Three-dimensional Power Doppler Indices Research Articles

Effects of different PCOS phenotypes on placental three-dimensional power Doppler indices and placental volume during the first trimester

IntroductionThe aim of the present study was to evaluate the effects of different polycystic ovary syndrome (PCOS) phenotypes using first-trimester placental three-dimensional power Doppler indices and placental volume. MethodsIn this prospective case-control study, 170 pregnant women who met the inclusion criteria were divided into five groups according to PCOS phenotype: non-PCOS control (n = 34), PCOS phenotype A (n = 34), PCOS phenotype B (n = 34), PCOS phenotype C (n = 34), and PCOS phenotype D (n = 34). The primary outcomes determined in the present study were the differences in placental volume and placental flow index (FI), vascularization flow index (VFI), vascularization index (VI), and uterine artery pulsatility index (PI) betweenthe PCOS groups and control group. ResultsThe mean placental volume and VI were significantly decreased in the phenotype A, B, and C groups compared to the control group and PCOS phenotype D group. The mean FI and VFI were significantly decreased in the phenotype A and B groups compared to the control group and PCOS phenotype C and D groups. The mean testosterone, dehydroepiandrostenedione, sex-hormone binding globulin, free androgen index, and insulin resistance levels were significantly increased in the phenotype A, B, and C groups compared to the control group and PCOS phenotype D group. DiscusionThe results indicated that placental volume and placental vascular Doppler indices in the first trimester were more adversely affected in the PCOS A and B phenotypes than other PCOS phenotypes.

Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus

Objective: To compare the changes of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy with gestational diabetes mellitus (GDM).Methods: This was a prospective case-control study of singleton pregnancies with risk factors for GDM. Data on placental vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI), as well as placental volume were obtained and analyzed during the first and the second trimesters between pregnant women with and without GDM.Results: Of the 155 pregnant women enrolled, 31 developed GDM and 124 did not. VI and VFI were significantly lower in the GDM group during the first and second trimesters (VI: p = .023, and VFI: p = .014 in the first trimester; VI: p = .049, and VFI: p = .031 in the second trimester). However, the placental volume was similar in both the groups during the first trimester, while it was significantly increased in the GDM group during the second trimester (p = .022). There were no significant differences in FI and uterine artery pulsatility index between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in the first trimester VFI (adjusted odds ratio (OR) 0.76, 95% confidence interval (CI) 0.61–0.93), second trimester VFI (adjusted or 0.83, 95%CI 0.71–0.96), and second trimester placental volume (adjusted or 1.03, 95%CI 1.01–1.05).Conclusions: Placental vascular indices can provide an insight into placental vascularization in GDM during early pregnancy. VFI rather than placental volume may be a sensitive sonographic marker in the first trimester of GDM placentas.

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery.

Chemoradiation-based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC), but ultrasound variables used to predict partial response to neoadjuvant treatment are not well defined. Our goal was to analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single-institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery. Between October 2010 and June 2014, we screened 108 women with histologically documented LACC Stage IB2-IVA, of whom 88 were included in the final analysis. Tumor volume, three-dimensional (3D) power Doppler indices and contrast parameters were obtained before (baseline examination) and after 2 weeks of treatment. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (microscopic and/or macroscopic residual tumor at pathological examination). Complete-response and partial-response groups were compared and receiver-operating characteristics (ROC) curves were generated for ultrasound variables that were statistically significant on univariate analysis to evaluate their diagnostic ability to predict partial pathological response. There was a complete pathological response to neoadjuvant therapy in 40 (45.5%) patients and a partial response in 48 (54.5%). At baseline examination, tumor volume did not differ between the two groups. However, after 2 weeks of neoadjuvant treatment, the tumor volume was significantly greater in patients with partial response than it was in those with complete response (P = 0.019). Among the 3D vascular indices, the vascularization index (VI) was significantly lower in the partial-response compared with the complete-response group, both before and after 2 weeks of treatment (P = 0.037 and P = 0.024, respectively). At baseline examination in the contrast analysis, women with partial response had lower tumor peak enhancement (PE) as well as lower tumor wash-in rate (WiR) and longer tumor rise time (RT) compared with complete responders (P = 0.006, P = 0.003, P = 0.038, respectively). There was no difference in terms of contrast parameters after 2 weeks of treatment. ROC-curve analysis of baseline parameters showed that the best cut-offs for predicting partial pathological response were 41.5% for VI (sensitivity, 63.6%; specificity, 66.7%); 16123.5 auxiliary units for tumor PE (sensitivity, 47.9%; specificity, 84.2%); 7.8 s for tumor RT (sensitivity, 68.8%; specificity, 57.9%); and 4902 for tumor WiR (sensitivity, 77.1%; specificity, 60.5%). ROC curves of parameters after 2 weeks of treatment showed that the best cut-off for predicting partial pathological response was 18.1 cm3 for tumor volume (sensitivity, 70.8%; specificity 60.0%) and 39.5% for VI (sensitivity; 62.5%; specificity, 73.5%). Ultrasound and contrast parameters differ between LACC patients with complete response and those with partial response before and after 2 weeks of neoadjuvant treatment. However, neither ultrasound parameters before treatment nor those after 2 weeks of treatment had cut-off values with acceptable sensitivity and specificity for predicting partial pathological response to neoadjuvant therapy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction

