High-definition Flow Imaging Research Articles

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging.

This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

Application of Color Doppler with 3- and 4-Dimensional Ultrasonography in the Prenatal Evaluation of Fetal Extracardiac and Placental Abnormalities

Using color Doppler flow imaging or high-definition flow imaging with three-dimensional volume or spatio-temporal image correlation (STIC) in the glass-body mode allows displaying both gray-scale and color information of the heart cycle-related flow events and vessel spatial relationship. Conventionally, STIC in the glass-body mode has been used to examine the fetal heart and assess heart defects. Recently, a novel application of STIC in the visualization of abdominal precordial veins and intraplacental vascularization in singleton pregnancies has been reported. The aim of this present review is to discuss the use of color Doppler with three- and four-dimensional ultrasonography in the evaluation of extracardiac, placental, umbilical cord and twin abnormalities with examples. The glass-body mode is complementary to conventional 2D ultrasonography. Further studies are required to investigate use of the glass-body mode in the assessment of intraplacental vascularization in singleton and twin pregnancies.

Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester.

This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging (CDFI) technology and the high-definition flow imaging (HDFI) technique in detecting fetal pulmonary veins (PVs) in the first trimester (11-13+6 weeks). From December 2018 to October 2019, 328 pregnant women with 328 normal singleton fetuses (crown-rump length: 45-84 mm) who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study. The cases were divided into three groups according to the gestational age: group A, 11+0 -11+6 weeks; group B, 12+0 -12+6 weeks; and group C, 13+0 -13+6 weeks. Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly. The abilities of CDFI and HDFI to display PVs were compared. Successful PV display rates via CDFI and HDFI were 2.3% and 68.2% (P<0.01), 22.4% and 82.4% (P<0.01), 41.5% and 91.2% (P<0.01) for group A, group B, and group C, respectively. The total successful display rates for the two methods were 28.9% (CDFI) and 84.8% (HDFI) (P<0.01). The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy (11-13+6 weeks). HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.

Update on Color Flow Imaging in Obstetrics.

Color flow imaging (CFI), being non-invasive, is commonly used in obstetrics to study the fetal and placental circulations. The conventional CFI modes include color Doppler flow imaging (CDFI) and power Doppler imaging (PDI). In recent years, there is increasing use of new modes, including high-definition flow imaging (HDFI), radiant flow, microvascular flow imaging (MVFI), and three-/four-dimensional rendering in glass-body mode. Compared to CDFI, HDFI can show a higher resolution and sensitivity and allow the detection of slower flows. MVFI increases the sensitivity to fine or low-flow vessels while producing little or no motion artifacts. Radiant flow shows the blood flow with a sense of depth and reduces blood overflow. Glass-body mode, showing both gray-scale and color-flow information, can demonstrate the heart-cycle-related flow events and the vessel spatial relationship. In this review, the characteristics and applications of the various CFI modes in obstetrics are discussed. In particular, how these new technologies are integrated in detailed diagnostic and early morphology scans is presented.

Prenatal diagnosis of an aberrant ductus venosus draining into the coronary sinus using two- and three-dimensional echocardiography: a case report

BackgroundDuctus venosus (DV) abnormalities may be associated with intracardiac or extracardiac deformities, chromosomal anomalies, and/or congestive heart failure. Aberrant DV connecting with the coronary sinus (CS) is rare and the prenatal diagnosis presents challenges for most examiners.Case presentation A 35-year-old pregnant woman, gravida 2, para 1, was referred to our center at 27 gestational weeks for a full evaluation of fetal cardiac anomalies. Transverse scans indicated normal cardiac anatomy except for a dilated CS; we then scanned sagittal planes to clarify the reasons for the CS dilatation. High-definition flow imaging (HDFI) together with radiant flow (R-flow) imaging was used to delineate the aberrant DV returning to the CS, enabling the diagnosis. Three-dimensional (3D) technology was also used to obtain color-rendered images showing the spatial relationships of the vessels involved, thus confirming the two-dimensional (2D) diagnosis. Chromosomal analysis revealed a normal karyotype. The neonate appeared healthy and the echocardiogram showed a normal cardiac anatomy except for a dilated CS with the DV closed and imperceptible.ConclusionsThe aberrant course of the DV returning to the CS was clearly demonstrable by traditional 2D echocardiography using HDFI and the R-flow technique. We deem it helpful to trace the inflow of the dilated CS to make the differential diagnosis. The 3D modality might also provide additional spatial information on the associated vessels and thereby assist in prenatal diagnosis.

