3D Power Doppler Ultrasonography Research Articles

Solid Breast Masses: Neural Network Analysis of Vascular Features at Three-dimensional Power Doppler US for Benign or Malignant Classification

To retrospectively evaluate the accuracy of neural network analysis of tumor vascular features at three-dimensional (3D) power Doppler ultrasonography (US) for classification of breast tumors as benign or malignant, with histologic findings as the reference standard. This study was approved by the local ethics committee; informed consent was waived. Three-dimensional power Doppler US images of 221 solid breast masses (110 benign, 111 malignant) were obtained in 221 women (mean age, 46 years; range, 25-71 years). After narrowing down vessels to skeletons with a 3D thinning algorithm, six vascular feature values--vessel-to-volume ratio, number of vascular trees, total vessel length, longest path length, number of bifurcations, and vessel diameter-were computed. A neural network was used to classify tumors by using these features. Independent-samples t test and receiver operating characteristic (ROC) curve analysis were used. Mean values of vessel-to-volume ratio, number of vascular trees, total vessel length, longest path length, number of bifurcations, and vessel diameter were 0.0089 +/- 0.0073 (standard deviation), 26.41 +/- 14.73, 23.02 cm +/- 19.53, 8.44 cm +/- 10.38, 36.31 +/- 37.06, and 0.088 cm +/- 0.021 in malignant tumors, respectively, and 0.0028 +/- 0.0021, 9.69 +/- 6.75, 5.17 cm +/- 4.78, 1.68 cm +/- 1.79, 6.05 +/- 7.55, and 0.064 cm +/- 0.028 in benign tumors, respectively (P < .001 for all six features). Area under ROC curve (A(z)) values of the six features were 0.84, 0.87, 0.87, 0.82, 0.84, and 0.75, respectively. Accuracy, sensitivity, specificity, and positive and negative predictive values were 85% (187 of 221), 83% (96 of 115), 86% (91 of 106), 86% (96 of 111), and 83% (91 of 110), respectively, with A(z) of 0.92 based on all six feature values. Three-dimensional power Doppler US images and neural network analysis of features can aid in classification of breast tumors as benign or malignant.

AGU14 Interval prostate cancers diagnosed by 3D power Doppler sonography and 3 Tesla MRI

Interval cancers are aggressive and occur within a 6 month period. Screening with 3D power Doppler ultrasound followed by 3 Tesla MRI was used to promote early diagnosis. 456 patients were prospectively scanned over 30 months with a Voluson Expert unit employing 3D glass body reconstruction and power Doppler imaging. Ail patients were scanned within one week with a 3.0 Tesla Philips Achieva unit without endorectal coil generating large field Tl weighted images and small field axial, sagittal and coronal T2 weighted images. 22 new tumors were located : 14 isolated lésions and 8 multiple tumor sites. 13 cancers were isoechoic and only detected by Doppler imaging and confirmed by contrast enhanced MRI. Tumor vascularity decreased following successful treatment. Corrélation between both modalities was 94 %. 3D power Doppler imaging appears as sensitive as 3.0 Tesla MRI in the détection of early cancers and may prove useful as a screening modality.

Reference data representative of normal findings at three‐dimensional power Doppler ultrasound examination of the cervix from 17 to 41 gestational weeks

To develop normal reference ranges for cervical volume and vascular indices using three-dimensional (3D) power Doppler ultrasonography from 17 to 41 gestational weeks. This was a cross-sectional study of 352 nulliparous and 291 parous women who delivered at term and underwent transvaginal 3D power Doppler ultrasound examination of the cervix once at 17 to 41 weeks' gestation. We examined approximately 25 women in each gestational week. Cervical volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated. There was no change in cervical volume between 17 and 40 weeks' gestation. At 41 weeks cervical volume was slightly smaller than it was at 17-40 weeks (P=0.03 for nulliparous women and P=0.08 for parous women). The cervical volume was larger in parous than it was in nulliparous women (median 38 cm3 vs. 32 cm3 at 17-40 weeks, P<0.0001; median 31 cm3 vs. 22 cm3 at 41 gestational weeks, P=0.288). FI did not differ between nulliparous and parous women and remained unchanged between 17 and 41 weeks' gestation (median 30.6, range 21.2-55.2). VI and VFI did not change consistently from 17 to 41 weeks, but the values were higher in parous than they were in nulliparous women at 17-30 weeks (median VI 5.3% vs. 3.1%, P<0.0001; median VFI 1.6 vs. 0.9, P<0.0001). At 31-41 gestational weeks the median VI for all women irrespective of parity was 4.9% and the median VFI was 1.4. Reference values for cervical volume and blood flow indices as assessed by 3D power Doppler ultrasonography have been established for the second half of pregnancy. These lay the basis for studies of pathological conditions.

