Three-dimensional Ultrasound Scans Research Articles

Sonothrombolysis Using Microfluidically Produced Microbubbles in a Murine Model of Deep Vein Thrombosis.

The need for safe and effective methods to manage deep vein thrombosis (DVT), given the risks associated with anticoagulants and thrombolytic agents, motivated research into innovative approaches to resolve blood clots. In response to this challenge, sonothrombolysis is being explored as a technique that combines microbubbles, ultrasound, and thrombolytic agents to facilitate the aggressive dissolution of thrombi. Prior studies have indicated that relatively large microbubbles accelerate the dissolution process, either in an in vitro or an arterial model. However, sonothrombolysis using large microbubbles must be evaluated in venous thromboembolism diseases, where blood flow velocity is not comparable. In this study, the efficacy of sonothrombolysis was validated in a murine model of pre-existing DVT. During therapy, microfluidically produced microbubbles of 18 μm diameter and recombinant tissue plasminogen activator (rt-PA) were administered through a tail vein catheter for 30min, while ultrasound was applied to the abdominal region of the mice. Three-dimensional ultrasound scans were performed before and after therapy for quantification. The residual volume of the thrombi was 20% in animals post sonothrombolysis versus 52% without therapy ( ), indicating a significant reduction in DVT volume. Histological analysis of tissue sections confirmed a reduction in DVT volume post-therapy. Therefore, large microbubbles generated from a microfluidic device show promise in ultrasound-assisted therapy to address concerns related to venous thromboembolism.

Automated endometrial identification and volume calculation in normal uteri using a novel smart ERA technique

To evaluate the repeatability of a novel automated technique called Smart ERA (Smart Endometrial Receptivity Analysis) for the automated segmentation and volume calculation of the endometrium in patients with normal uteri,, and to compare the agreement of endometrial volume measurements between Smart ERA, the semi-automated Virtual Organ Computer-aided Analysis (VOCAL) technique and manual segmentation. This retrospective study evaluated endometrial volume measurement in infertile patients who underwent frozen-thawed embryo transfer (FET). Transvaginal three-dimensional ultrasound scans were performed using a Resona R9 ultrasound machine. Data was collected from patients between 2021 and 2022. Patients with normal uteri and optimal ultrasound images were included. Endometrial volumes were measured using Smart ERA, VOCAL at 15° rotation, and manual segmentation. Intra-observer repeatability and agreement between techniques were assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. A total of 407 female patients were evaluated (mean age 33.2 ± 4.7 years). The repeatability of Smart ERA showed an ICC of 0.983 (95% CI 0.984–0.991). The agreement between Smart ERA and the manual method, Smart ERA and VOCAL, and VOCAL and the manual method, as assessed by ICC, were 0.986 (95% CI 0.977–0.990), 0.943 (95% CI 0.934–0.963), and 0.951 (95% CI 0.918–0.969), respectively. The Smart ERA technique required approximately 3 s for endometrial volume calculation, while VOCAL took around 5 min and the manual segmentation method took approximately 50 min. The Smart-ERA software, which employs a novel three-dimensional segmentation algorithm, demonstrated excellent intra-observer repeatability and high agreement with both VOCAL and manual segmentation for endometrial volume measurement in women with normal uteri. However, these findings should be interpreted with caution, as the algorithm's performance may not be generalizable to populations with different uterine characteristic. Additionally, Smart ERA required significantly less time compared to VOCAL and manual segmentation.

Periconceptional maternal supplement intake and human embryonic growth, development, and birth outcomes: the Rotterdam Periconception Cohort.

