Three-dimensional Doppler Ultrasonography 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.

Особливості гемодинаміки тіла матки залежно від її об’єму та ступеня васкуляризації вузлів, які досліджували за допомогою методу тривимірної допплерографії, у хворих з лейоміомою

with leiomyoma using doppler sonography there is information about the fact that the degree of uterus blood supply in this disease is associated with its proliferative capacities.Use of three-dimensional power doppler sonography allows to evade a subjective assessment of organs and tumors vascularization, present in two-dimensional doppler sonography, by quantitative evaluation of vascular blood flow intensity with calculation of volume indices of uterine body vascularization in female patients with leiomyoma.We decided to conduct this study to develop a standardized approach to the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma predictors. The objective: to study peculiarities of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography. Materials and methods. 238 women aged 18 to 39 years were examined (Me=28.5). The main group consisted of 127 (53.36%) fertile age women aged 27 to 39 years (Me=33.0) with uterine leiomyoma, found during ultrasonography.All of them were divided into further sub-groups: women with small and large leiomyomas, and they, in their turn, into women with uterine leiomyoma of moderate vascularization with single color loci peripherally in the mode of two-dimensional power flow mapping and women with uterine leiomyoma of profound vascularization with a great amount of color loci both peripherally and in the center in the mode of two-dimensional power flow mapping.The comparison group consisted of 111 (46.6%) of apparently healthy women aged 18 to 39 years (Ме=28.5), in which uterus examination allowed to develop new and improve the existent nomograms of uterine body blood flow values (VI, FI, VFI) and develop uterine cervix nomograms. In case of three-dimensional (3D) reconstruction of the uterus using power mapping and options of VOCAL (Virtual Organ Computer-aided Analysis), an objective assessment of hemodynamics of the uterine body was carried out by calculating the vascularization index (VI) that characterizes the percentage of color voxels in the volume of the uterine body, index of flow intensity (FI) that shows median brightness of the color voxels depending on the flow velocity in a predetermined three-dimensional volume, and vascularization flow index (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100. Results. In the fertile period the study three-dimensional blood flow indices values, reflecting hemodynamics of uterus, affected by leiomyoma, depended on uterine body volume (Kruskal–Wallis test, p&lt;0.05), falling to the bottom boundary of reference values of the comparison group progressively as the uterine body volume increases by more than 370 cm3 (large uterine leiomyoma) subject to moderate vascularization of lumps, and approaching with some exceedence to median values of norm subject to significant vascularization (CC, Mann-Whitney U-test; p&lt;0.05).Therefore uterine body volume of 370 cm3 we consider the differential criteria, which allows to get oriented in the dynamics of the indices under study. Characteristics of small (less than 370 cm3) uterine leiomyoma values under study depended on lumps vascularization degree: if vascularization was medium, practically no differences from norm were observed, and if vascularization was profound, the significant exceedence in comparison groups nomograms values was obvious (Mann–Whitney U-test; p&lt;0.05). Conclusion. Obtained regularities in changes of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography, opens new prospects of the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma.Use of standardized diagnostic approach should considerably increase the sensibility and specificity of three-dimensional power doppler sonography method in diagnostics of leiomyoma and uterine sarcoma in future. Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine sarcoma, uterine body volume, lumps vascularization degree.

Study of hemodynamics of the uterine body by the method of three-dimensional energy dopplerography of patients with leiomyoma in different age periods