Prenatal diagnosis of coarctation of the aorta with a long and angled isthmus by two- and three-dimensional echocardiography: a case report

BackgroundPrenatal diagnosis of coarctation of the aorta (CoA) is challenging for most examiners. The malformation often occurs at the aortic isthmus, which is a short segment between the origin of the left subclavian artery and the insertion of the ductus. We report herein a rare case of CoA with a long, angled, and hypoplastic isthmus. The echocardiographic characteristics and postmortem findings are presented to approach the skill of fetal diagnosis.Case presentationA pregnant women undergone fetal echocardiography at 26 + 3 gestational weeks in our center. Conventional two-dimensional echocardiography (2DE) showed that ascending aorta went straight upward branching three brachiocephalic arteries without the appearance of the arch, suggesting the possibility of an interrupted aortic arch. Three-dimensional echocardiography (3DE) using spatiotemporal image correlation (STIC) and high-definition flow imaging technique was performed to obtain the 3D rendered images, which clearly showed the arch and its angled junction with the slim isthmus in space. Intra-uterine fetal death occurred and an autopsy was performed. The gross findings showed the angled hypoplastic aortic isthmus in detail and thus confirmed the prenatal diagnosis.ConclusionsTraditional 2DE may be limited in showing the angled hypoplastic aortic isthmus, while the 3DE STIC technique can provide additional spatial information to show great arteries in detail, help to find tiny vessels, and thus benefit the examiners to make an accurate diagnosis.

Prediction of congenital diaphragmatic hernia with abnormal course of fetal superior mesenteric artery detected by ultrasound in first-trimester

Objective To investigate the clinical value of abnormal course of fetal superior mesenteric arteries (SMA) detected by ultrasound during the first trimester (11-13+6 weeks) in predicting congenital diaphragmatic hernia (CDH). Methods This study enrolled women who underwent fetal nuchal translucency (NT) screening during the first trimester in Central Hospital of Panyu District from March to December 2017. Low-speed high-definition flow imaging was used to observe the course of fetal SMA, and it was regarded as abnormal when the angle between SMA and abdominal aorta >90°. Once abnormal course of the SMA was suspected, the position of fetal thoracic cavity and abdominal organs would be scanned carefully. Furthermore, ultrasound examinations would be repeated at 16-18, 20-24, 28-32 and 37-40 weeks of gestation. Fetus diagnosed as CDH by ultrasound would be scheduled for MRI or autopsy to confirm the diagnosis. Pregnancy outcomes of all cases were followed up by telephone. Descriptive statistical analysis was used in this study. Results A total of 6 899 gravidas (6 964 fetuses) underwent NT scan during the first trimester were enrolled and the SMA of all fetuses were successfully displayed. Three cases with abnormal course of the SMA were identified. Two of them were diagnosed with left CDH at 17+ and 23+ weeks of gestation, which was confirmed by autopsy after termination of pregnancy, and the other one terminated pregnancy in first trimester due to a large omphalocele. Among the 6 961 fetuses with normal SMA, the pregnancy outcomes of 6 120 were successfully followed up, only one of which was found to have left CDH at 32 gestational weeks by ultrasound examination, and was later confirmed by neonatal MRI after delivery. No other fetal CDH was detected. Conclusions Abnormal course of the SMA identified in early pregnancy may be a simple and effective indicator for CDH that allow early intervention and treatment. Key words: Pregnancy trimester, first; Mesenteric artery, superior; Congenital abnormalities; Hernias, diaphragmatic, congenital; Forecasting

Strategies for Accurate Diagnosis of Fetal Aortic Arch Anomalies: Benefits of Three-Dimensional Sonography With Spatiotemporal Image Correlation and a Novel Algorithm for Volume Analysis

