Three-dimensional Color Doppler Research Articles

Hysteroscopic laser ablation of symptomatic uterine fibroids: insights from a prospective study

Objective This study aimed to evaluate the feasibility and efficacy of in-office hysteroscopic ablation of submucous uterine fibroids using a diode laser. Method A pilot study was conducted between January 2018 and January 2019 in a tertiary care university hospital. Patients with at least one symptomatic, class 0–2 FIGO classification, uterine fibroid ≤7 cm in size were eligible for inclusion. Evaluation of the changes in fibroid size and vascularity was performed using three-dimensional Doppler ultrasonography. Vaporization of the fibroid core was conducted using a 980–1470 nm wavelength diode laser inserted through the hysteroscope’s working channel. The primary outcome was evaluation of the fibroid volume before and at 2 months after the procedure. Results Twenty women were enrolled in the study. At 2-month follow-up, the volume of the fibroids was significantly reduced (51.6 ± 22.5 vs. 33.4 ± 17.1 mm3; p < 0.001). A major reduction of three-dimensional sonographic color Doppler vascularity (observed by the same operator and confirmed by four blind reviewers) was also achieved in 12/20 patients (60%; p = 0.03) while a reported symptom of heavy menstrual bleeding decreased from 18/20 (90%) to 2/18 (10%; p < 0.01). Conclusion Hysteroscopic laser ablation represents a feasible and effective alternative for treating women with symptomatic submucous fibroids in the office setting. Further studies with larger sample size and longer follow-up periods are needed to validate this promising technique. Key message This pilot study shows that in-office hysteroscopic laser ablation (HLA) could be a feasible alternative to treat symptomatic submucous uterine fibroids by coagulating their core, reducing their size and vascularization.

Prenatal diagnosis and characterization of extra-axial, supratentorial pial arteriovenous malformation using high-resolution transvaginal neurosonography.

Prenatal diagnosis and characterization of extra-axial, supratentorial pial arteriovenous malformation using high-resolution transvaginal neurosonography.

Application of Color Doppler Ultrasound in Microscopic Imaging Diagnosis of Adenomyosis.

In order to explore the value of color Doppler ultrasonography (TVCDS) in the diagnosis and differential diagnosis of adenomyosis. A total of 150 patients with adenomyosis admitted to a hospital from January 2020 to December 2021 were selected, taking transvaginal three-dimensional color Doppler ultrasound and abdominal ultrasound for examination, all results were compared with patient pathology or surgical results, in order to compare the accuracy of the two inspection methods. The positive predictive value of three-dimensional color Doppler ultrasonography was higher than that of abdominal ultrasonography, and the difference was statistically significant (P < 0.05). The coincidence rate, sensitivity, and specificity of three-dimensional color Doppler ultrasonography were higher than those of abdominal ultrasonography, while the misdiagnosis rate was lower than that of abdominal ultrasonography, and the differences were statistically significant (all P < 0.05). The imaging features of vaginal three-dimensional color Doppler ultrasound in patients with adenomyosis are mainly enlarged uterus, slightly stronger echoes in the myometrium with enhanced echogenic spots, and short or short branch blood flow signals in the lesions. After statistical analysis, there was a significant difference in the blood flow changes between benign and malignant endometrial echoes and abnormal echoes in the uterine cavity, P < 0.05. Normal endometrium and benign intrauterine lesions mainly showed no blood flow signal, while malignant lesions in the uterine cavity mostly showed changes in blood flow signal. Compared with abdominal examination, transvaginal color Doppler ultrasonography has obvious advantages in the diagnosis of adenomyosis. According to the characteristics of ultrasound images, blood flow distribution, frequency spectrum, etc., it can provide a more accurate basis for clinical timely, provide the identification points of uterine fibroids, and provide help for clinicians to choose a treatment plan.

