High-definition Flow Research Articles

Prenatal Diagnosis of Persistent Left Superior Vena Cava Using High-Definition Flow Render Mode and Spatiotemporal Image Correlation.

This study aimed to assess the use of two-dimensional (2D) ultrasound combined with high-definition flow (HD-flow) render mode and spatiotemporal image correlation (STIC) in diagnosing and classifying fetal persistent left superior vena cava (PLSVC). Overall, 114 cases of fetal PLSVC were diagnosed using 2D ultrasound combined with STIC, and 114 normal fetuses of the same gestational week were selected. These cases were retrospectively analyzed to evaluate the effectiveness of the diagnostic approach. All 114 PLSVC cases were diagnosed using 2D ultrasound combined with STIC. Although the diagnostic coincidence rate of PLSVC in the HD-flow combined with STIC was similar to that in the 2D ultrasound combined with HD-flow (96.8 vs 96.2%), 2D ultrasound with STIC enabled dynamic visualization of the PLSVC, furthering prenatal diagnosis. These cases were classified as type I PLSVC: 80 cases of type Ia, 29 cases of type Ib, and 5 cases of type Ic. Seventy isolated PLSVC cases (61.4%) were noted, whereas 44 cases (35.6%) were associated with concomitant structural abnormalities. Intracardiac structural malformations accounted for the highest proportion (n = 53, 58.89%), followed by single umbilical artery and facial/bodily abnormalities (n = 10, 11.11%). Combining HD-flow and STIC complements 2D ultrasound in diagnosing and classifying fetal PLSVC, demonstrating significant clinical relevance.

Analysis of Bubble-Flow Characteristics in Scavenge Pipe and Establishment of a Flow-Prediction Model

In the modern aerospace industry, the importance of a lubrication system is self-evident for aero-engines, and the aero-engine bearing chamber return line is an even more challenging environment, as it involves a complex two-phase flow. The designer of the scavenge pipe needs to have an accurate understanding of the flow conditions in the scavenge pipe. This paper establishes a visual scavenge pipe test system. The flow direction was vertical flow, the test temperature was 370 k, and a high-speed camera was used to take high-definition flow photographs, which can observe the three main flow types: bubble flow, slug flow, and annular flow. Code program was created to analyze many pictures taken to obtain the apparent flow rate and perimeter of bubbles in the pipe under different flow conditions and to explore the gas–liquid two-phase flow in the scavenge pipe. A support vector machine (SVM) was used for data regression prediction, and the converted velocities of the gas–oil phases were inputted as eigenvalues to obtain the predicted values of bubble-flow velocity. The bubble-flow analysis prediction model established in this paper has a good prediction effect with root mean square error RMSE = 0.0172, which can more objectively and accurately describe the bubble-flow characteristics in the scavenge pipe.

Prenatal diagnosis of interrupted aortic arch using high-definition flow render mode and spatiotemporal image correlation.

To evaluate the clinical utility of two dimensional (2D) ultrasound combined with spatiotemporal image correlation (STIC) in diagnosing interrupted aortic arch (IAA) in fetal life. A total of 53 cases of fetal IAA were diagnosed using 2D ultrasound combined with STIC, and 53 normal fetuses of the same gestational week were selected. These cases were retrospectively analyzed to assess the utility of employing 2D ultrasound combined with STIC in the diagnosis of IAA. 2D ultrasound combined with STIC detected 22 cases of type A IAA, 24 cases of type B IAA, and seven cases of type C IAA. Furthermore, combining 2D ultrasound with STIC enabled dynamic visualization of the IAA, aiding in prenatal diagnosis. The diagnostic coincidence rate of IAA was found to be higher in the HD-flow combined with STIC than that in the 2D combined with HD-flow. HD-flow combined with STIC can assist in diagnosing fetal IAA, and this technique has important clinical value.

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.