Quantitative analysis of fetal pulmonary vasculature by 3-dimensional power Doppler ultrasonography in isolated congenital diaphragmatic hernia

The purpose of this study was to evaluate the potential of 3-dimensional (3D) power Doppler imaging to predict neonatal outcome and pulmonary arterial hypertension (PAH) in congenital diaphragmatic hernia (CDH). In this prospective observational study, 3D-power Doppler ultrasonography was performed in 21 cases with isolated CDH between 23 and 33 weeks of gestation and in 58 controls between 20 and 40 weeks. Using the same preestablished settings for all cases, power Doppler was applied to each lung, and fetal lung volumes (FLV) were estimated using the rotational technique. The 3D power Doppler histogram was used to determine the vascular indices, which were plotted against gestational age and compared with neonatal outcome, PAH, gestational age, and FLV. Fetal pulmonary vascular indices showed a constant distribution throughout gestation, being significantly lower in cases with CDH than in controls (P < .001). Among CDH cases, the vascular indices were significantly lower in fetuses who died (P < .05), and in fetuses with neonatal PAH (P < .05). The severity of neonatal PAH was also associated with a progressive reduction in prenatal vascular indices (P < .05). All vascular indices correlated with o/e-FLV, but not with gestational age. All vascular indices seem to be constant throughout gestation. In isolated CDH, perinatal outcome and postnatal PAH can be predicted using the vascular indices assessed by 3D power Doppler histogram.

Assessment of changes in endometrial and subendometrial volume and vascularity during the normal menstrual cycle using three‐dimensional power Doppler ultrasound

To describe changes in endometrial and subendometrial volume and vascularity during the normal menstrual cycle using three-dimensional (3D) power Doppler ultrasonography. Fourteen healthy volunteers, 24-44 years old with regular menstrual cycles, underwent serial transvaginal 3D power Doppler ultrasound examinations of the uterus on cycle day 2, 3 or 4, then daily from cycle day 9 until follicular rupture and 1, 2, 5, 7 and 12 days after follicular rupture. Endometrial and subendometrial volume (cm3), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. Endometrial and subendometrial vascularity indices increased throughout the follicular phase, decreased to a nadir 2 days after follicular rupture and then increased again during the luteal phase. Endometrial and subendometrial volume increased rapidly during the follicular phase and then remained almost unchanged during the luteal phase. Substantial changes occur in endometrial volume and vascularization during the normal menstrual cycle. There is the potential for 3D power Doppler ultrasonography to become a useful tool for assessing pathological changes associated with female subfertility and abnormal uterine bleeding.

Three-dimensional power doppler ultrasound is useful to monitor the response to treatment in a patient with primary papillary serous carcinoma of the peritoneum

To date, this is the first report to monitor changes of intratumor vascularization and the response to radiation and Cyberknife therapy in a patient with recurrent primary papillary serous carcinoma of the peritoneum by three dimensional (3D) power Doppler ultrasonography (PDUS). Transvaginal 3D PDUS detected a recurrent presacral tumor with abundant intratumor vascularity. Serial examinations of the tumor volume and serum CA-125 level were studied before, during, and 6 mo after therapy. Meanwhile, the intratumor blood flow was measured and expressed as vascularity indices. All of the tumor volume, intratumor vascularity indices and serum CA-125 level decreased progressively following therapy. A remaining lesion with nearly absent intratumor power Doppler signals suggested a scarring lesion posttreatment. Indeed, CT-guided tissue biopsy confirmed fibrotic change. 3D PDUS is useful to monitor the response to treatments and to differentiate residual tumors from lesions of scarring change posttreatment. It provides more accurate posttreatment information than pelvic computed tomography. (E-mail: chougyn@mail.ncku.edu.tw)