Prognostic value of three dimensional-vena contracta area in patients with secondary mitral regurgitation

Abstract Background Effective regurgitant orifice area (EROA) is an important quantitative measurement for mitral regurgitation (MR) grading. Yet, the accuracy of this method is limited in patients with secondary mitral regurgitation (SMR). Three-dimensional (3D) color Doppler echocardiography allows for the direct assessment of the vena contracta area (VCA). The prognostic value of 3D-VCA in patients with secondary MR has not been investigated. Purpose The aim of the present study was to assess the association between 3D-VCA and prognosis of patients with SMR. Methods A total of 218 patients (69% men, median age 74 years) with significant SMR were retrospectively analyzed. 3D-VCA was measured offline with dedicated software, from restored 3D color Doppler full volume datasets of the mitral valve (Figure 1). The population was divided according to the American College of Cardiology expert recommendation for the grading of severe MR (VCA ≥50 mm2 and VCA &amp;lt;50 mm2). Patients were followed up for the combined end point of all-cause mortality or heart failure hospitalization. Results Of the total population, 63% had an ischemic etiology, 60% had atrial fibrillation and 25% cardiac resynchronization therapy. Patients with 3D-VCA ≥50 mm2 needed more diuretic therapy, had a larger left ventricle and atrium, and had more post-procedural residual MR. A total of 82% of patients underwent MitraClip device implantation, 17% had mitral valve repair and 1% had mitral valve replacement. During a median follow-up of 28 months, 130 (60%) met the combined end point (101 (46%) patients died and 81 (37%) were hospitalized due to heart failure). When dividing the population according to the cut-off of 3D-VCA, patients with a 3D-VCA≥50 mm2 had a worse prognosis compared with their counterparts (Figure 2). In a multivariable Cox regression analysis, 3D-VCA≥50 mm2 remained independently associated with the composite endpoint of all-cause mortality or heart failure hospitalization (HR=1.454, 95% CI 1.020–2.072, p=0.038). Conclusion In patients with SMR, a 3D-VCA ≥50 mm2 was independently associated with a combined endpoint of death or heart failure hospitalization. Funding Acknowledgement Type of funding sources: None. Figure 1. Method of 3D-VCA measurementFigure 2. Kaplan-Meier survival curve

Three-dimensional color Doppler acquisition of a highly vascular giant placental chorioangioma

A 25-year-old primigravida, on scan at 27 weeks, was diagnosed with a large vascular placental chorioangioma (Figure 1). The different intrauterine treatment options such as ablation of vessels by laser or glue embolization seemed difficult, as there were multiple feeders inside the tumor draining into a large feeding vessel (Figure 2); moreover, it was in close proximity to the umbilical cord, subjecting it to a higher risk of fetal demise. We managed the pregnancy conservatively with serial scans.

Sources of Variability in Vena Contracta Area Measurement for Tricuspid Regurgitation Severity Grading: Comparison of Technical Settings and Vendors

Previous studies found different cutoffs of vena contracta area (VCA) to define severe tricuspid regurgitation (TR). The aim of this study was to investigate the factors associated with such variability by comparing technical variables and vendors. Sixty-nine patients with scheduled tricuspid surgery were included in this prospective study. For each patient, TR data sets were obtained on three-dimensional color Doppler transthoracic echocardiography on at least two of three systems: GE Vivid E95 (n=39), Siemens SC2000 Prime (n=64), and Philips EPIQ 7C (n=60). VCA was measured using default settings or with color baseline shifted on all three platforms and with minimal color gain (10%-20%) on the GE platform. Color gain reduction and baseline shift caused significant change sin VCA measurement (-46% and 10%, respectively). Intervendor comparison exhibited wide limits of agreement (narrowest range, -74% to 167%), with either default or optimized settings. Different technical settings, platforms, and reference methods all produced different VCA cutoffs for severe TR. VCA measurement in TR is sensitive to technical factors and demonstrates intervendor variability. Technical variables in VCA measurement should be reported in detail to allow comparison among research studies. The same vendor and settings should be used for longitudinal analysis of TR VCA in the same patient in multivendor echocardiography laboratories.

Three-dimensional color Doppler before and after embolization of postpartum-acquired enhanced myometrial vascularity/arteriovenous malformation

The figures illustrate a case of a woman with acquired enhanced myometrial vascularity/arteriovenous malformation after vaginal delivery. The woman had a secondary postpartum hemorrhage 25 days after delivery and underwent bilateral selective uterine artery embolization. She had a history of hysteroscopic resection of a uterine septum. Figure 1 shows transvaginal three-dimensional (3D) ultrasound with color Doppler of the lesion before (solid arrow) and after (dotted arrow) uterine artery embolization.