Accuracy Assessment of the Eulerian Two-phase Model for the CFD Simulation of Gas Bubbles Dynamics in Alkaline Electrolyzers

To date, the most industrially developed technology to produce green hydrogen is represented by alkaline water electrolysis (AWE). To improve on design and efficiency of these devices, however, multiphysics simulations based on Computational Fluid Dynamics (CFD) are needed, able to account for electrophysical phenomena and multiphase flows. Focusing on internal flow optimization, the requirements for CFD simulations are anyhow extremely challenging, since solving the gas bubbles’ motion implies the solution of a two-phase flow characterized by very low Reynolds numbers and a high fraction of dispersed gas. Despite some interesting studies have been presented in the literature so far, validation of CFD results with detailed experimental measurements is quite rare and, therefore, the reliability of the adopted modelling approaches is not assessed yet. This study presents the results of a multivariate CFD analysis of an electrochemical cell and its validation through a literature test case. Bubbles generation is introduced as a source term, thus overlooking for the moment the electrochemistry to focus on fluid-dynamics. In particular, attention is given to the Eulerian multiphase modelling, investigating the influence of both the inter-phase interaction sub-models’ settings (e.g., lift and drag forces, virtual-mass force) and the general settings of the simulation. The mean velocity field of the PIV-measured bubbles is considered to assess the accuracy of numerical predictions, while the available high-definition flow pictures allow a qualitative assessment of the bubbles size and location. CFD results are shown to be in decent agreement with experimental data and able to reproduce the key flow features such as the spreading of the bubble curtains and the gas shifting towards the inner part of the cell. The effect of the bubbles’ diameter and of source layer thickness is also discussed.

Imaging of placental circulations by 4D sonography with high-definition flow and spatiotemporal image correlation technology.

Conventionally, two- and three- dimensional color Doppler ultrasonography are used to examine the placental vascularization, but there are limitations in the examinations. In this report, spatiotemporal image correlation (STIC) volume acquisition in high-definition flow, displayed in glass-body mode was used to study the placental vascularization in eight pregnancies. At 20 weeks' gestation, STIC technique allowed visualization of blood flow in the intraplacental branches of the umbilical artery (IPB) and the spiral artery jets in a cardiac cycle. In particular, blood flow from a mega jet penetrating more than half of the placental thickness was demonstrated. Small blood flow from a tertiary order branch of the IPB traversing the placenta and sharply diminishing into the uterine wall was also demonstrated. There were differences in the IPB pattern between normal pregnancies and pregnancies at risk of fetal growth restriction/pre-eclampsia. There were also differences in the appearance of IPB between 20- and 33-weeks' gestation. The results of this report support that it is feasible to use STIC technology to study the placental vascularization. This novel application of STIC technology can increase the understanding of the complex vascularization.

Fetal cardiac sectional schemas - Normal and abnormal. Part 1: Upper abdominal and thoracic sections.

A representational illustrated cardiac schema is useful for understanding and interpreting normal and abnormal fetal echocardiographic findings. Normal and abnormal fetal echocardiographic images can be better appreciated with the support of sectional schemas. An attempt is made to include normal and abnormal variations in both grayscale and color images for easy understanding with the help of the schemas. The fetal cardiac sectional schemas are drawn by the author, using Microsoft Office Word drawing canvas. It is based on the best grayscale, color Doppler, power-angio, 3-dimensional, and high definition flow ultrasound images, supported by embryological and anatomic specimens in literature. Different sections are drawn in accordance with the planes suggested by Society for Maternal-Fetal Medicine, Society of Radiologists in Ultrasound, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American College of Radiology, and American Society of Echocardiography. Every effort has been meticulously pursued to match with the best ultrasound images with minor modifications for better clarity, understanding, and reproducibility. The drawings include normal and most of the common cardiac anomalies depicting different sectional views starting from the abdomen and upward. Each drawing complies with the ultrasound images. Users with basic computer knowledge can easily modify these images using them as templates for reference, reporting, and publications. An attempt is made to represent the fetal echocardiographic images by simplified memorable sectional schemas. These schemas will facilitate a better understanding and interpretation of various normal and abnormal fetal echocardiographic images. Being electronically transmittable, these schemas can be used as templates for further modifications.

Prenatal diagnosis of anomalous left brachiocephalic vein courses using high-definition flow render mode and spatiotemporal image correlation

BackgroundThis study aimed to examine the clinical value of high-definition (HD) flow render mode and spatiotemporal image correlation (STIC) to diagnose anomalous left brachiocephalic vein (LBCV) courses in fetuses.Methods and resultsSeventeen cases of anomalous LBCV courses were diagnosed using two-dimensional (2D), HD-flow, and HD-flow combined with STIC images and retrospectively analyzed to examine the significance of using HD-flow combined with STIC technology in the diagnosis of anomalous LBCV courses.ConclusionsHD-flow combined with STIC technology can help in the diagnosis of anomalous fetal LBCV courses, and this technique has important clinical value.