Obtaining an accurate diagnosis of fetal aortic arch anomalies is often difficult with traditional two-dimensional (2D) sonography. Thus, the aim of this study was to assess the value of three-dimensional (3D) sonography with spatiotemporal image correlation for diagnosing fetal aortic arch anomalies using a novel algorithm for 3D volume analysis. Two-dimensional and 3D echocardiographic image data from 300 normal fetuses and 30 fetuses with aortic arch anomalies were retrospectively reviewed. Grayscale and high-definition flow imaging data were available for 2D echocardiography. Three-dimensional volumes were acquired in parasagittal views with high-definition flow imaging information. Volume postprocessing was performed using a novel algorithm to obtain 3D tomographic ultrasound imaging slices and color-rendered images. Detection of aortic arch positions, aberrant brachiocephalic patterns, and aortic arch anomalies was compared for 2D and 3D modalities. Postnatal echocardiography was used as the truth standard in assessing aortic anatomy. In total, four cases of double aortic arch, 21 cases of right aortic arch, one case of retroesophageal aortic arch, and four cases of left aortic arch with aberrant right subclavian arteries were included. Inter- and intraobserver agreement were excellent for 2D and 3D modalities. The 3D modality offered better sensitivity and accuracy compared with 2D imaging for the detection of brachiocephalic anomalies (P<.01) and arch anomalies (P<.01) but comparable sensitivity for arch position. There was no difference in specificity for both modalities. The proposed novel algorithm for volume postprocessing ensures that 3D reconstructed images are obtained with high repeatability. The addition of 3D spatiotemporal image correlation to fetal echocardiography may offer a more accurate diagnosis for arch anomalies.

Severe tortuous intra-abdominal segment of isolated single umbilical artery by three-dimensional high-definition flow imaging

The authors report a tortuous intra-abdominal segment of isolated single umbilical artery (SUA) that proved to be an omega-shaped variant by three-dimensional high-definition-flow (3D-HD-flow) imaging. A 28-year-old woman was referred to the present center for detailed fetal echocardiography examination after finding SUA during routine two-dimensional ultrasound examination at 24+3 weeks’ gestation. 3D-HD-flow demonstrated a severely tortuous and dilated intra-abdominal segment of SUA mimicking omega-shaped variant. Postnatal abdominal ultrasound and cardiac examination were unremarkable. This case suggests that the omega-shaped variant of SUA is probably a normal variant when unassociated with other structural anomalies. When a locally dilated umbilical artery is detected during routine 2D ultrasound, the authors recommend using 3D color Doppler imaging to more precisely determine the course of the umbilical artery.

Role of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation in detecting fetal pulmonary veins.

Prenatal diagnosis of fetal total anomalous pulmonary vein connection (TAPVC) remains challenging for most screening sonographers. The purpose of this study was to evaluate the use of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation (4D-HDFI) in identifying pulmonary veins in normal and TAPVC fetuses. We retrospectively reviewed and performed 4D-HDFI in 204 normal and 12 fetuses with confirmed diagnosis of TAPVC. Cardiac volumes were available for postanalysis to obtain 4D-rendered images of the pulmonary veins. For the normal fetuses, two other traditional modalities including color Doppler and HDFI were used to detect the number of pulmonary veins and comparisons were made between each of these traditional methods and 4D-HDFI. For conventional echocardiography, HDFI modality was superior to color Doppler in detecting more pulmonary veins in normal fetuses throughout the gestational period. 4D-HDFI was the best method during the second trimester of pregnancy in identifying normal fetal pulmonary veins. 4D-HDFI images vividly depicted the figure, course, and drainage of pulmonary veins in both normal and TAPVC fetuses. HDFI and the advanced 4D-HDFI technique could facilitate identification of the anatomical features of pulmonary veins in both normal and TAPVC fetuses; 4D-HDFI therefore provides additional and more precise information than conventional echocardiography techniques.

Using Flow Characteristics in Three-Dimensional Power Doppler Ultrasound Imaging to Predict Complete Responses in Patients Undergoing Neoadjuvant Chemotherapy.

Strategies are needed for the identification of a poor response to treatment and determination of appropriate chemotherapy strategies for patients in the early stages of neoadjuvant chemotherapy for breast cancer. We hypothesize that power Doppler ultrasound imaging can provide useful information on predicting response to neoadjuvant chemotherapy. The solid directional flow of vessels in breast tumors was used as a marker of pathologic complete responses (pCR) in patients undergoing neoadjuvant chemotherapy. Thirty-one breast cancer patients who received neoadjuvant chemotherapy and had tumors of 2 to 5 cm were recruited. Three-dimensional power Doppler ultrasound with high-definition flow imaging technology was used to acquire the indices of tumor blood flow/volume, and the chemotherapy response prediction was established, followed by support vector machine classification. The accuracy of pCR prediction before the first chemotherapy treatment was 83.87% (area under the ROC curve [AUC] = 0.6957). After the second chemotherapy treatment, the accuracy of was 87.9% (AUC = 0.756). Trend analysis showed that good and poor responders exhibited different trends in vascular flow during chemotherapy. This preliminary study demonstrates the feasibility of using the vascular flow in breast tumors to predict chemotherapeutic efficacy.