Vaginal repaired cesarean section diverticulum is beneficial in women with two prior cesarean sections

BackgroundThe aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs).MethodsFrom January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound.ResultsA total of 221 (89.11%) women were followed-up for more than 3 months, and 168 (67.74%) women were followed-up for more than 6 months. There were significant differences in the average duration of menstruation (7.77 ± 2.05 and 8.02 ± 2.06 days VS 13.99 ± 3.71 days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18 mm VS 7.99*12.43*6.62 mm) and the TRM (7.61 ± 2.52 and 7.60 ± 3.00 mm VS 2.51 ± 1.02 mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P < 0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P > 0.05).ConclusionIn CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.

Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography

The aim of this study was to evaluate the accuracy of mitral regurgitation (MR) volume quantified on three-dimensional (3D) color Doppler transesophageal echocardiography (TEE) using new semiautomated software compared with conventional two-dimensional (2D) proximal isovelocity surface area (PISA) transthoracic echocardiography (TTE) and TEE and cardiac magnetic resonance imaging (CMR). Fifty-one patients (mean age, 63±16years; 35 men) prospectively underwent TTE, TEE, and CMR for MR evaluation. Regurgitant volume (RVol) by 3D MR flow quantification was compared with 2D TTE, TEE, and CMR, and the accuracy of evaluation of severe MR by 3D MR flow quantification was compared against guideline criteria by TEE. Twenty-nine patients had severe MR, 16 had moderate MR, and six had mild MR. Three-dimensional MR flow quantification was feasible in all patients, including prolapse (n=37), restriction (n=9), functional MR (n=5), and eccentric or multiple jects (n=41). RVol on 3D MR flow quantification correlated well with RVol on 2D PISA TTE (interclass correlation coefficient [ICC]=0.75, P<.001), quantitatively estimated RVol (ICC=0.74, P<.001), and 2D PISA TEE (ICC=0.79, P<.001). Three-dimensional MR flow quantification agreed better with CMR (ICC=0.86, P<.001) than did RVol on 2D PISA TTE (ICC=0.66, P<.001) and 2D PISA TEE (ICC=0.69, P<.001), with narrower limits of agreement on Bland-Altman analysis. Three-dimensional MR flow quantification had high accuracy for diagnosing severe MR using TEE (area under the curve=0.85, 95% CI 0.74-0.96, P<.001) or CMR (area under the curve=0.95; 95% CI, 0.89-1.00; P<.001) as the criterion. The new software enabled semiautomated 3D MR flow quantification in complex MR with multiple and eccentric jets and showed better agreement with CMR than 2D PISA TTE or TEE, suggesting that this method is more accurate than conventional 2D PISA TTE and TEE.

Combined flow-based imaging assessment of optimal cardiac resynchronization therapy pacing vector: a\xa0case report

BackgroundThere are still many pendent issues about the effective evaluation of cardiac resynchronization therapy impact on functional mitral regurgitation. In order to reduce the intrinsic difficulties of quantification of functional mitral regurgitation itself, an automatic quantification of real-time three-dimensional full-volume color Doppler transthoracic echocardiography was proposed as a new, rapid, and accurate method for the assessment of functional mitral regurgitation severity. Recent studies suggested that images of left ventricle flow by echo-particle imaging velocimetry could be a useful marker of synchrony. Echo-particle imaging velocimetry has shown that regional anomalies of synchrony/synergy of the left ventricle are related to the alteration, reduction, or suppression of the physiological intracavitary pressure gradients.Case summaryWe describe a case in which the two technologies are used in combination during acute echocardiographic optimization of left pacing vector in a 63-year-old man, Caucasian, who showed worsening heart failure symptoms a few days after an implant, and the effect of the device’s optimization at 6-month follow-up.DiscussionThe degree of realignment of hemodynamic forces, with quantitative analysis of the orientation of blood flow momentum (φ), can represent improvement of fluid dynamics synchrony of the left ventricle, and explain, with a new deterministic parameter, the effects of cardiac resynchronization therapy on functional mitral regurgitation. Real-time three-dimensional color flow Doppler quantification is feasible and accurate for measurement of mitral inflow, left ventricular outflow stroke volumes, and functional mitral regurgitation severity.ConclusionThis clinical case offers an innovative and accurate approach for acute echocardiographic optimization of left pacing vector. It shows clinical utility of combined three-dimensional full-volume color Doppler transthoracic echocardiography/echo-particle imaging velocimetry assessment to increase response to cardiac resynchronization therapy, in terms of reduction of functional mitral regurgitation, improving fluid dynamics synchrony of the left ventricle.

