Artery Peak Systolic Velocity Research Articles

Arterial Diameter and Percentage of Monocytes are Sex-Dependent Predictors of Early Arteriovenous Fistula Maturation

Arteriovenous fistulae mature less frequently in women than in men, leading to inferior patency and decreased fistula utilization in women. We hypothesized that both anatomic and physiologic sex differences explain reduced maturation. The electronic medical records of patients who had a primary arteriovenous fistula created from 2016 to 2021 at a single center were reviewed; sample size was determined using a power calculation. Postoperative ultrasound and laboratory tests were obtained at least 4weeks after fistula creation. Primary unassisted fistula maturation was determined up to 4years postprocedure. A total of 28 women and 28 men with a brachial-cephalic fistula were analyzed. The inflow brachial artery diameter was smaller in women than in men, both preoperatively (4.2±0.9 vs. 4.9±1.0mm, P=0.008) and postoperatively (4.8±0.8 vs. 5.3±0.9mm, P=0.039). Despite similar preoperative brachial artery peak systolic velocity, women had significantly lower postoperative arterial velocity (P=0.027). Fistula flow was reduced in women, particularly in the midhumerus (747.0±570.4 vs. 1,117.1±471.3cc/min, P=0.003). Percentages of neutrophils and lymphocytes were similar among women and men 6weeks after fistula creation. However, women had reduced monocytes (8.5±2.0 vs. 10.0±2.6%, P=0.0168). Among 28 men, 24 of 28 (85.7%) achieved unassisted maturation, whereas only 15 of 28 (53.6%) women had fistulae that matured without intervention. Secondary analysis using logistic regression suggested that postoperative arterial diameter was associated with maturation in men, while postoperative monocyte percentage was associated with maturation in women. Sex differences during arteriovenous fistula maturation are present in arterial diameter and velocity, suggesting that both anatomic and physiologic differences in arterial inflow contribute to sex differences in fistula maturation. In men, postoperative arterial diameter is correlated with maturation, whereas in women, the significantly lower proportion of circulating monocytes suggests a role for the immune response in fistula maturation.

Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment

ObjectiveTo obtain multicentre data on the prevalence of normal, high or conditional (intermediate) blood velocity in the cerebral arteries among children with sickle cell disease (SCD) in Nigeria.DesignA prospective observational...

Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

BackgroundTwin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy.Case presentationWe describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas.ConclusionsThis is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a “twin anemia polycythemia sequence-like” setting.

Brachiocephalic arteriovenous fistula maturity in end stage renal disease: The role of intraoperative brachial artery blood flow rate and peak systolic velocity.

Arteriovenous fistula (AVF) is the preferred vascular access option due to its lower risk of complications and better long-term outcomes. However, AVF maturation failure is still quite high. Achieving an adequate blood flow rate (BFR) through the AVF is essential for maintaining hemodialysis adequacy. This study aims to investigate brachial artery intraoperative BFR and peak systolic velocity (PSV) increase as a predictor of brachiocephalic AVF maturation. A multicenter retrospective cohort study was conducted on patients with end stage renal disease undergoing brachiocephalic AVF creation from July 2019 to February 2022 from five hospitals. Doppler ultrasound examinations of BFR and PSV were collected. BFR and PSV increases were calculated by comparing pre-operative and intraoperative results. Maturity was determined at 6 weeks postoperatively. This study included 83 patients, with 50 patients (60.24%) achieving maturity at 6 weeks. Brachial artery BFR difference has an excellent diagnostic value to predict brachiocephalic AVF maturation with an area under the curve (AUC) of 97%. BFR increase of 184.58 ml/min predicts brachiocephalic AVF maturity with a sensitivity of 100%, specificity of 84.8%, and accuracy of 93.98%. Meanwhile, brachial artery PSV increase has a low diagnostic value to predict brachiocephalic AVF with an AUC of 71.2%. PSV increase of 8.97 cm/s predicts brachiocephalic AVF maturity with a sensitivity of 82%, specificity of 51.5%, and accuracy of 69.9%. The increase in intraoperative brachial artery BFR and PSV in brachiocephalic AVF can be used as a useful parameter to predict AVF maturation.