Development of intrauterine growth restriction (IUGR) can be traced back to maternal or fetal factors, but in many cases we find placental factors (reduced placental circulation) in the background. Our aim was to examine whether the reduced placental bloodperfusion and vascularity show any correlation with cesarean section frequency and the clinical outcome in IUGR pregnancies. The aim of the present study was also to use a properly calibrated and reproducible method for evaluating placental blood flow, that can later be incorporated into the routine examination. 254 women were recruited in our prospective case-control study. The 3 dimensional power Doppler (3DPD) ultrasound indices; vascularisation index (VI), flow index (FI) and vascularization flow index (VFI) were measured on each participant. Median VI was 3.7% (interquartile range [IQR] 3.2%-4.2%) in the IUGR group and 10.1% (IQR 8.6%-10.9%) in the control group (p = 0.001). Median FI value was 40.0 (IQR 39.7-42.5) in the IUGR group and 45.1 (IQR 44.1-53.1) in the control group (p = 0.012). Median VFI was 2.2 (IQR 2.1-2.4) in the IUGR group and 4.8 (IQR 4.4-5.3) in the control. The 3DPD indices may be useful for examining changes in circulation in IUGR pregnancies to characterize the underlying pathology. Orv Hetil. 2017; 158(26): 1008-1013.

Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction

ObjectiveTo examine placental vascularization using three-dimensional power Doppler (3DPD) ultrasonography in pregnancies complicated by intrauterine growth restriction (IUGR). MethodsThe present prospective study was conducted at the University of Szeged (Szeged, Hungary) from February 2012 to March 2013. Women with a singleton pregnancy who attended the maternity outpatient ward in the second or third trimester were enrolled consecutively. Women were divided into two groups: those with a normal pregnancy and those with a pregnancy complicated by IUGR. Three 3DPD indices—vascularization index (VI), flow index (FI), and vascularization flow index (VFI)—were assessed. ResultsA total of 223 women were enrolled: 171 were in the control group and 52 in the IUGR group. Median VI was 3.7% (interquartile range [IQR] 3.2%–4.2%) in the IUGR group and 10.1% (IQR 8.6%–10.9%) in the control group (P=0.001). Median FI was 40.0 (IQR 39.7–42.5) in the IUGR group and 45.1 (IQR 44.1–53.1) in the control group (P=0.012). Median VFI was 2.2 (IQR 2.1–2.4) in the IUGR group and 4.8 (IQR 4.4–5.3) in the control group (P<0.001). ConclusionPlacental vascularization was reduced in pregnancies complicated by IUGR.

Three-dimensional power Doppler indices at 18-22 weeks' gestation for prediction of fetal growth restriction or pregnancy-induced hypertension.

We assessed placental perfusion based on placental vascular sonobiopsy (PVS) at 18-22 weeks of gestation in a low-risk population to predict fetal growth restriction (FGR) or pregnancy-induced hypertension [PIH; gestational hypertension (GH) and preeclampsia (PE)]. PVS using three-dimensional (3D) power Doppler ultrasound with the VOCAL imaging analysis program was performed in 226 pregnancies [FGR, 25; appropriate-for-gestational age (AGA) 191; and large-for-gestational age (LGA), 10] [PIH, 13 (GH, 7 and PE, 6) and non-PIH, 213] at 18-22 weeks of gestation. 3D power Doppler indices such as the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) using PVS were calculated in each placenta. There were no significant differences in VI, FI, or VFI values among FGR, AGA, and LGA pregnancies. No significant differences in VI, FI, or VFI values between PHI and non-PIH pregnancies were noted. There were also no significant differences in VI, FI, or VFI values between GH and PE pregnancies. 3D power Doppler placental vascular indices at 18-22 weeks could not be used to predict high-risk pregnancies that develop FGR or PIH in a low-risk population.