The application of high definition flow imaging in fetal hemodynamics

Objective: This work aims to investigate the application of high definition flow imaging (HD-flow) in fetal hemodynamics, and establish reference range of hemodynamic parameters in fetal with different gestational ages. Materials and Methods: A thousand of normal pregnant women were divided into five groups: 18-22, 23-27, 28-32, 33-37, and 38-40 gestational weeks. Color Doppler flow imaging (CDFI) and HD-flow were adopted to display the heart structure and measure the blood flow velocity. The pulmonary vein display results were scored. The results of HD-flow and CDFI were compared. Results: The catheter peak velocity of fetal mitral, tricuspid, aortic, pulmonary artery, aortic arch, ductal arch, the inferior vena cava, pulmonary vein, and venous catheter increased continuously with the increase of gestational age, showing a linear correlation. HD-flow was superior to CDFI on the display of pulmonary vein in 18-22, 23-27, and 28-32 weeks (p Conclusion: HD-flow can make accurate evaluation of fetal hemodynamics and the demonstration of low blood flow, such as pulmonary venous, is better than CDFI. Pulmonary veins can be accurately positioned with HD-flow. HD-flow can demonstrate the main blood vessels of the whole fetal circulation and can display the spatial relationship of the blood vessels. It is of important clinical significance in hemodynamic study.

Spatio-temporal image correlation with high definition flow imaging in diagnosis of anomalies of fetal venous connections

Objective To investigate the role of spatio temporal image correlation (STIC) combined with high definition flow(HDF) in the diagnosis of anomalies of fetal veins connections.Methods HDF-STIC volumes datasets were collected and grey-scale 2-dimensional imaging were obtained in 50 normal fetuses and 48 fetuses with anomalies of fetal veins connections.Results Successful acquisition of HDF-STIC volumes data in 46 normal fetuses and in 43 fetuses with abnormal veins connections.The rate of umbiliciat vein,ductus venous,inferior vena cave and pulmonary vein demonstrated by color Doppler flow imaging(CDFI) were 90％,80％,84％,40％ and those demonstrated by HDF-STIC were 90％,90％,89％,82％ in normal fetuses.Only sixteen (16/20)cases with persistent left superior vena cava were founded by CDFI while twenty (20/20) cases were founded by HDF,six (6/7)cases with anomalies of umbilical venous connection were displayed by in CDFI while seven (7/7)cases were displayed by in HDF,five (5/6)cases with abnormalities of inferior vena cava were displayed by CDFI while six(6/6) cases were displayed by HDF,five(5/10) cases with anomalous pulmonary venous connection were displayed by CDFI but seven(7/ 10) cases were displayed by HDF.Conclusions HDF-STtC could supplying additional information over 2D fetal sonography and facilitate identification of the anatomical features of normality and abnormalities of fetal veins connectiona.Therefore,HDF-STIC is beneficial to prenatal diagnosis of anomalies of fetal veins connection. Key words: Ultrasonography, prenatal; Umbilical veins; Ductus venous; Vena cava, inferior; Pulmonary veins

Are there any differences in three-dimensional placental vascular indices obtained using conventional power Doppler and high-definition flow imaging?

Objective: The purpose of this study was to determine whether there are differences in values and reproducibility of three-dimensional (3D) vascular indices obtained on placental volumes using power Doppler (PD) or high-definition flow imaging (HDFI) techniques. Methods: A prospective study was performed on 121 uncomplicated singleton pregnancies at 11 + 0 to 13 + 6 weeks of gestation. Two placental volumes were acquired from each pregnancy. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were then analyzed and compared. In order to assess the reproducibility of the measurements, two additional placental volumes obtained with both PD and HDFI were acquired in 31 pregnancies and the agreement assessed by intraclass correlation coefficients. Inter-observer variability was assessed by analyzing all the volumes by two observers blinded to each other’s. Results: A significant relationship was observed between the vascular indices values obtained with the two techniques (VI Pearson’s r = 0.891 p < 0.001; FI r = 0.769 p < 0.001; VFI r = 0.847 p < 0.001). The median values of VI, FI and VFI were significantly higher when obtained with HDFI imaging. In serial recordings, the ICCs resulted higher when volumes were acquired with HDFI rather than with PD techniques. Similarly, HDFI demonstrated a higher inter-observer reproducibility. Conclusions: 3D vascular indices calculated using HDFI are higher than those calculated using conventional PD. Although the relationship between the two methods is high, HDFI shows a better reproducibility suggesting its potential clinical application.