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.

Antenatal detection of aberrant subclavian artery (ARSA) by 4D-volume contrast ?maging in mid-trimester ultrasound exam

Background and Purpose: To report a small series of ARSA (Aberrant Right Subclavian Artery) cases which were diagnosed by 4-D (Dimensional) ultrasound (Volume Contrast Imaging-A Plane) with high definition flow technique. Methods: Clinical data of total 1859 singleton, low risk pregnancies from the hospital database. Total 13 cases with isolated ARSA cases were identified. Results: Total 13 cases with isolated ARSA cases were identified. Median maternal age was 32 years old. Median gestational age at ultrasound exam was 21 weeks. Eleven of thirteen cases were isolated. Case 3 had a muscular ventricular septal defect (VSD) and case 6 had an aberrant left subclavian artery. All cases were detected by 4D VCI-A with high definition flow technique successfully. One fetus with ARSA who was misdiagnosed as normal by conventional 2-D ultrasound, 4D VCI-A with high definition flow revealed abnormal courses of the right subclavian artery. Course of azygos vein was discriminated from the ARSA in all cases. Conclusion: 4D VCI-A mode activated with HD-flow (High Definition) is a valuable tool for the investigation of outflow tracts of fetal heart and proximal branches of aorta in midtrimester scans and carries some advantages over conventional 2D sonography combined with High Definition Flow mode.

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.

Non-invasive dynamic observation of placental vascular anastomoses in monochorionic twins: Assessment using three-dimensional sonography combined with tomographic ultrasound imaging

IntroductionThree-dimensional (3D) sonography combined with tomographic ultrasound imaging (TUI) to observe placental vascular anastomoses in monochorionic diamniotic (MCDA) twin pregnancies was evaluated. MethodsWomen with MCDA twin pregnancies at a gestational age of 16–32 weeks were enrolled in this retrospective study. Placental anastomoses were detected using two-dimensional (2D) and 3D sonography. Two-dimensional data were obtained by color and spectral Doppler and 3D data with high-definition flow within the area between twins’ umbilical cord insertions. Volume post-processing using TUI mode identified anastomoses. Anastomotic findings on ultrasound were compared with fetoscopic surgery or postnatally injected placentas for diagnostic value. Anastomoses detection was compared between the two imaging modalities. ResultsSeventy-six twin pregnancies were analyzed: 11 selective intrauterine growth restrictions (sIUGR), 10 twin-to-twin transfusion syndrome (TTTS), and 55 without complications. Seventy-one twin pregnancies had arterio-arterial (AA) anastomoses and 75 had arterio-venous (AV) anastomoses. Three-dimensional sonography combined with TUI was more sensitive (87.3%) and accurate (88.2%) in detecting AA anastomoses than 2D sonography (74.6%, 76.3%, respectively; P < 0.05), but had comparable sensitivity for AV anastomoses. The specificity of both modalities for anastomoses was 100%. The detection rate of AA anastomoses by 3D modality was (40%) TTTS vs. (87.3%) normal (P < 0.05), but comparable (90.9%) for sIUGR. The detection rates of AV anastomoses (90%, 81.8%) in TTTS and sIUGR were comparable with (87.3%) normal (P > 0.05). DiscussionThree-dimensional sonography combined with TUI highlighted placental anastomoses and may be useful for the clinical diagnosis and therapy of MCDA twin complications.

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

Spatio-temporal image correlation (STIC) in evaluation of advanced neuroendocrine tumours.