To date, there is not enough papers to establish the reproducibility of the calculation of three-dimensional indices of blood flow and their threshold values for the diagnosis of a particular pathology. In this regard, the technique of three-dimensional Doppler sonography requires further study.The aim of research is studying the hemodynamics of the uterine body of patients with leiomyoma by three-dimensional energy Doppler ultrasonography to determine the possible patterns of changes in the indicators of three-dimensional vascularization indices depending on the phases of the menstrual cycle of women of reproductive age, in perimenopause and at different periods of menopause.Materials and methods. 326 women between the ages of 18 and 75 were surveyed (Me = 46.5). The comparison group consisted of 157 (48.15 %) healthy women, the main group was 169 women (51.84 %) with uterine leiomyoma. All patients in both groups were divided into women of reproductive age, women in peri - and menopause.In 3D reconstruction of the uterus using the energy mapping function and the VOCAL (Virtual Organ Computer - aided Analysis) option, an objective assessment of the hemodynamics of the uterine body was performed by calculating the vascularization index (VI), which characterizes the percentage of colour voxels in uterus body volume, flow intensity index (FI), showing the median luminance of colour voxels, which depends on the blood flow velocity in a given three-dimensional volume and vascularization-flow index (VFI), which is a product of multiplying the vascularization index and the flow index, divided by 100.Result. As a result, the main group identified the patterns of dynamics of three-dimensional indices of blood flow, depending on the survey at different ages, similar to the comparison group. In the reproductive period in patients with uterine leiomyoma, regardless of the size and degree of vascularization, the minimum values of the indexes VI, FI and VFI of the body of the uterus were registered in the early proliferative phase, significantly increasing to the middle secretion phase, coinciding with the fertility period of corpus luteum, secretion (p <0.05, CCU). In peri - and menopause, patients with leiomyomas have a statistically significant dynamics, similar to the nomograms of the comparison group, in reducing the values of the three-dimensional index of perfusion of the VI of the uterus as the period of absence of menstruation increases (CCU, p = 0.0472), with the highest values being characteristic of the perimenopause period. In the analysis of the dynamics of the FI and VFI indices of the body of the uterus of women with perio- and menopausal leiomyomas, the distribution of the studied indices was not confirmed by statistical significance. However, their pattern quite accurately reproduces the dynamics of a gradual decrease in these three-dimensional indices of blood flow in women with uterine body leiomyoma as the duration of absence of menstruation increases: the highest values were characteristic of the perimenopause period and the lowest - for the menopause period of more than 10 years.Conclusions. Taking into account the revealed patterns of dynamics of indicators of three-dimensional indices of blood flow depending on the age periods of women with leiomyoma will in the future increase the sensitivity and specificity of the method of three-dimensional energy Doppler sonography in the differential diagnosis of proliferative activity of uterine leiomyoma

Placental Blood Flow by Three-dimensional Doppler Ultrasound

ABSTRACT This review aims to provide the reader with an overview of the potential clinical applications in three-dimensional (3D) Doppler ultrasound for the evaluation of vascularity and blood flow within the placenta. Significant innovations have recently occurred, improving the visualization and evaluation of placental vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequencyand/ or amplitude-based color Doppler ultrasound. Spatial representation of vascularity can be improved by utilizing 3D processing. Greater sensitivity of 3D Doppler ultrasound to macro- and microvascular flow has provided improved anatomical and physiologic assessment throughout pregnancy. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in placental studies. Three-dimensional Doppler sonography is a unique ultrasound technique that enables assessment of vascular signals within the whole investigated area. Homodynamic changes included in the process of placentation are one of the most exciting topics in the investigation of early human development. How to cite this article Zalud I. Placental Blood Flow by Threedimensional Doppler Ultrasound. Donald School J Ultrasound Obstet Gynecol 2016;10(1):55-62.

Endometrial, subendometrial, and ovarian stromal blood flow in patients treated with two different doses of recombinant human chorionic gonadotropin

The effects of two different doses of recombinant hCG on blood flow to the uterus and ovary on the day of oocyte retrieval were studied by three-dimensional Doppler ultrasonography in 60 women during IVF treatment. There were no differences in all the indices of endometrial, subendometrial, and ovarian stromal blood flow in women who had received 250 microg or 500 microg of recombinant hCG for final oocyte maturation.

3D Doppler ultrasound in the study of placental vascularization

AbstractThis review aims to provide the reader with an overview of the potential clinical applications in 3D Doppler ultrasound for the evaluation of vascularity and blood flow within the placenta. Significant innovations have recently occurred, improving the visualization and evaluation of placental vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler ultrasound. Spatial representation of vascularity can be improved by utilizing 3D processing. Greater sensitivity of 3D Doppler ultrasound to macro- and microvascular flow has provided improved anatomicand physiologic assessment throughout pregnancy. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in placental studies. Three-dimensional Doppler sonography is a unique ultrasound technique that enables assessment of vascular signal...