75-g oral glucose tolerance testing does not affect fetal cardiac doppler parameters in low-risk pregnant women

The study aimed to examine whether acute hyperglycemia, caused by the 75-g oral glucose tolerance test (OGTT) can produce fetal cardiac adverse effects that are detectable with fetal cardiac Doppler ultrasound in healthy low-risk pregnancies. Healthy low-risk pregnant women who underwent 75-g OGTT during the gestational period of 24 to 28 weeks were considered eligible and during the test, they were examined with fetal ultrasound at the fasting and 1- and 2-h timepoints. The study findings included the parameters of umbilical artery pulsatility index, uterine artery, fetal heart rate, middle cerebral artery (MCA) peak systolic velocity (MCA-PSV), MCA pulsatility index, and fetal cardiac Doppler parameters including myocardial performance index, left isovolumetric contraction and relaxation times, K-index, filling time, mitral E- and A-wave velocities, and E/A ratio. The data of 53 women without gestational diabetes mellitus were used for statistical analyses. There was no statistical significance among the three-time points of OGTT regarding all the Doppler parameters (p>0.05). The median MCA-PSV measured at the fasting of OGTT was significantly higher than the values measured at the first and second hour of OGTT [28 (22-42) vs. 26 (18-39) and 26 (18-38), respectively; p<0.05]. This increase provided no relationship with other study parameters (p>0.05). Overall, 75-g OGTT does not affect fetal cardiac Doppler parameters in healthy pregnant women except for abnormal findings of MCA-PSV. The results of the current study can provide significant support to clinicians in reducing the hesitations of women with low-risk pregnancies regarding gestational diabetes screening.

Assessment of extracranial carotid artery disease using digital twins – A pilot study

To improve risk stratification in extracranial internal carotid artery disease (CAD), patients who would benefit maximally from revascularization must be identified. In cardiology, the fractional flow reserve (FFR) has become a reference standard for evaluating the functional severity of coronary artery stenosis, and noninvasive surrogates thereof relying on computational fluid dynamics (CFD) have been developed. Here, we present a CFD-based workflow using digital twins of patients’ carotid bifurcations derived from computed tomography angiography for the noninvasive functional assessment of CAD. We reconstructed patient-specific digital twins of 37 carotid bifurcations. We implemented a CFD model using common carotid artery peak systolic velocity (PSV) acquired with Doppler ultrasound (DUS) as inlet boundary condition and a two-element Windkessel model as oulet boundary condition. The agreement between CFD and DUS on the PSV in the internal carotid artery (ICA) was then compared. The relative error for the agreement between DUS and CFD was 9% ± 20% and the intraclass correlation coefficient was 0.88. Furthermore, hyperemic simulations in a physiological range were feasible and unmasked markedly different pressure drops along two ICA stenoses with similar degree of narrowing under comparable ICA blood flow. Hereby, we lay the foundation for prospective studies on noninvasive CFD-based derivation of metrics similar to the FFR for the assessment of CAD.

The Value of Delta Middle Cerebral Artery Peak Systolic Velocity for the Prediction of Twin Anemia-Polycythemia Sequence-Analysis of a Heterogenous Cohort of Monochorionic Twins.

Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) > 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of >1.5 and <1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Our data shows that delta MCA-PSV > 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.

Accuracy of the Society of Radiologists in Ultrasound (SRU) Carotid Doppler Velocity Criteria for Grading North American Symptomatic Carotid Endarterectomy Trial (NASCET) Stenosis: A Meta-Analysis.