Three-dimensional power Doppler indices of ovarian stromal blood flow and serum vascular endothelial growth factor after laparoscopic ovarian drilling in women with polycystic ovary syndrome

Abstract Objective To evaluate the effects of laparoscopic ovarian drilling (LOD) on three-dimensional (3D) power Doppler indices of ovarian stromal blood flow and serum vascular endothelial growth factor (VEGF) levels in women with polycystic ovary syndrome (PCOS). Design Prospective controlled study. Setting Minia University Hospital, Minia, Egypt. Material and methods 30 clomiphene citrate resistant women with PCOS undergoing LOD and 30 fertile women with normal ovaries were recruited in this study. Hormonal profile, Doppler indices of ovarian stromal blood flow and serum VEGF assays before and after LOD were evaluated and compared between the two groups. Evaluation was done at the beginning of the study, 1 week after LOD and at 3 and 6 month follow up periods. Main outcome measures 3-D power Doppler indices of both ovaries and serum VEGF concentration. Results Before LOD, serum levels of VEGF, total testosterone (T), free androgen index (FAI), LH, LH:FSH ratio, total antral follicle count (AFC), total ovarian volume (OV) and the 3D power Doppler blood flow indices were significantly higher in the PCOS group than in the control group. After LOD, there was a significant reduction in the serum levels of VEGF, T, sex-hormone binding globulin (SHBG), FAI, LH, LH:FSH ratio, AFC, OV and the 3D power Doppler indices and remained all low at 3 and 6 month follow up. There were significant positive correlations between power Doppler flow indices (VI, FI, and VFI) with serum VEGF, total T, and LH before and after LOD. Conclusions Serum VEGF and ovarian blood flow indices were higher in women with PCOS than in normal women. LOD reduced serum levels of VEGF, in addition to ovarian blood flow indices, in women with PCOS.

First-trimester 3D power Doppler of the uteroplacental circulation space and fetal growth restriction

The objective of the study was to compare the 3-dimensional power Doppler (3DPD) of the uteroplacental circulation space in the first trimester between women who subsequently deliver growth-restricted vs normally grown neonates. This was a prospective observational study of singleton pregnancies at 11-14 weeks' gestation. The 3DPD indices, vascularization index, flow index, and vascularization flow index were determined on a uteroplacental circulation space sphere biopsy with the virtual organ computer-aided analysis program. Growth restriction was defined as a birthweight less than the 10th percentile for gestational age and was evaluated using both population-based and customized birth curves. Five hundred seventy-seven women were enrolled. Five hundred twenty-six were eligible for analysis using population centiles, and 497 were available for evaluation using customized centiles. There was no difference in the first-trimester 3DPD indices between patients with growth-restricted and normally grown neonates using either curve. Three-dimensional power Doppler indices of the uteroplacental circulation space in the first trimester are similar between neonates who develop growth restriction and those who will grow normally.

Three-dimensional power Doppler indices of preeclamptic placentas correlated to umbilical artery Doppler and albuminuria

Purpose: To obtain three-dimensional power Doppler (3DPD) indices of placenta in pregnancies complicated with preeclampsia compared to normal pregnancies and correlated to umbilical artery Doppler and albuminuria.Methods: A case-control study was conducted at Ain Shams University Maternity Hospital. Evaluation of placental vascular indices, vascularization index (VI), flow index (FI) and vascularization flow index (VFI), was done using 3DPD in 80 preeclampsia pregnancies compared to 80 normal controls.Results: 3DPD indices (VI, FI and VFI) of preeclampsia cases revealed lower values than controls (p < 0.001). There was a statistical inverse correlation between albuminuria versus VI (p < 0.05) and a statistical inverse correlation was found between VI, FI and VFI versus umbilical artery RI.Conclusion: 3DPD indices of placental vasculature revealed lower values in preeclamptic pregnancies than normal pregnancies. Further studies are needed to discuss the possible role of 3DPD in predicting preeclampsia.