Optimal B-spline Mapping of Flow Imaging Data for Imposing Patient-specific Velocity Profiles in Computational Hemodynamics.

Objective:We propose a novel method to obtainmap patient-specific blood velocity profiles (obtained from imaging data such as 2D flow MRI or 3D colour Doppler ultrasound) and map them to geometric vascular models suitable to perform CFD simulations of haemodynamics. We describe the implementation and utilisation of the method within an open-source computational hemodynamics simulation software (CRIMSON).Methods:tThe proposed method establishes point-wise correspondences between the contour of a fixed geometric model and time-varying contours containing the velocity image data, from which a continuous, smooth and cyclic deformation field is calculated. Our methodology is validated using synthetic data, and demonstrated using two different in-vivo aortic velocity datasets: a healthy subject with normal tricuspid valve and a patient with bicuspid aortic valve.Results:We compare the performance of our method with results obtained with the state-of-the-art Schwarz-Christoffel method, in terms of preservation of velocities and execution time. Our method is as accurate as the Schwarz-Christoffel method, while being over 8 times faster. The proposed method can preserve either the flow rate or the velocity field through the surface, and can cope with inconsistencies in motion and contour shape.Conclusions:Our results show that the method is as accurate as the Schwarz-Christoffel method in terms of maintaining the velocity distributions, while being more computationally efficient.Our mapping method can accurately preserve either the flow rate or the velocity field through the surface, and can cope with inconsistencies in motion and contour shape.Significance:The proposed method and its integration into the CRIMSON software enable a streamlined approach towards incorporating more patient-specific data in blood flow simulations.

The diagnostic value of two-dimensional ultrasound and three-dimensional color Doppler ultrasonography combined with AFP and CK in the diagnosis of scar uterus and placenta previa implantation

Objective To compare the diagnostic value of two-dimensional ultrasound and three-dimensional color Doppler ultrasonography combined with alpha-fetoprotein (AFP) and creatine kinase (CK) in the diagnosis of scar uterus and placenta previa implantation. Methods 120 cases of pregnancy delivery documented in our hospital from February 2013 to January 2017 were selected as the research object. All cases were divided into implantation group and non implantation group accorded to the pathological diagnosis. The implantation group of 44 cases were diagnosed as placenta previa implantation and the non implantation group of 76 cases were diagnosed as non placenta previa implantation. Two-dimensional ultrasound and three-dimensional color Doppler ultrasound diagnosis characteristic and effect in the two groups were recorded. The AFP, CK expression in the two groups were also detected. Results AFP and CK expression were detected in the serum levels of all pregnant women. The AFP and CK expression in the implantation group were (152.80±11.66)μg/L and (125.98±16.67)IU/L, significantly higher than non implantation group [(80.65±22.84)μg/L and (77.55±23.32)IU/L, P<0.05]. Ultrasonic diagnosis of placenta implantation in 39 cases, and non placenta previa implantation81 cases ; there were 38 cases of placenta accreta and 82 cases of non placenta previa implantation judged by AFP and CK expression; 43 cases of placenta previa implantatio, and 77 cases of non placenta previa implantation judged by ultrasound combined with AFP and CK. So the combined diagnostic sensitivity were significantly higher than that of single diagnostic sensitivity (P<0.05). The receiver operating characteristic (ROC) curve shows that the area under the curve of ultrasound is =0.879, AFP and CK=0.835, and the ultrasound was better than AFP and CK. Conclusions The two-dimensional ultrasound and three-dimensional color Doppler ultrasonography combined with AFP and CK in the diagnosis of scar uterus and placenta previa implantation can improve the diagnostic effect, and they have very good application values. Key words: Placenta previa/US; Placenta accreta/US/BL; Uterus/US; Cicatrix; Ultrasonography, Doppler, color; Alpha-fetoproteins/BL; Creatine kinase/BL