The Society of Radiologists in Ultrasound (SRU) consensus panel proposed six Doppler velocity cut points for classifying internal carotid artery (ICA) stenosis of 50% and 70% according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Their relative accuracies have not been compared. Meta-analysis performed following comprehensive literature review and identification of manuscripts with graphs of individual patient NASCET ICA stenosis measured by arteriography versus ICA peak-systolic velocity (PSV), end-diastolic velocity (EDV) and ICA PSV to common carotid artery (CCA) PSV. True positives, true negatives, false positives, and false negatives were calculated and used in two-level mixed effects models. Hierarchical summary receiver operating characteristic (ROC) curves were generated. Areas under the ROC curves were estimated. Nine studies performed between 1993 and 2016 were identified after review of 337 manuscripts. There were 1738 bifurcation data points extracted for PSV, 1026 for EDV, and 775 for ICA/CCA ratio. The highest sensitivity was 96% (95% CI: 93%, 98%) for PSV of 125 cm/s (50% stenosis) and highest specificity 86% (95% CI: 71%, 93%) for PSV of 230 cm/s (70% stenosis). Areas under the ROC curves ranged from a high of 0.93 (95% CI: 0.92, 0.95) for PSV (50% stenosis) to a low of 0.86 (95% CI: 0.84, 0.88) for EDV (70% stenosis). The SRU consensus Doppler cut points vary in their accuracies for predicting ICA stenosis. The PSV cut points have tradeoffs: high sensitivity/low specificity for 50% stenosis and high specificity/moderate sensitivity for 70% stenosis.

Association between brachial artery peak systolic velocity and ipsilateral radio-cephalic arteriovenous fistula maturation.

To evaluate the association between brachial artery blood velocity by color Doppler flow imaging (CDFI) and primary maturation of radio-cephalic autologous arteriovenous fistula (RC-AVF). Clinical data from patients who underwent end-to-side cephalic-radial anastomosis were collected from December 2015 to December 2020. The anastomosis diameter (mm), blood velocity (cm/s), and brachial artery diameters (mm) 7 cm proximal to the elbow pre- and postoperation were measured by GE LOGIC-E9 ultrasound. The AVF was mature if it could be cannulated successfully and the blood flow was >200 ml/min during dialysis. A total of 197 patients were included in our statistical analysis. A total of 163 patients had mature AVFs, and 34 patients had poor maturity (assisted and failed maturation). There were no significant differences in the clinical characteristics, peak systolic velocity (PSV) of the brachial artery, diameter of the radial artery or cephalic vein measured by CDFI preoperatively. The diameter of the brachial artery (5.41 ± 0.77 vs 4.89 ± 0.90, p = 0.00) and the fistula anastomosis (2.79 ± 0.78 vs 2.45 ± 0.85, p = 0.02) and PSV of the brachial artery (123.58 ± 37.11 vs 89.63 ± 28.31, p = 0.00) in the mature group were higher than those in the immature group. Brachial artery PSV and increased brachial artery PSV could be used to detect RC-AVF maturation in the early stage.

Role of Interventional Radiology in the Management of Early Vascular Complications After Liver Transplant.

A hepatic vascular complication after liver transplant is a critical situation, often resulting in graft failure and potentially leading to patient death. Early diagnosis and treatment of vascular complications can provide prolonged graft survival and prohibit further complications. This study presents our experiences with endovascular treatment during the first week after liver transplant. Between January 2012 and February 2021, 240 liver transplants were performed, with 43 patients having early endovascular treatment (37 men; mean age 27 ± 2.9 years) at a single center. Early endovascular interventions were carried out 1 to 7 days (mean ± SD of 2.7 ± 0.24 days) after transplant. Patients with vascular complications were grouped by arterial, venous, and portal complications. In addition, arterial complications were subgrouped by occlusive (hepatic artery thrombosis) and nonocclusive (hepatic artery stenosis/splenic artery steal syndrome) complications. Patients had median follow-up of 47 ± 4 months. In the first week after liver transplant, vascular complications included splenic artery steal syndrome in 27 patients (62.7%), hepatic complications in 10 patients (23.2%) (7 with hepatic artery thrombosis, 3 with hepatic artery stenosis), hepatic venous outflow complications in 4 patients (9.3%), and portal vein complications in 2 patients (4.6%). Only 1 patient required revision surgery because of excessive arterial kinking; the remaining patients with arterial complications were successfully managed with multiple endovascular treatment attempts. Patients with splenic artery steal syndrome were treated by selective arterial embolization with coil devices. Resistivity index, peak systolic velocity of hepatic arteries, and portal vein maximal velocity significantly improved (P < .001). Patients with hepatic venous outflow and portal vein complications who had endovascular treatments and vascular structures maintained good results over follow-up. Early endovascular intervention is feasible and safe for hepatic vascular complications following liver transplant, with high success treatment rates with advances in interventional radiology.