Three-dimensional Doppler sonographic vascular imaging in regions with increased MR enhancement in inflamed wrists of patients with rheumatoid arthritis

Objective To compare three-dimensional (3D) power Doppler ultrasonography (PDUS) with contrast enhanced magnetic resonance imaging (MRI) in their capability to visualize synovial vascularity in inflamed wrists of patients with rheumatoid arthritis (RA). Methods Nine patients with RA showing clinically active arthritis of the wrist as determined by tenderness and swelling were examined by contrast enhanced MRI and 3D PDUS. Vascularity close to and inside the joint capsule was visualized by conventional power Doppler mode. In a region with high Doppler signal intensity (= region of interest/ROI) a 3D blood vessel tree was obtained by a free-hand sweep. 3D images were evaluated with regard to the number of blood vessels in the intra- and peri-articular region. MRI examinations were performed using a 1.5 T Scanner. In MRI, time resolved coronal contrast enhanced T1-weighted sequences with fat suppression were acquired during an 8 min period to assess tissue enhancement. Relative enhancement was calculated and compared to 3D PDUS findings. Results A 3D vascular tree consisting of peri- and intra-articular blood vessels could be demonstrated in the same anatomical ROI in which an increased gadolinium enhancement was measured by MRI in all examined RA patients. The number of penetrating vessels into the joint capsule, the number of intra-articular vessels and a semiquantitative estimation of the strength of blood flow were used to generate a 3D score for the intensity of synovial vascularity. Conclusion When compared with clinical symptoms and the gold standard dynamic MRI, 3D PDUS is a reliable imaging technique for assessing synovial vascularity in inflamed wrists of RA patients.

OC26.01: First trimester screening for trisomy 21: a statewide evaluation

Objective: To compare the usefulness of two angiogenesis markers: VCAM-1 and CD-105 measurements with Doppler and 3D vascular blood flow indices in women with benign and malignant adnexal masses. Methods: Preoperative transvaginal color Doppler followed by 3D power Doppler sonography (Voluson 730, GE, Austria) was performed in 79 patients. Doppler blood flow indices: PI, RI and PSV were calculated in detected tumor vessels. Tumor volume and 3D vascular blood flow indices: VI, FI and VFI were measured (VOCAL software) in all cases. Serum concentrations of VCAM-1 and CD-105 (RD p = 0.0003), RI (0.62 vs 0.48; p = 0.0013), VI (3.48 vs 1.28; p = 0.00002) and VFI (0.46 vs 1.87; p = 0.001). Mean (±SD) serum VCAM-1 concentrations were not significantly different in malignant (297.2 ± 148 ng/ml) and benign (357.8 ± 227 ng/ml) adnexal tumors (p > 0.05). Also, mean serum CD105 concentrations were not significantly different in malignant (4.15 ± 1.35 ng/ml) vs benign (4.46 ± 1.03 ng/ml) masses (p > 0.05). Significant correlations between sonographic and serum markers were only found for PI and VCAM-1 (p = 0.033) and RI and VCAM-1 (p = 0.0002). Endoglin and VCAM-1 concentrations were not correlated with each other (p = 0.37). Conclusions: Three-dimensional sonoangiography and Doppler assessment of adnexal tumors blood flow and vascularity, but not soluble VCAM-1 or endoglin serum concentrations are effective in differential diagnosis of angiogenesis in detected benign or malignant lesions. Acknowledgement: This study was supported by the Polish Ministry of Science grant # KBN 3P0 5E 115 24.