Effect of pregestational diabetes mellitus on first trimester placental characteristics: Three-dimensional placental volume and power Doppler indices

ObjectiveTo investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. MethodsThis was a prospective case–control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. Results3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. ConclusionsPregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

Influence of attenuation on three-dimensional power Doppler indices and STIC volumetric pulsatility index: a flow phantom experiment

Influence of attenuation on three-dimensional power Doppler indices and STIC volumetric pulsatility index: a flow phantom experiment

Endometrial scratching performed in the non‐transfer cycle and outcome of assisted reproduction: a randomized controlled trial

To investigate the effect of endometrial scratching, performed during oral contraceptive pill (OCP) pretreatment, on reproductive outcome and on ultrasound markers of endometrial receptivity, and to assess the pain involved in the procedure, in unselected women undergoing assisted reproductive techniques (ART). Women undergoing ART were randomly allocated to undergo either endometrial scratching with a pipelle de Cornier or a sham procedure, 7-14 days before starting controlled ovarian stimulation (COS). We evaluated subsequent rates of clinical pregnancy, live birth, implantation, miscarriage and multiple pregnancy. Pain during the procedure was evaluated using a 10-cm visual analog scale. Endometrial thickness and volume and three-dimensional power Doppler (3D-PD) indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were assessed during COS when there was at least one follicle ≥ 17 mm in diameter. We included 158 women. Endometrial scratching was associated with higher rates of live birth (41.8% vs 22.8%, P = 0.01) and clinical pregnancy (49.4% vs 29.1%, P = 0.01) and higher pain score (6.42 ± 2.35 cm vs 1.82 ± 1.52 cm, P < 0.001), endometrial VI (3.71 ± 1.77 vs 2.95 ± 1.56, P < 0.01) and VFI (0.97 ± 0.51 vs 0.76 ± 0.40, P < 0.01). There was no significant effect of endometrial scratching on rate of miscarriage (15.4% vs 21.7%, P = 0.53) or multiple pregnancy (22.5% vs 25.0%, P = 0.79), or on endometrial thickness (10.12 ± 1.55 mm vs 9.98 ± 1.62 mm, P = 0.59), endometrial volume (6.18 ± 1.63 cm(3) vs 6.01 ± 1.48 cm(3) , P = 0.51) or FI (26.12 ± 2.82 vs 25.91 ± 2.72, P = 0.65). Endometrial scratching performed once, during OCP pretreatment 7-14 days before starting COS, increases the chance of live birth and clinical pregnancy, but might cause considerable pain.

Placental three‐dimensional power Doppler indices in mid‐pregnancy and late pregnancy complicated by gestational diabetes mellitus

The aim of our study was to evaluate placental three-dimensional power Doppler indices in diabetic pregnancies in the second and third trimesters and to compare them with those of the normal controls. Placental vascularization of pregnant women was determined by three-dimensional power Doppler ultrasound technique. The calculated indices included vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Uncomplicated pregnancies (n = 113) were compared with pregnancies complicated by gestational diabetes mellitus (n = 56) and diabetes mellitus (n = 43). The three-dimensional power Doppler indices were not significantly different between the two diabetic subgroups. All the indices in diabetic patients were significantly reduced compared with those in non-diabetic individuals (p < 0.001). Placental three-dimensional power Doppler indices are slightly diminished throughout diabetic pregnancy [regression coefficients: -0.23 (FI), -0.06 (VI), and -0.04 (VFI)] and normal pregnancy [regression coefficients: -0.13 (FI), -0.20 (VI), and -0.11 (VFI)]. The uteroplacental circulation (umbilical and uterine artery) was not correlated significantly to the three-dimensional power Doppler indices. If all placental indices are low during late pregnancy, then the odds of the diabetes are significantly high (adjusted odds ratio: 1.10). A decreased placental vascularization could be an adjunct sonographic marker in the diagnosis of diabetic pregnancy in mid-gestation and late gestation.