Conversion From Hypothyroidism to Hyperthyroidism and Back After Anti-SARS-CoV-2 Vaccination

Cases presenting with changes in various organs caused by anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination are rare. In particular, after such instances of vaccination, onset of subacute thyroiditis, Hashimoto thyroiditis, and Graves’ disease was observed. We present the case of a 55-year-old woman whose hypothyroidism converted to hyperthyroidism after vaccination with Gam-COVID-Vac (Sputnik V). After the first dose of vaccine, a hormonal metabolism alteration was noted, i.e., conversion from hypothyroidism to euthyroidism. After the second dose of vaccine, onset of hyperthyroidism with thyrotoxicosis was noted without signs of subacute thyroiditis. Hyperthyroidism persisted for several weeks before reverting to hypothyroidism. Assessments did not reveal an increase in the patient’s thyroid-stimulating hormone receptor antibody levels throughout the indicated period. However, after hyperthyroidism reverted to hypothyroidism, a significant increase in the peak systolic velocity of the superior thyroid arteries was observed, which is characteristic of hyperthyroidism. Owing to the known involvement of the autonomic nervous system (ANS) in blood vessel tone regulation, thyroid hormonogenesis, and stress, the ANS-mediated conversion from hypothyroidism to hyperthyroidism in certain individuals after receiving a vaccine, which may serve as a sufficient stimulus for ANS nerve centers, is highly probable. Therefore, diagnostic assessment of ANS condition should be performed before vaccination in patients with chronic thyroid disorders or diseases of other organs or organ systems. If changes in ANS are found, providing preemptive treatment before vaccination is recommended. J Endocrinol Metab. 2022;12(6):202-208 doi: https://doi.org/10.14740/jem833

Sonographic Assessment of Acute Versus Chronic Cholecystitis: An Ultrasound Probability Stratification Model.

What sonographic variables are most predictive for acute cholecystitis? What variables differentiate acute and chronic cholecystitis? The surgical pathology database was reviewed to identify adult patients who underwent cholecystectomy for cholecystitis and had a preceding ultrasound of the right upper quadrant within 7 days. A total of 236 patients were included in the study. A comprehensive imaging review was performed to assess for gallstones, gallbladder wall thickening, gallbladder distension, pericholecystic fluid, gallstone mobility, the sonographic Murphy's sign, mural hyperemia, and the common hepatic artery peak systolic velocity. Of 236 patients with a cholecystectomy, 119 had acute cholecystitis and 117 had chronic cholecystitis on surgical pathology. Statistical models were created for prediction. The simple model consists of three sonographic variables and has a sensitivity of 60% and specificity of 83% in predicting acute versus chronic cholecystitis. The most predictive variables for acute cholecystitis were elevated common hepatic artery peak systolic velocity, gallbladder distension, and gallbladder mural abnormalities. If a patient had all three of these findings on their preoperative ultrasound, the patient had a 96% chance of having acute cholecystitis. Two of these variables gave a 73-93% chance of having acute cholecystitis. One of the three variables gave a 40-76% chance of having acute cholecystitis. If the patient had 0 of 3 of the predictor variables, there was a 29% chance of having acute cholecystitis. Gallbladder distension, gallbladder mural abnormalities, and elevated common hepatic artery peak systolic velocity are the most important sonographic variables in predicting acute versus chronic cholecystitis.