OC25.04: Malignant and benign adnexal tumor vascularity assessment with three‐dimensional (3D) power Doppler sonography, soluble vascular adhesion molecule‐1 (VCAM‐1) and soluble endoglin (CD‐105) measurements

OC25.04: Malignant and benign adnexal tumor vascularity assessment with three‐dimensional (3D) power Doppler sonography, soluble vascular adhesion molecule‐1 (VCAM‐1) and soluble endoglin (CD‐105) measurements

Three-Dimensional Power Doppler Sonography in the Diagnosis of Arteriovenous Malformation of the Uterus

Arteriovenous malformations (AVMS) are uncommon vascular lesions that may arise in the myometrial layer of the uterus, causing menometrorrhagia. 1 - 3 As reported previously, they are amenable to sonographic detection, 4 - 8 although Doppler ultrasound examinations are not always able to distinguish true AVMs from other types of vascular lesions of the uterus. X-ray angiography is commonly required to confirm the diagnosis and to establish the appropriate treatment.7-9 In this case, 3-dimensional (3D) power Doppler sonography was valuable in diagnosing a true AVM of the uterus.

Recent advances in sonographic imaging of fetal thoracic structures

Recent ultrasonographic methods applied in the evaluation of fetal thoracic structures and anomalies are presented. Fetal lung volumetric assessment by 3D ultrasonography, analysis of the thoracic wall by 3D-rendered image and 3D skeletal-mode imaging, intrathoracic vessel evaluation by 3D power Doppler ultrasonography, analysis of heart anatomy and abnormalities by 4D spatiotemporal image correlation™, identification of normal and abnormal intrathoracic almost isoechogenic structures by volume contrast imaging and evaluation of the heart and great vessels by 3 and 4D inverse mode will be reviewed.

P09.13: Clinical application of 3D power Doppler ultrasound in fetal medicine and reproductive biology

Objective: To assess the clinical application of three-dimensional (3D) power Doppler ultrasound (PDU) in fetal medicine and reproductive biology. Methods: In this project, we evaluated the clinical use of 3D PDU in the following aspects of fetal medicine and reproductive biology. Part I. Fetal medicine: Fetal organ circulation development assessment, including the vascularization and blood flow of (1) fetal brain, (2) fetal liver, and (3) placenta. Part II. Reproductive biology: The difference of ovarian vascularization and blood flow in the following conditions were compared: (1) Pre-, periand post-menopause stages, (2) Before and after hormonal therapy in postmenopausal women, (3) In endometriosis, (4) In polycystic ovary syndrome (PCO), (5) In hyper-responders of IVF patients, and (6) In poorresponders of IVF patients. Results: In fetal medicine, our studies using 3D PDU showed that the brain VI (vascularization index), FI (flow index) and VFI (vascularization-flow index) are increasing with gestational age in normal pregnancies. Similarly, the hepatic VI, FI, and VFI are also increasing with gestational age. Furthermore, the placental VI, FI, and VFI are increasing with gestational age. On the other hand, for the six projects of studies in reproductive biology, 3D PDU revealed that all the blood flow indexes (VI, FI and VFI) are significantly different in each group. Conclusions: From our studies, 3D PDU may be a clinically important tool in the clinical application on fetal medicine and reproductive biology.

OC093: Comparison of follicular vascularization between normal and polycystic ovaries during IVF as measured using 3D power Doppler ultrasonography

OC093: Comparison of follicular vascularization between normal and polycystic ovaries during IVF as measured using 3D power Doppler ultrasonography

OC172: Ovarian tumor vascularity assessment with the use of 3D power Doppler sonography and vascular blood flow indices measurements

OC172: Ovarian tumor vascularity assessment with the use of 3D power Doppler sonography and vascular blood flow indices measurements

Impaired ovarian blood flow and reduced antral follicle count following laparoscopic salpingectomy for ectopic pregnancy.

Whether salpingectomy affects ovarian function is controversial. In this study, ovarian function was assessed by antral follicle count, ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasonography. The objectives of the study were to compare the ovarian function of the operated side with the non-operated side after unilateral salpingectomy performed through laparoscopy or laparotomy for ectopic pregnancy. Thirty-two patients with unilateral salpingectomy performed for ectopic pregnancy were recruited: 18 through laparoscopy and 14 through laparotomy. Ultrasound scans were performed in the early follicular phase. Ovarian volume, antral follicle count and 3D power Doppler indices were comparable between the operated and the non-operated sides in the whole group and in the laparotomy group. The antral follicle count and 3D power Doppler indices were significantly reduced on the operated side in the laparoscopy group. Ovarian function seems to be impaired after laparoscopic unilateral salpingectomy at short-term assessment.

