Color Power Doppler Imaging Research Articles

Percutaneous Intrauterine Laser Ablation of the Abnormal Vessel in Pulmonary Sequestration With Hydrops at 29 Weeks' Gestation

Congenital pulmonary sequestration (PS) is a rare malformation consisting of a nonfunctioning bronchopulmonary mass separated from the tracheobronchial tree, which receives an arterial blood supply directly from the systemic circulation. 1 The key feature for diagnosing fetal PS is the identification of a hyperechoic pulmonary mass with an abnormal blood supply. 2 ' 3 The systemic artery from the aorta to the fetal lung mass can be detected by 2-dimensional (2D) color power Doppler imaging 2,3 ; however, 3-dimensional (3D) power Doppler ultrasonography may be even more sensitive. 4 Distinguishing PS from a type III congenital cystic adenomatoid malformation is of interest for prenatal counseling of the parents and for planning postnatal treatment. 5 Although nonimmune hydrops fetalis rarely occurs in cases of PS, it is associated with a high rate of perinatal mortality and severe respiratory insufficiency in the neonate.6'7 Different strategies of in utero treatment have been proposed, such as thoracoamniotic shunting of pleural effusion, 8,9 alcohol ablation of the vascular pedicle, 10 and open fetal surgery. 11 However, prenatal treatment of such cases remains controversial. Another therapeutic option is reported here, which consists of promoting ablation of the abnormal systemic artery from the aorta to the PS at 29 weeks' gestation. In this case, the diagnosis was made by 2D color Doppler ultrasonography. Three-dimensional power Doppler imaging revealed that the abnormal arterial pedicle was in close proximity to the pulmonary vein, leading to a vascular shunt phenomenon and hydrops fetalis. The therapeutic option described appears to act directly on the physiopathologic process of PS, providing an interesting option for such cases.

Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with 3-dimensional color power Doppler imaging and successful treatment with uterine artery embolization

Objective The purpose of this study was to investigate the use of a 3-dimensional virtual organ computer-aided analysis imaging system for the monitoring of the quantification of changes of uterine neovascularization before and after successful treatment with uterine artery embolization in cesarean scar pregnancy. Study design A case of cesarean scar pregnancy that was associated with extensive uterine neovascularization was diagnosed at 8 weeks of gestation with the 3-dimensional virtual organ computer-aided analysis imaging system. After appropriate counseling, a bilateral uterine arteries embolization procedure was performed with nonresorbable microspheres by interventional radiologists. Results The gestational cystic mass at the site of previous cesarean scar completely disappeared at the follow-up examination 3 months later. Conclusion A 3-dimensional virtual organ computer-aided analysis imaging system can be used for the monitoring of the quantification of changes of uterine neovascularization before and after successful treatment with uterine artery embolization in cesarean scar pregnancy.

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Comparison of ultrasonographic and Doppler mapping of the intervillous circulation in normal and abnormal early pregnancies

Objective To assess the value of ultrasonography and Doppler imaging in characterizing the intervillous circulation in normal and abnormal early pregnancy. Design Cross-sectional study. Setting Tertiary care academic hospital. Patient(s) Eighty-five normal pregnancies and 125 missed miscarriages at 7 to 13 weeks of gestation. Intervention(s) Grey-scale ultrasonography was used to evaluate the placental anatomy and detect moving echoes inside the intervillous space, and color power Doppler imaging was used to detect continuous venous-like flow in the placental tissue. Main outcome measure(s) Degree of agreement between two investigators for use of grey-scale imaging, comparison of detection of moving echoes in normal and abnormal pregnancies, and comparison of detection of intervillous circulation with grey-scale and color Doppler imaging in abnormal pregnancies. Result(s) The overall degree of agreement between the two investigators was good. A significantly different distribution of blood flow was found between normal and abnormal pregnancies at 7 to 9 weeks and 10 to 11 weeks but not at 12 to 13 weeks. Intervillous moving echoes were detected by grey-scale imaging significantly more frequently than an intervillous blood flow was detected with color Doppler imaging. Conclusion(s) In early pregnancy failure, there is a premature and diffuse onset of intervillous blood flow that can be detected by grey-scale imaging. This abnormal blood flow pattern may increase the oxidative stress on the early placental tissue and subsequently impair placental development.

Three-dimensional color power Doppler imaging in the assessment of uteroplacental neovascularization in placenta previa increta/percreta

A case of placenta previa increta/percreta was diagnosed at 18 weeks’ gestation with the 3-dimensional color power Doppler imaging technique. Unusually extensive uteroplacental vascular network architecture was seen on the 3-dimensional angiohistogram. After appropriate counseling, the patient chose to terminate the pregnancy. A hysterectomy was performed with prophylactic preoperative embolization of internal iliac arteries at 21 weeks’ gestation, and histopathologic examination revealed placenta previa increta/percreta. This new 3-dimensional angiohistogram technique allowed us to visualize all 3 orthogonal planes of the angioarchitectural information. It appears to be a useful complementary tool and is likely to play a more defining and clarifying role in assessing the quantification of abnormal uteroplacental neovascularization for patients with placenta previa increta/percreta. (Am J Obstet Gynecol 2001;185:1257-60.)

Imaging of placental vasculature using three-dimensional ultrasound and color power Doppler: a preliminary study.

To assess placental vasculature using color power Doppler and three-dimensional ultrasound techniques. A prospective study was performed in patients to correlate visualization of placental vessels in vivo with known anatomy. Fourteen normal patients and one patient with intrauterine growth restriction were recruited to the study. Vessels were assessed with regard to, first, the number of vessels seen within the placenta, second, the branching pattern of the vessels within the placenta, third, the number of vessels seen along the surface of the placenta, and, last, the number of vessels seen in the maternal circulation. Our results show that the placental vessels seen with this technique correlate well with known anatomy. A progressive increase in the number of intraplacental vessels and the number of vascular branches observed was seen with increasing gestational age. Volume data review using three orthogonal planar images had two distinct advantages. First, they could be obtained from orientations not possible using two-dimensional ultrasound alone, and, second, they could be viewed in conjunction with volume-rendered images to allow for referencing and identification of specific vessels. Volume-rendered images were valuable in allowing the observer to acquire an improved overall understanding of placental anatomy. They also assisted the observer in following the continuity of vessels as they wrapped around and twisted through three-dimensional space. Stereo viewing was helpful in distinguishing overlapping vessels. Our study showed that sonographic volume imaging combined with color power Doppler imaging methods allowed for individual vessels in the placenta to be identified, both in the fetal and maternal circulations.