Compact Point of Care Ultrasound Reveals Hemodynamic Abnormalities in Children with Sickle Cell Disease

In sickle cell disease (SCD), kidney related morbidity and mortality are significant, with ~80% of patients displaying signs of chronic kidney disease (CKD) by age 401 and kidney related mortality being the third leading cause of death (16.4%)2. Children with SCD are also prone to kidney disease with 20% of 12 years-old displaying microalbuminuria4 and enuresis and hyposthenuria commonly observed in infants4. Current clinical guidelines are insufficient as they ignore pediatric disease until the development of late signs like proteinuria or large drops in eGFR have occurred5. A major limitation in the assessment of kidney disease in children with SCD is the incomplete understanding of disease progression and the lack of suitable biomarkers to discriminate health and disease. Serum creatinine based eGFR is the most common biomarker of kidney function but is poorly validated and relatively insensitive in SCD patients due low muscle mass and hyperfiltration6. Point of care ultrasound (POCUS) offers a non-invasive alternative to blood based biomarkers. POCUS has proven clinical utility in decreasing primary and secondary stroke7. Additionally, POCUS technology now offers compact, cartless systems, with tablet and smartphone compatibility, multiprobe functionality in a single probe and an economical price point (<3000$)8. Therefore, the goals of this study were two-fold. 1) Determine the feasibility of renal assessment using compact POCUS in children with SCD in a clinical setting. 2) Establish normative values for possible compact POCUS biomarkers that could supplement existing biomarkers of kidney disease in SCD. Methods: Studies were performed with informed consent under an IRB approved protocol. 18 patients with SCD were recruited during their routine clinical visit to undergo a 10-20 minute ultrasound examination. All POCUS exams were performed in supine position, on the right kidney by an experienced imaging researcher (AB, +10 years). Images were acquired with a Butterfly IQ+ (Burlington, MA, USA) system and an Apple Smartphone (Cupertino, CA, USA). The abdominal preset and B-mode imaging was used to determine the long axis renal length and echogenicity of the renal/liver parenchyma. The cardiac preset, pulsed Doppler mode was used to determine the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI = (PSV-EDV)/PSV) of the main right renal artery. Images were saved to a cloud based, HIPPA protected database, downloaded to a local workstation and processed using custom MATLAB scripts. An angle correction of 1/cos(60°) was applied to the uncorrected velocity values. Results: Renal length and serum creatinine was measured in 18 patients with SCD (3 HbSC, 15 HbSS) and pulsed Doppler estimates were obtained in 14 of 18 subjects (hemoglobin 9.9±2.3,12 male). The average renal length was 8.7±1.3 cms and serum creatinine was 0.69±0.16 and showed a statistically significant increase with respect to age (Figure 1). The average angle corrected main renal artery PSV was 74.5±64.4 cm/s and RI was 0.49±0.33 and both decreased with respect to age (Figure 1). The average echogenicity ratio between kidney and liver parenchyma was 0.64±0.14 and was uncorrelated with age. Discussion: This work demonstrates that high quality structural and hemodynamic images can be acquired with low cost, compact POCUS in a clinical setting. The age dependent increase in serum creatinine9 and kidney length10 were in good agreement with prior cart-based sonography work in healthy children. Conversely, the age dependent drop in main renal artery PSV and RI was in opposition to work in healthy children that showed no change11 or an increase with age12. The clinical significance of abnormally elevated velocity in young children with SCD and its impact on the development of sickle nephropathy should be studied in more detail. Future work comparing cross-sectional and longitudinal variability in compact POCUS and physiologic biomarkers of kidney function in both pediatric and adult subjects with and without SCD is ongoing.

Preoperative high-frequency color Doppler ultrasound assessment of the blood vessels of the fibular myocutaneous flap.