Quantification of Doppler signal in polycystic ovarian syndrome using 3D power Doppler ultrasonography

Quantification of Doppler signal in polycystic ovarian syndrome using 3D power Doppler ultrasonography

3D-Power Doppler Ultrasound of Breast Lesions with a Microbubble Contrast Agent

3D-Power Doppler Ultrasound of Breast Lesions with a Microbubble Contrast Agent

Quantification of Doppler signal in polycystic ovary syndrome using three-dimensional power Doppler ultrasonography: a possible new marker for diagnosis

Differences in the ovarian stromal blood flow of women embarking on an IVF treatment, as assessed on day 2 or 3 of the menstrual cycle, using three-dimensional (3D) power Doppler ultrasonography to quantify the blood flow and vascularization, were compared. The women were divided into two groups: group 1, 54 women with regular, ovulatory menstrual cycles and normal ovaries on ultrasound scan; and group 2, 25 women with polycystic ovary syndrome (PCOS). The quantification of Doppler signal in the ovarian stroma appeared to be greater in the PCOS group compared with the normal group. The mean of ovarian volume was significantly higher (P < 0.05) in women with PCOS compared with the normal ovaries. The vascularization flow index (VFI), flow index (FI), and vascularization index (VI), were significantly higher (P < 0.05) in the women with PCOS compared with the women with normal ovaries. This observation may help to explain the excessive response often seen during gonadotrophin administration in women with PCOS. We believe that a quantification study of the vascular flow, including the VI, FI, and VFI of the entire ovarian stroma using 3D power Doppler, is more accurate than the previously reported quantification analysis using 2D imaging, and may be a new parameter to assist in the ultrasound diagnosis of PCOS.

Three‐dimensional power Doppler sonography in screening for carotid artery disease

Purpose Color Doppler sonography has gained considerable recognition as a noninvasive method to detect carotid artery disease and to assess the degree of carotid artery stenosis. However, results are highly operator-dependent and cannot be presented as survey images. The purpose of this study was to evaluate real-time 3-dimensional (3D) power Doppler sonography as a method for screening for atherosclerosis in the carotid arteries. Methods We prospectively screened 75 patients for carotid artery disease using both conventional color Doppler sonography and 3D power Doppler sonography, and the results from the 2 modalities were compared. A total of 150 common carotid arteries, 150 internal carotid arteries, and 150 external carotid arteries were examined utilizing a 7.5-MHz linear-array transducer combined with tissue harmonic imaging. Results Color Doppler sonography detected 297 normal or atherosclerotic arteries without stenosis, 57 arteries with mild (1–49%) stenosis, 41 with moderate (50–69%) stenosis, 32 with severe (70–99%) stenosis, and 9 with occlusions. The degree of stenosis determined by color Doppler sonography correlated with that determined by 3D power Doppler sonography (r = 0.982–0.998). Moreover, there was a good correlation between the measurements for both the length of the lesion and its distance from the bulb as determined by the 3D volume surveys and by color Doppler sonography (r = 0.986). The interobserver variability rate was 3.7% ± 0.5%. Generally, the acquisition and reconstruction of the 3D data took less than 5 minutes. Conclusions 3D power Doppler sonography is easy to perform and is an accurate method in screening for atherosclerotic lesions of the carotid arteries. Moreover, it provides excellent 3D volume surveys that may be helpful in the planning of surgical treatment. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:441–451, 2000.

WS09‐06What does contrast media add to three dimensional power Doppler evaluation of adnexal masses?

AimTo investigate the potential usefulness of contrast enhanced three‐dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions.MethodsA total of 31 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three‐dimensional power Doppler sonography before and after injection of the contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy.The results were compared with histopathology.ResultsThere were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of the 10 ovarian cancers, 6 (60%) showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy with two benign lesions (fibroma and cystadenofibroma) which were misdiagnosed as malignant. The use of a contrast agent with three‐dimensional power Doppler sonography showed diagnostic efficiency (96.7%) that was superior to nonenhanced 3D power Doppler sonography (93.5%).ConclusionContrast enhanced 3D power Doppler sonography provides better visualizatoin of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.