Transesophageal echocardiography for incremental value of Amplatezer cribriform septal occluder for percutaneous transcatheter closure of complex septal defects: Case series

BackgroundThe anatomy of septal defects can be complex and morphologically unpredictable. Balloon sizing of such defects may not be feasible, and an appropriately sized commercial occluder may not be available. Therefore, percutaneous transcatheter closure of such defects can be challenging because of an increased risk of complications. In this study, we have described the efficacy and safety of transcatheter closure of complex septal defects using Amplatzer cribriform occluder devices, assessed by real time three-dimensional (RT 3D) color Doppler transesophageal echocardiography (TEE). Methods and ResultsFour complex septal defects were involved in this investigation: (1) reimplanted multiple atrial septal defects (ASD) with one device embolization; (2) postinfarction ventricular septal defect; (3) long tunnel patent foramen ovale; and (4) postoperative residual ASD. All patients underwent percutaneous transcatheter interventions due to the high risk of surgical complications, and one of the three available cribriform ASD device sizes (18 mm, 25 mm, or 35 mm) was implanted. Perioperative RT 3D TEE combined with fluoroscopy was used for monitoring during the procedure. All defects were successfully occluded by cribriform septal occluder devices using the transcatheter technique. ConclusionOur patients with complex septal defects were successfully treated by transcatheter closure using an Amplazter cribriform septal occluder device with careful planning based on patient presentation and close interdisciplinary collaboration. RT 3D color Doppler TEE provided precise information for the selection of the appropriate occluder device and facilitated the procedure by guiding the catheter through the often challenging patient anatomy.

The value of three-dimensional color Doppler trans-esophageal echocardiography in predicting the number of MitraClip devices needed during the procedure.

PurposeDuring MitraClip procedure, one or more clips might be needed to effectively reduce the mitral regurgitation (MR). Three-dimensional vena-contracta (3D-VC) assessed by color Doppler three-dimensional trans-esophageal echocardiography (3D-TEE) was proven to be well correlated with MR severity. However, its role in predicting the number of MitraClip devices needed during the procedure was not fully determined. Aim of this study is to assess the predictive value of 3D-VC area & length in determining the number of clips needed during the procedure.Methods3D-TEE with color Doppler was performed in 20 patients ( age: 68.9 ± 2.5 years; 65% males; with functional severe/moderately severe MR) who underwent successful MitraClip procedure (reduction of MR to <2+). Manual tracing and measurement of the 3D-VC area (3D-VCA) as well as the 3D-VC length (3D-VCL) was done. These values were compared between patients who received 1 clip (n = 4) and ≥ 2 clips (n = 16).ResultsPatients who received ≥ 2 clips had larger 3D-VC area compared to patients who received 1 clip (0.39 ± 0.23 cm2 vs. 0.13 ± 0.03 cm2, p = 0.04, t = 2.22) . Patients who received ≥ 2 clips had bigger 3D-VC length compared to patients who received 1 clip (1.14 ± 0.33 cm vs. p = 0.005, t = 3.25 ). A cut-off values of 0.20 cm2 & 1 cm for the VCA & VCL respectively, are suggestive that the patient will most likely require more than one MitraClip device to treat his mitral regurgitation.ConclusionsThe 3D-VCA & 3D-VCA using 3D TEE is helpful indetermining the number of MitraClip devices needed during the procedure in functional mitral regurgitation.

Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic Echocardiography in Quantifying Mitral Regurgitation: A Comparison with Conventional Two-Dimensional Methods