The fibular myocutaneous flap is a classic flap used to reconstruct oral and maxillofacial defects. This study aimed to evaluate the effectiveness of high-frequency color Doppler ultrasound in detecting the blood vessels in the fibular myocutaneous flap, analyze the influence of variations in the peroneal vessels and perforating peroneal arteries on the surgical design, and explore the value of this technology in preoperatively assessing the blood vessels of the fibular myocutaneous flap. Twenty-five patients with mandibular disease or defect underwent preoperative evaluation of the blood vessels of the calf by high-frequency color Doppler ultrasound. The inner diameter and peak systolic velocity (PSV) of the peroneal arteries and veins and the perforating peroneal arteries were compared between different groups. The consistency between the perforating peroneal arteries marked by ultrasonography and the intraoperative findings was analyzed. The initial segment of the peroneal artery had a larger inner diameter (p<0.001) and lower PSV (p<0.05) than the middle segment. The perforating peroneal arteries were mainly distributed in the middle of the fibula. The inner diameter of the perforating peroneal artery was larger in men than in women (p<0.05). In comparison with surgical exploration as the gold standard, high-frequency color Doppler ultrasound results showed good consistency (Kappa=0.684, 95% CI: 0.512-0.856, p<0.001), with a sensitivity of 89.36%, specificity of 78.57%, and accuracy of 85.33%. High-frequency color Doppler ultrasound can detect, quantitatively evaluate, and accurately mark the peroneal artery and vein and perforating peroneal artery before fibular myocutaneous flap transplantation.

Pathophysiology, diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations.

Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Significantly discordant velocities are diagnostic, while severity staging is based on signs of cardiovascular compromise. Conservative management, fetoscopic laser coagulation, selective twin reduction, fetal blood and exchange transfusion, and delivery may be selected guided by the gestational age of diagnosis, the severity of the condition, the likelihood of success, and the patients' priorities. Prenatal curative treatment that minimizes the risk for prematurity and residual morbidity at birth is most likely to offer the greatest short-term and long-term benefits.

The effect of middle cerebral artery peak systolic velocity on prognosis in early and late-onset fetal growth restriction.

We aim to investigate the utility of middle cerebral artery peak systolic velocity (MCA PSV) Doppler in determining the perinatal mortality and morbidity in serial Doppler measurements from the time of diagnosis to the delivery of complicated cases with fetal growth restriction (FGR). At 24-38weeks of gestation, 65 pregnant women diagnosed with FGR were included in the study. The fetal biometry measurements, MCA pulsatility index (PI), and MCA PSV Doppler evaluation of the cases formed at the diagnosis and the delivery were recorded. Gestational weeks, birth weights, APGAR scores, cord pH values, NICU (neonatal intensive care unit) admission, NICU duration of stay, and perinatal morbidity parameters such as RDS (respiratory distress syndrome), BPD (bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), sepsis and perinatal mortality were compared. The patients were divided into two groups: early and late-onset fetal growth restriction. Perinatal morbidity and mortality were accepted as adverse perinatal outcomes. MCA PSV above the 95th percentile at the diagnosis and delivery time was seen at a significantly higher rate with adverse perinatal outcomes. This study shows that evaluating MCA PSV with Doppler can be a helpful diagnostic method for early diagnosis of restriction and hypoxic fetuses. Also, it may be used in clinics as a noninvasive method to predict neonatal prognosis.

Asymptomatic course of overt primary hypothyroidism with a very high peak systolic velocity of the superior thyroid arteries: A case report

This study reports the case of a 59-year-old woman with asymptomatic overt hypothyroidism who presented with signs of increased thyroid exertion involving the autonomic nervous system. These signs included significantly increased peak systolic velocity (PSV) of the superior thyroid arteries (STA) and moderately increased blood flow intensity. The findings suggest an increase in the rate of thyroxine deiodination and the sufficiency of free triiodothyronine (FT3) for the functional needs of the body. The absence of typical symptoms of hypothyroidism may depend on the sufficiency of FT3 in the serum and additional nonhormonal circumstances. Hence, FT3 should always be measured in addition to thyroid-stimulating hormone and free thyroxine levels. When Doppler ultrasound is used, the intensity of blood flow and PSV-STA from both sides should be determined to assess the magnitude of thyroid exertion. Probably, PSV-STA may not be an absolute criterion for the diagnosis of Graves’ disease.

Hepatic arterial buffer response in monochorionic diamniotic pregnancies with twin-to-twin transfusion syndrome.