Three‐dimensional high‐definition flow imaging in prenatal diagnosis of a true umbilical cord knot

Three‐dimensional high‐definition flow imaging in prenatal diagnosis of a true umbilical cord knot

Three-Dimensional Vascular Indices Calculated Using Conventional Power Doppler and High-Definition Flow Imaging

The purpose of this study was to determine whether there are differences in 3-dimensional (3D) vascular indices when calculated using high-definition flow imaging (HDF) and power Doppler imaging (PD). Twenty-five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28-33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) from the endometrium. The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Three-dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.

OP28.07: Efficacy of routine transabdominal fetal heart screening at the time of NT measurements: role of high-definition blood flow imaging mode

OP28.07: Efficacy of routine transabdominal fetal heart screening at the time of NT measurements: role of high-definition blood flow imaging mode

Three‐Dimensional Ultrasonographic Depiction of Fetal Abdominal Blood Vessels

The purpose of this study was to identify fetal abdominal vasculature with 3-dimensional (3D) ultrasonography and to describe a systematic method for analysis of volume data sets. Three-dimensional volumes of the fetal abdomen were acquired prospectively in 30 patients between 15 and 34 weeks' gestation with color Doppler, high-definition (HD) flow, power Doppler, and B-flow imaging. All volumes were analyzed offline by 2 examiners separately. The feasibility of identifying the fetal abdominal blood vessels was analyzed. A standardized approach was applied to identify specific vessels by correlating the images with known anatomic landmarks. The volumes were rotated into an anatomic orientation in the multiplanar mode, and then the vessels were identified in the following order: aorta (30 of 30), celiac trunk (29 of 30), superior mesenteric vein (28 of 30 and 26 of 30 for readers 1 and 2, respectively), superior mesenteric artery (29 of 30), left renal artery (25 of 30 and 26 of 30), right renal artery (27 of 30), common iliac arteries (30 of 30), umbilical arteries (26 of 27), external iliac arteries (20 of 22), umbilical vein (29 of 30), ductus venosus (30 of 30), hepatic vein (29 of 30), right portal vein (29 of 30), inferior vena cava (28 of 30), adrenal artery (2 of 30), hepatic artery (24 of 30 and 23 of 30), splenic artery (24 of 30 and 23 of 30), gastric artery (14 of 30 and 9 of 30), splenic vein (19 of 30 and 15 of 30), and renal vein (1 of 30). A step-by-step systematic approach to identify the abdominal vasculature from the ultrasonographic volume data set was developed. Fetal abdominal vessels can be easily visualized when a systematic analysis is performed on 3D data set volumes. Visualization of the vessels was optimal when volumes were acquired with HD flow imaging.

Aktueller Stand der 3D-/4D-Volumensonografie der Mamma

3D/4D volume ultrasound is an established method that offers various options for analyzing and presenting ultrasound volume data. The following imaging techniques are based on automatically acquired ultrasound volumes. The multiplanar view is the typical mode of 3D ultrasound data presentation. The niche mode view is a cut open view of the volume data set. The surface mode is a rendering technique that represents the data within a volume of interest (VOI) with different slice thicknesses (typically 1-4 mm) with a contrast-enhanced surface algorithm. Related to the diagnostic target, the transparency mode helps to present echopoor or echorich structures and their spatial relationships within the ultrasound volume. Glass body rendering is a special type of transparency mode that makes the grayscale data transparent and shows the color flow data in a surface render mode. The inversion mode offers a three-dimensional surface presentation of echopoor lesions. Volume Contrast Imaging (VCI) works with static 3D volume data and is able to be used with 4D for dynamic scanning. Volume calculation of a lesion and virtual computer-assisted organ analysis of the same lesion is performed with VoCal software. Tomographic Ultrasound Imaging (TUI) is the perfect tool to document static 3D ultrasound volumes. 3D/4D volume ultrasound of the breast provides diagnostic information of the coronal plane. In this plane benign lesions show the compression pattern sign, while malignant lesions show the retraction pattern or star pattern sign. The indeterminate pattern of a lesion combines signs of compression and retraction or star pattern in the coronal plane. Glass body rendering in combination with Power-Doppler, Color-Doppler or High-Definition Flow Imaging presents the intra- and peritumoral three-dimensional vascular architecture. 3D targeting shows correct or incorrect needle placement in all three planes after 2D or 4D needle guidance. In conclusion, it is safe to say that 3D/4D volume ultrasound of the breast is technically advanced and suitable for daily diagnostic and interventional breast work in addition to routinely used 2D sonography.