Automatic quantification of real-time three-dimensional (3D) full-volume color Doppler transthoracic echocardiography (FVCD) has been proposed as a feasible and accurate method for quantifying MR. We aimed to explore the clinical implications of real-time 3D-FVCD for mitral regurgitation (MR) with various clinical manifestations, in comparison with the conventional two-dimensional (2D) proximal isovelocity surface area (PISA) and volumetric method and cardiac magnetic resonance imaging (CMR) methods. A total 186 patients with MR were enrolled prospectively. Based on exclusion criteria and image quality review, 152 patients were included in the final analysis for 3D-FVCD and 2D transthoracic echocardiography. Among them, 37 patients underwent subsequent CMR for the validation of 3D-FVCD. MR volume from 3D-FVCD demonstrated a better agreement (r=0.94) with CMR than 2D-PISA or the 2D volumetric method (VM; r=0.87 vs 0.56). Overall, 2D methods underestimated MR when compared with 3D-FVCD (35.4±28.4mL for 2D-VM vs 43.8±24.6mL for 2D-PISA vs 64.6±35.1mL for 3D-FVCD; P<.001). In subgroup analysis, multijet MR (odds ratio [OR], 6.30; 95% CI, 2.52-15.72) and dilated left ventricular end-systolic diameter ≥40mm (OR, 2.90; 95% CI, 1.12-7.50) were predictors of significant difference in MR volume (>30mL for primary MR and >15mL for secondary MR) between 2D-PISA and 3D-FVCD. In identifying surgical candidates, patients with multijet MR (OR, 4.53, 95% CI, 1.99-10.35) demonstrated a higher risk of discrepancy between 2D-PISA and 3D-FVCD, which were consistent in both primary and secondary MR, respectively. MR quantification with 3D-FVCD showed better correlation and agreement than conventional 2D methods. MR was underestimated by 2D methods, especially in multijet and dilated left ventricle. Multijet MR demonstrated higher risk of discrepancy for the identification of surgical candidate, regardless of MR etiology.

Choriovitelline placenta: prenatal sonographic imaging and clinical characteristics.

To describe the fetal sonographic characteristics, in-utero natural history and postnatal outcome of choriovitelline placenta, in which the fetal umbilical vein is replaced by the extra-embryonic vitelline circulation. This was a retrospective study of pregnancies examined during the period 2010-2014. Fetuses which presented with sonographic criteria of a downward caudal course of an enlarged vein from the umbilical annulus to the hepatic hilum were followed prospectively. Two-dimensional and three-dimensional color Doppler with high-definition flow were used in order to investigate the extra- and intrahepatic venous system. Ultrasound images and volumes were stored digitally, clinical data were obtained from patients' medical files and telephone interviews were conducted regarding the course of the pregnancy, perinatal data and developmental milestones. Four cases were identified during the study period. The mean ± SD gestational age at diagnosis was 19.5 ± 4.3 (range, 13-23) weeks. The characteristic downward course of the persistent vitelline vein was associated with aneurysmal dilatation and anomalous anatomical configuration of the intrahepatic venous system. One case ended with antepartum death at 28 weeks. The mean gestational age at delivery was 34.6 (±5.0) weeks and the birth weight corresponded to the 57.2nd (± 16.8 SD) centile. In two cases, a thrombotic mass was detected in the portal venous system after birth. One necessitated antithrombotic treatment for 6 months; in the other case, spontaneous resolution occurred 7 days after birth. In the three surviving infants, the persistent extrahepatic vitelline vein regressed gradually within 6 months after birth. Neurodevelopment was normal at follow-up aged 1 year and 7 months, 3 years and 6 months and 5 years and 5 months. The main clinical importance of choriovitelline placentation derives from the possible formation of thrombus in the portal venous system. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Three-dimensional colour Doppler of ductus venous agenesis in the first trimester

Ductus venosus (DV) has a pivotal role in the fetal circulation. It serves as a conduit connecting the fetal umbilical and portal venous system with the inferior vena cava (IVC). The absence of DV is an uncommon anomaly. In case of agenesis of DV, the umbilical vein joins the fetal systemic venous circulation via the intra-hepatic or extra-hepatic route. We report a case of absent DV with associated anomaly diagnosed in the first trimester using three-dimensional (3D) colour Doppler.

The prediction of radiofrequency ablation zone volume using vascular indices of 3-dimensional volumetric colour Doppler ultrasound in an in vitro blood-perfused bovine liver model.

