on day 6 of the cycle using 3D power Doppler USG equipment (GE Voluson E8), and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were measured. The mean values of VI, FI and VFI measured by power Doppler ultrasonography were significantly increased (P value=0.000) in women with PCOS when compared with healthy women. This study suggests that blood flow and vascularization measured by 3D power Doppler ultrasonography in ovaries of polycystic ovary syndrome patients were significantly more than the ovaries of normal women.

Study of Endometrial Volume and Vascularity by 3D Power Doppler Ultrasound in Women with Perimenopausal Bleeding

Study of Endometrial Volume and Vascularity by 3D Power Doppler Ultrasound in Women with Perimenopausal Bleeding

First Trimester Placental Volume and Vascular Indices by 3D Ultrasonography and 3D Power Doppler in Pregestational Diabetic and Non-Diabetic Pregnant Patients

Background: 3D power Doppler ultrasonography enables quantitative analysis of region observed through vascular indices as VI (vascularization index), FI (flow index) and VFI (vascularization flow index), which show quantity of vessels, local blood flow and their combination and placental volume. These indices can be calculated using VOCAL program. Aim of Study: This study aimed at comparing placental volume and vascular indices using 3D ultrasonography and 3D power Doppler in pregestational diabetic and non-diabetic pregnant women at first trimester (11th week and 13th week). Patients and Methods: This current study was conducted at Antenatal care Clinic in cooperation with the feto-maternal Unit for ultrasound assessment, Ain-Shams University Maternity Hospital during period between November 2015 and April 2017, on 46 women at eleventh 11th week and thirteen 13th week of gestation. They were divided into two groups: Group (A) included 23 women with pregestational diabetes mellitus and group (B) included 23 non-diabetic pregnant women as a control group after respecting certain inclusion and exclusion criteria. Results: There was no statistically significant difference between pregestational diabetic and non - diabetic group as regard placental volume and vascular indices (VI, FI and VFI). Conclusion: There was no statistically significant difference as regard placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic compared to non-diabetic pregnant patients at first trimester of pregnancy especially with good glycemic control but changes may be present with poor glycaemic control. Recommendations: Further studies are recommend as regard evaluating placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic at second and third trimester of pregnancy giving more time for pathological effect of diabetes mellitus to appear.

Impact of transvaginal hydrolaparoscopy ovarian drilling on ovarian stromal blood flow and ovarian volume in clomiphene citrate-resistant PCOS patients: a case-control study

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in gynecology. In PCOS patients vascularization parameters are altered. Transvaginal hydrolaparoscopy (THL) is a mini-invasive approach for ovarian drilling in PCOS patients. In this study, we assessed the effect of ovarian drilling using THL on ovarian volume (OV) and vascularization index (VI) using 3D power Doppler ultrasonography in CC-resistant PCOS patients. A case-control study on 123 CC-resistant PCOS women who underwent THL ovarian drilling was performed. Patients underwent 3D ultrasound and power Doppler to measure VI, flow index (FI), vascularization flow index (VFI) and to evaluate OV before and after the procedure, at six months, and on the early follicular phase of the menstrual cycle. After THL ovarian drilling, OV and power Doppler flow indices were significantly reduced compared to pre-operative values (OV: 7.85 versus 11.72 cm3, p < 0.01; VI: 2.50 versus 4.81, p < 0.01; VFI: 1.10 versus 2.16, p < 0.01; FI: 32.05 versus 35.37, p < 0.01). In conclusion, THL ovarian drilling seems to reduce OV and 3D power Doppler indices, and could therefore be a viable alternative to LOD in PCOS patients resistant to medical therapy.

Ultrasonographic Evaluation of Cervical Length, Cervical Volume and Cervical Vascularization between 18 and 40 Weeks of Gestation

Objective: To evaluate the correlation of cervical length, cervical volume and cervical vascularization during pregnancy using 3D power Doppler ultrasonography, and to examine the reliability of these measurements. Methods: This is a cross-sectional study of 196 pregnant women who delivered at term and had undergone transvaginal 3D power Doppler ultrasonographic examination of the cervix once between 18 and 40 weeks’ gestation. Cervical length, cervical volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were measured and calculated. The reliability of the measurements was also evaluated. Results: Mean cervical length and volume were 35.2 mm. and 28.2 cm 3 . Mean cervical VI, FI and VFI were 2.65, 38.44 and 1.07, respectively. Cervical length and cervical volume significantly decreased during pregnancy (Spearman’s rank correlation coefficient, Rho = -0.422 and -0.514, respectively, correlation significant <0.01). There was a minimal change in the vascular flow indices between 18 and 40 weeks’ gestation (Spearman’s rank correlation coefficient, Rho, varied from 0.010 to 0.042). Both intraobserver and interobserver agreement for cervical volume measurements were excellent with intraclass correlation coefficient (ICC) values of 0.96, and 0.95 respectively. Intraobserver and interobserver agreement for vascular flow indices measurements were good. Conclusion: Cervical length and volume significantly decreased with gestational age. Cervical vascularization tends to be increased, but without statistical significance. The measurements were reliable.