4D Ultrasound technology merging the Power Doppler option called High-Definition Flow (HDF) with Spatio-Temporal Image Correlation (STIC) is used in gynaecology and obstetrics. It seems to be a promising tool in assessing tissue vascularisation. The aim of the paper was to assess whether HDF STIC technique could be a useful tool for the evaluation of gastro-entero-pancreatic neuroendocrine neoplasm (GEP-NEN) advancement. Forty-eight patients [mean age 57.7 ± 10.3 years; male 40.9% (n = 18)] diagnosed with metastatic GEP-NENs were included in the analysis. All subjects were enrolled in the Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice. We analysed liver metastases. Patients with G3 grading or faintly vascularised lesions were excluded. HDF STIC volumes were acquired during USG examination. 4D indices [volumetric pulsatility index (vPI) and volumetric systolic/diastolic index (vS/D)] were calculated using dedicated software. There were no correlations between vS/D and Ki-67 [p = 0.67; r = -0.19; (-0.28-0.19)], CgA [p = 0.47; r = -0.11; (-0.38-0,19)], 5-HIAA [p = 0.52; r = -0.09 (-0.37-0.2)], serotonin [p = 0.83; r = -0.03 (-0.32-0.26)], and VCAM-1 (p = 0.62; r = 0.09 (-03-0.47)]. The were no correlations between vPI and Ki-67 [p = 0.29; r = -0.16 (-0.45-0.14)], CgA (p = 0.46; r = -0.11 (-0.39-0.19)], 5-HIAA [p = 0.52; r = -0.09 (-0.37-0.2)], serotonin [p = 0.82; r = -0.03 (-0.32-0.26)], and VCAM-1 (p = 0.62; r = -0.09 (-03-0.47)]. There was no significant difference between carcinoid versus non-carcinoid patients if compared by vS/D and vPI (p = 0.62, p = 0.61, respectively). HDF STIC seems not to be an efficient marker to assess advancement of NENs, due to lack of correlation with widely used and approved markers of progression.

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.

HCC Immune Surveillance and Antiviral Therapy of Hepatitis C Virus Infection

Objective: HCV clearance by current antiviral therapies improves clinical outcomes but falls short in eliminating the risk for hepatocellular carcinoma (HCC) emergence. As the HCC immune surveillance establishment is vital for the control of neoplastic development and growth, we investigated its correlation with on-/post-treatment HCC emergence, and further analyzed the influence of viral eradication on this setup in patients with HCV-related liver cirrhosis. Design: PBMC isolated at baseline and longitudinally during therapy were analyzed for tumor-associated antigen (TAA)-specific CD8+ T cell responses against glypican-3 overlapping peptides in vitro using high-definition flow cytometry. Multianalyte profiling of fifty soluble inflammatory mediators (SIM) in the plasma was also performed using Luminex-based multiplex technology. Results: Cirrhosis patients were characterized by an altered profile of distinct SIMs at baseline. At this time point, immune-surveilling T cells targeting specific HCC-associated antigens were readily detectable in HCV-free cirrhosis patients whilst being rather weak in such patients who further developed HCC upon virus eradication. Therapy-induced cure of HCV infection analogously reduced the strength of the prevailing HCC immune surveillance machinery, particularly by CD8+ T cells in cirrhosis patients. These results were further validated by T cell reactivities to six immuno-dominant HCC-associated HLA-A2-restricted epi­topes. Further, we demonstrated that this phenomenon was likely orchestrated by alterations in SIMs – with evidence of IL-12 being a major culprit. Conclusion: Given the relationship between the baseline HCC-specific immune surveilling T cell responses and therapy-associated HCC emergence, and the impact of HCV clearance on its strength and magnitude, we recommend a continued HCC screening in cirrhotic HCV patients despite HCV resolution.

Anomalies in T Cell Function Are Associated With Individuals at Risk of Mycobacterium abscessus Complex Infection.

The increasing global incidence and prevalence of non-tuberculous mycobacteria (NTM) infection is of growing concern. New evidence of person-to-person transmission of multidrug-resistant NTM adds to the global concern. The reason why certain individuals are at risk of NTM infections is unknown. Using high definition flow cytometry, we studied the immune profiles of two groups that are at risk of Mycobacterium abscessus complex infection and matched controls. The first group was cystic fibrosis (CF) patients and the second group was elderly individuals. CF individuals with active M. abscessus complex infection or a history of M. abscessus complex infection exhibited a unique surface T cell phenotype with a marked global deficiency in TNFα production during mitogen stimulation. Importantly, immune-based signatures were identified that appeared to predict at baseline the subset of CF individuals who were at risk of M. abscessus complex infection. In contrast, elderly individuals with M. abscessus complex infection exhibited a separate T cell phenotype underlined by the presence of exhaustion markers and dysregulation in type 1 cytokine release during mitogen stimulation. Collectively, these data suggest an association between T cell signatures and individuals at risk of M. abscessus complex infection, however, validation of these immune anomalies as robust biomarkers will require analysis on larger patient cohorts.