To determine the most reliable predictor of radiofrequency (RF) ablation zone volume among three-dimensional (3D) volumetric colour Doppler vascular indices in an in vitro blood-perfused bovine liver model. 3D colour Doppler volume data of the local hepatic parenchyma were acquired from 37 areas of 13 bovine livers connected to an in vitro oxygenated blood perfusion system. Doppler vascular indices of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained from the volume data using 3D volume analysis software. 37 RF ablations were performed at the same locations where the ultrasound data were obtained from. The relationship of these vascular indices and the ablation zone volumes measured from gross specimens were analyzed using a general linear mixed model fit with random effect for liver and backward stepwise regression analysis. FI was significantly associated with ablation zone volumes measured on gross specimens (p = 0.0047), but explained little of the variance (Rβ2 = 0.21). Ablation zone volume decreased by 0.23 cm3 (95% confidence interval: -0.38, -0.08) for every 1 increase in FI. Neither VI nor VFI was significantly associated with ablation zone volumes (p > 0.05). Although FI was associated with ablation zone volumes, it could not sufficiently explain their variability, limiting its clinical applicability. VI, FI and VFI are not clinically useful in the prediction of RF ablation zone volume in the liver. Advances in knowledge: Despite a significant association of FI with ablation zone volumes, VI, FI and VFI cannot be used for their prediction. Different Doppler vascular indices need to be investigated for clinical use.

Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance.

To review our experience with fetal umbilical-portal-systemic venous shunts (UPSVS), to devise an in-utero classification system, and to analyze their clinical and prognostic characteristics. This was a retrospective review of cases of UPSVS examined at an academic tertiary referral center over the 14-year period from 2001 to 2014 inclusive. The anatomical origin and drainage of the fetal umbilical, portal, ductus venosus and hepatic venous systems, and the integrity of the intrahepatic portal venous system (IHPVS), were assessed using two- and three-dimensional color Doppler sonography. Fetomaternal clinical characteristics and long-term outcome were investigated by means of medical files, imaging documentation and telephone interviews with the mothers. Forty-four cases with UPSVS were reviewed. Prenatal classification was based on the anatomical origin of the shunt (umbilical, portal or ductal), with cases classified into four types: Type I, umbilical-systemic shunt (n = 9 (20.4%)); Type II, ductus venosus-systemic shunt (n = 19 (43.2%)); and Type III, portal-systemic shunt, divided into two subtypes: Type IIIa, intrahepatic portal-systemic shunt (n = 12 (27.2%)) and Type IIIb, extrahepatic portal-systemic shunt (n = 4 (9.1%)). Each type presented particular clinical and prognostic characteristics. The most important favorable prognostic factors were absence of associated major malformation and presence of the IHPVS. Thus, Type IIIa (intrahepatic portal-systemic shunt) had the best outcome. Fetal UPSVS are anomalies with a broad spectrum of manifestations and prognoses. Accurate mapping of the IHPVS is paramount for optimizing prenatal counseling and postnatal care. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Abstract TP136: Four-dimensionally Guided Three-dimensional Color-doppler Ultrasonography Quantifies Carotid Artery Stenoses With Equally High Reproducibility and Accuracy Compared to Catheter Angiography

Introduction: Clinical stratification in patients with ICAS largely depends on symptomatic status and stenosis grading. The purpose was to analyze the agreement and binary accuracy for the degree of internal carotid artery stenoses (ICAS) as determined by four-dimensional (4D) real-time guided three-dimensional color-Doppler (3DC) ultrasonography (4D/3DC-US) compared to catheter angiography (CA). Hypothesis: We hypothesized that 4D/3DC-US is non inferior to CA in grading ICAS in selected patients. Methods: Screening with 4D/3DC-US was performed in 93 patients (122 ICAS) admitted to our vascular center.Main exclusion criteria were insufficient image quality, previous revascularization and contraindications to CA. Eighty patients were prospectively examined in optimal planes with 4D-US assisted static 3DC-US color-Doppler (10MHz) followed by blinded multiplanar off-line rendering to determine %-NASCET stenosis. Multiplane selective CA of the same ICAS were quantified with dedicated software in a blinded fashion. Results: Quantitative CA of 103 stenoses with a mean degree of 65 ± 17% were compared to 4D/3DC-US resulting in a Pearson correlation coefficient of 0.89 and a standard deviation of differences (SDD) of 8.1% at a bias of +1.7%. Binary 50, 60 and 70%-stenosis detection with 3DC-US revealed an accuracy of 96, 89, 85%, a sensitivity of 97, 92, 87% and a specificity of 92, 83 and 84%. Interobserver SDD for CA of 52 stenoses (7.2%) did not differ from SDD between 3DC-US and CA (P = 0.274). Conclusions: 4D/3DC-US allowed good metric stenosis quantification and accurate binary classification with high reproducibility in a selected cohort.