Reply

We appreciate the interest of Dr Martins in our paper and thank him for his comments about our study. First of all we would like to state that discussion and argument are always positive in the scientific world. We agree that mean gray value (MGV), like three-dimensional power Doppler indices, is affected by attenuation. Certainly, we did not comment on this fact in our paper and we should have done. However, we would like to say that in this particular study, attenuation probably had only a small effect on the results, since the vast majority of deep infiltrating endometriosis (DIE) lesions are very close to the vaginal probe (2–3 cm). The idea of using a ratio between the MGV of DIE lesions and that of surrounding structures is certainly interesting. The cervix might be the best reference tissue and we shall analyze this concept in a future study. Regarding our comparison between Hounsfield units (HU) and MGV, the physical modalities are clearly different because computed tomographic (CT) analysis of HU is determined by the attenuation of the X-ray through the body tissues, whereas MGV is dependent on the differences in acoustic impedance of the tissues. However, it is our opinion that these two modalities can be considered similar from a conceptual point of view because of their potential in differentiating tissues quantitatively. However with both MGV and HU there are (similar) difficulties: it was well demonstrated in a recent publication1 that not only are HU values dependent on the tissue being examined but that they change markedly according to the keV (kiloelectronvolt) level used for the exam. This may produce such a big difference in HU values that the tissue might be misclassified as the wrong tissue type (e.g. fatty vs mixed). Moreover, on CT analysis of tissues, it has been demonstrated that the amount of keV applied may modify the tissue's spatial dimensions2 because of the different HU values that the tissues may show. It was for these reasons that we compared MGV with HU, knowing well each of these methods relies on different physical properties. Finally, regarding reproducibility, we agree that repeated acquisitions should be performed for proper assessment of reproducibility of the method and this can be considered as a weakness of our study. However, very few studies in the literature use repeated acquisitions, which is a very time-consuming procedure. S. Guerriero*†, L. Saba‡ and J. L. Alcazar§ †Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; ‡Department of Imaging Science, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy; §Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain *Correspondence. (e-mail: gineca.sguerriero@tiscali.it)

Influence of Gain Adjustment On Three-Dimensional Power Doppler Indices and On Stic Volumetric Pulsatility Indices Using an In Vitro Flow Phantom Experiment

To compare the effect of color gain on the volumetric pulsatility index (vPI) using an in vitro flow phantom model. We hypothesized that the vPI would remain unchanged despite serial increments in gain whilst conventional three dimensional 3D vascular measures would increase in a linear fashion. We divided gains into 3 bands: -8 to -1 (no noise); -1 to +5 (low noise); and +5 to +8 (obvious noise). The vPI was determined from the 3D vascularization index (VI) or vascularization flow index (VFI) using the formula: vPI = (maximum-minimum)/(average). we plotted the values of VI, VFI and vPI obtained with each gain setting. Using ‘no noise’ gains, we observed that whilst the VI and VFI increased linearly with gain, the vPI was significantly less dependent on this adjustment. The VI and VFI continued to increase linearly with gain while the vPI decreased slightly using ‘low noise’ gains. When gain was increased above the lower limit of ‘obvious noise’ (+5) the VI and VFI increased pronouncedly and there were marked reductions in the vPI. We conclude that the vPI is less affected by changes in color gain than the VI and VFI at ‘no noise’ gains.

Three‐dimensional Doppler evaluation of single spherical samples from the placenta: intra‐ and interobserver reliability

To evaluate the intra- and interobserver reliability of assessment of three-dimensional power Doppler (3D-PD) indices from single spherical samples of the placenta. Women with singleton pregnancies at 24-40 weeks' gestation were included. Three scans were independently performed by two observers; Observer 1 performed the first and third scan, intercalated by the scan of Observer 2. The observers independently analyzed the 3D-PD datasets that they had previously acquired using four different methods, each using a spherical sample: random sample extending from basal to chorionic plate; random sample with 2 cm(3) of volume; directed sample to the region subjectively determined as containing more color Doppler signals extending from basal to chorionic plate; or directed sample with 2 cm(3) of volume. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were evaluated in each case. The observers were blinded to their own and each other's results. Additional evaluation was performed according to placental location: anterior, posterior and fundal or lateral. Intra- and interobserver reliability was assessed by intraclass correlation coefficients (ICC). Ninety-five pregnancies were included in the analysis. All three placental 3D-PD indices showed only weak to moderate reliability (ICC < 0.66 and ICC < 0.48, intra- and interobserver, respectively). The highest values of ICC were observed when using directed spherical samples from basal to chorionic plate. When analyzed by placental location, we found lower ICCs for lateral and fundal placentae compared to anterior and posterior ones. Intra- and interobserver reliability of assessment of placental 3D-PD indices from single spherical samples in pregnant women greater than 24 weeks' gestation is poor to moderate, and clinical usefulness of these indices is likely to be limited.