Hepatic arterial buffer response (HABR) is animportant regulatory process for hepatic blood flow. Itsactivity has been described in some fetal adverse conditions but in twin-to-twin transfusion syndrome (TTTS) it is unknown if such response is present. The aim of this study is to test the hypothesis that HABR operates in monochorionic diamniotic twins (MCDA) with TTTS. Hepatic artery pulsatility index (PI) and peak systolic velocity (PSV) were measured prospectively in 64 MCDA pregnancies. 43 without TTTS (group 1) and in 21 pregnancies with TTTS (group 2). We calculated ratios for PI (HAPI-ratio) and PSV (HAV-ratio) between recipient and donor in group 2 or bigger and smaller fetus in group 1 and compared groups. The association of HAV-ratio and HAPI ratio with TTTS, relation with other fetal Dopplers and reliability of measurement by a single operator were investigated. HAV-ratio and HAPI-ratio appears to be independent from fetal Dopplers, estimated weight and gestational age. In group 2, HAV-ratio is lower than group 1 (p<0.001, 95% CI 0.443-0.643). In group 1 the mean HAV-ratio is 1.014 (±0.021) while in group 2 is 0.47 (±0.035). HAPI-ratio is lower in group 2 than in group 1 although this difference was not significant (p=0.066, 95% CI-0.007-0.231). A good reliability of measurements of hepatic artery PSV and PI was demonstrated by intraclass correlation coefficient analysis (ICC 0.971 95% CI 0.963-0.977, p<0.001 and ICC 0.694 95% CI 0.596-0.772, p<0.001, respectively). Monochorionic pregnancies with TTTS are associated with lower HAV-ratios. This could be explained by an active HABR.

Decreased fetal movements—the utility of ultrasound to identify infants at risk and prevent stillbirth is poor

Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements. This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester. This was a retrospective cohort study performed at the Mater Mothers' Hospital in Brisbane between 2017 and 2020. We undertook propensity score matching analysis comparing abnormal ultrasound parameters in women with singleton, nonanomalous pregnancies presenting with decreased fetal movements after 28 weeks' gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebroplacental ratio <10th centile, estimated fetal weight <10th centile for gestation, middle cerebral artery peak systolic velocity >1.5 multiples of the median, or deepest vertical pocket of amniotic fluid <2 or >8 cm. After propensity score matching, the study cohort comprised 1466 cases and 2207 controls. The rate of the primary composite outcome was not significantly different between the 2 cohorts (20.2% vs 21.3%; P=.42). There were 30 new cases of small-for-gestational-age detected in the decreased fetal movements cohort, giving a number needed to scan of 48 in the decreased fetal movements group to detect 1 case of small-for-gestational-age. However, the frequency of the composite outcome was higher (13.0% vs 5.4%) at the final scan before birth in women with multiple decreased fetal movement presentations. Despite this, there was no significant difference in clinical outcomes between the 2 cohorts. Ultrasound abnormalities are not increased in women with decreased fetal movements compared with controls.

Qualitative analysis of Doppler assessment used for surveillance of alloimmunized individuals.

To summarize image quality variables for alloimmunized women at risk for fetal anemia. To investigate the association between image quality with the highest and median middle cerebral artery peak systolic velocity (MCA-PSV) at the last visit and fetal anemia based on hemoglobin. This study was a qualitative retrospective analysis of 192 Doppler ultrasound images used in the detection of fetal anemia in 26 alloimmunized women seen in a Minneapolis hospital over the past 3 years. Images were graded on seven criteria found in literature. Of the images analyzed, 23 (12.0%) of the 192 met all seven image quality criteria. Using the highest MCA-PSV value, the sensitivity, and specificity were 55.6% and 94.1%, respectively. Using the median MCA-PSV value, the sensitivity, and specificity were 44.4% and 94.1%, respectively. Only a minority of Doppler images meet all suggested image criteria. This could negatively impact the accuracy of the MCA-PSV measurements as indicated by the decreased sensitivity in our evaluations.