2D and 3D Ultrasound Examination of Labia Minora

The aim of the study was to prospectively evaluate, by using 2D/3D ultrasonography and 3D color Doppler analysis, the morphological and vascular changes in the labia minora during the menstrual cycle of women not sexually aroused. A total of 81 young, healthy eumenorrheic women, in a stable heterosexual relationship (>1year) and without any sexual dysfunction, underwent 2D/3D ultrasound and color Doppler examination of the labia minora on Days 3-5 and 12-14 of the menstrual cycle. Estradiol serum levels were also evaluated. Estradiol plasma levels increased in the periovulatory phase. The labia minora thickness increased from the follicular (3.8±0.3mm) to the periovulatory phase (4.6±0.4mm; p=.005). Furthermore, in the periovulatory phase, the vaginal introitus area and the angles were wider than in the follicular phase. The Pulsatility Index of the posterior labial artery significantly decreased in the periovulatory period. Three-dimensional power Doppler indices of vascularization and blood flow in the labia minora significantly increased in the periovulatory period. The relationship between the different parameters showed that estradiol was positively correlated with labia minora thickness and vaginal introitus area and angles. Furthermore, the circulating levels of estradiol were negatively correlated with posterior labial artery PI and positively correlated with other indices of labia minora vascularization. In conclusion, it seems that estrogen production may influence the anatomic and vascular changes of the labia minora during the menstrual cycle and these changes can be easily identified by ultrasound.

Impact of laparoscopic ovarian drilling on anti-Müllerian hormone levels and ovarian stromal blood flow using three-dimensional power Doppler in women with anovulatory polycystic ovary syndrome

To evaluate the effect of laparoscopic ovarian drilling (LOD) on plasma levels of anti-Müllerian hormone (AMH) and ovarian stromal blood flow changes, by using three-dimensional power Doppler ultrasonography, in polycystic ovary syndrome (PCOS). Prospective controlled study. Taiba hospital, Kuwait. Twenty-three anovulatory clomiphene citrate (CC)-resistant women with PCOS and 20 fertile women as a control group. Laparoscopic ovarian drilling. Serum levels of AMH, ovarian three-dimensional power Doppler indices (vascularization index, flow index, and vascularization flow index) and occurrence of ovulation or pregnancy. Plasma AMH and power Doppler indices of ovarian stromal blood flow were significantly higher in the PCOS group than in the control group. Plasma AMH and ovarian stromal blood flow Doppler indices were significantly reduced in the PCOS group after LOD. Women who ovulated after LOD had a significantly lower preoperative AMH compared with the nonresponders. There was a significant positive correlation between AMH and power Doppler flow indices before and after LOD in PCOS group. Measuring AMH and ovarian stromal three-dimensional power Doppler blood flow for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of LOD.

Placental volume and three‐dimensional power Doppler analysis in prediction of pre‐eclampsia and small for gestational age between Week 11 and 13 weeks and 6 days of gestation

To assess three-dimensional placental volume measurement and three-dimensional power Doppler (3D-PD) indices between 10 weeks and 6 days and 13 weeks and 6 days in predicting pregnancy-induced hypertension (PIH) and small for gestational age (SGA). Three hundred and eight women undergoing fetal nuchal translucency measurement were prospectively assessed using three-dimensional ultrasound in order to measure placental volume and 3D-PD indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI), using the VOCAL software. The outcome was scored as normal, PIH, SGA or both. Eight women developed PIH and ten delivered SGA; and 17 developed PIH or SGA. The age, gestational age at the examination or delivery, number of the pregnancy and the nuchal translucency, were similar in all groups. The placental volume, FI and VFI were similar between the groups. The VI was significantly lower when PIH developed (7.86 ± 3.92 vs. 12.02 ± 7.09 in the normal group, P = 0.035). The crown-rump length (CRL) was significantly smaller in the group where either PIH or SGA developed compared to normal outcome (54.29 ± 6.50 and 59.04 ± 8.89, respectively, P = 0.02). Placental volume is not appropriate for early prediction of PIH or SGA, whereas the VI may be of some potential in detection of PIH. The significance of small CRL in these patients should be further tested.