Is periconceptional multiple-micronutrient supplement (MMS) use including folic acid (FA) compared to FA use only associated with increased embryonic growth, development, and birth weight in a high-risk population? Women with MMS intake show no significant differences in first-trimester morphological embryo development, but increased first-trimester embryonic growth trajectories and fewer neonates born small for gestational age (SGA), less than the 3rd percentile (<p3), compared to women using only FA. Periconceptional maternal FA intake in the general population is associated with increased embryonic and fetal growth, and reduced risks of neural tube defects, other congenital malformations, low birth weight, and neonates born SGA. A prospective tertiary hospital-based cohort study (the Rotterdam Periconceptional Cohort) was conducted from January 2010 to December 2020. We included 1076 women from the Rotterdam Periconceptional Cohort, before 10 weeks of pregnancy with follow-up until delivery. Embryonic growth was assessed by measurement of crown-rump length (CRL) and embryonic volume (EV), and embryonic morphology was described by Carnegie stages using longitudinal three-dimensional ultrasound scans and virtual reality techniques. Birth outcomes were extracted from medical records. General characteristics and supplement use were extracted from research questionnaires. This study showed increased embryonic growth trajectories (adjusted models, CRL: β = 0.052, 95% CI 0.012-0.090, EV: β = 0.022, 95% CI 0.002-0.042) in women using MMS compared to those using only FA. Moreover, a 45% reduced risk of a neonate-born SGA (<p3) was shown in women using MMS compared to FA users (adjusted OR = 0.546, 95% CI 0.308, 0.969). Embryonic morphological development (Carnegie stages) and the occurrence of miscarriages did not differ between women using MMS or solely FA. Following the heterogeneity of the composition and dose of MMS preparations, it is unclear which specific micronutrient, combination, or dose explains the increased embryonic growth trajectory and reduction in risk for SGA. This also hampers the possibility of differentiating between the effects of FA alone or as a component of MMS. Our findings emphasize the importance of periconceptional maternal MMS use as a potential preventative intervention against reduced embryonic growth and neonates born SGA. Therefore, we recommend the periconceptional use of MMS in women at risk of inadequate micronutrient intake. However, awareness of potentially harmful side effects of high doses and combinations of micronutrients is essential, therefore the optimal composition and dose need to be investigated, and careful surveillance is recommended. This research was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, and the ZonMw grant Open Competition 2018 (09120011910046). The authors declare that they have no conflict of interest. NTR4356.

Three-Dimensional Ultrasound Imaging under Optimized Nuclear Regression Reconstruction Algorithm in the Diagnosis Vaginal Delivery and Cesarean Section on the Anal Sphincter Complex of Primiparas.

This study was aimed at analyzing the injury of anal sphincter (AS) for primipara caused by the vaginal delivery and cesarean section under the guidance of three-dimensional (3D) ultrasound images. A total of 160 patients who underwent postpartum reexamination were enrolled as the research subjects, including 80 cases of natural delivery (group A) and 80 cases of cesarean section pregnant women (group B), all of whom underwent three-dimensional ultrasound imaging scans. At the same time, an optimized kernel regression reconstruction (KRR) algorithm was proposed for the enhancement of ultrasound images. It was found that the running time after acceleration by the graphics processing unit (GPU) was obviously superior to that of a single-threaded CPU and a multithreaded CPU, showing statistical differences (P < 0.05). The thickness of the proximal and distal external AS in group A was much thinner in contrast to that in group B, showing statistical difference (P < 0.05). Therefore, the 3D ultrasound image based on the optimized KRR algorithm can accurately assess the morphology of AS injury in primipara, and the adverse effect of natural delivery on the AS complex in primipara was greater than that of cesarean section.

First Trimester Maternal Homocysteine and Embryonic and Fetal Growth: The Rotterdam Periconception Cohort.

Homocysteine is a marker for derangements in one-carbon metabolism. Elevated homocysteine may represent a causal link between poor maternal nutrition and impaired embryonic and fetal development. We sought to investigate associations between reference range maternal homocysteine and embryonic and fetal growth. We enrolled 1060 singleton pregnancies (555 natural and 505 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies) from November 2010 to December 2020. Embryonic and fetal body and head growth was assessed throughout pregnancy using three-dimensional ultrasound scans and virtual reality techniques. Homocysteine was negatively associated with first trimester embryonic growth in the included population (crown-rump length B −0.023 mm, 95% CI −0.038,−0.007, p = 0.004, embryonic volume B −0.011 cm3, 95% CI −0.018,−0.004, p = 0.003). After stratification for conception mode, this association remained in IVF/ICSI pregnancies with frozen embryo transfer (crown-rump length B −0.051 mm, 95% CI −0.081,−0.023, p < 0.001, embryonic volume B −0.024 cm3, 95% CI −0.039,−0.009, p = 0.001), but not in IVF/ICSI pregnancies with fresh embryo transfer and natural pregnancies. Homocysteine was not associated with longitudinal measurements of head growth in first trimester, nor with second and third trimester fetal growth. Homocysteine in the highest quartile (7.3–14.9 µmol/L) as opposed to the lowest (2.5–5.2 µmol/L) was associated with reduced birth weight in natural pregnancies only (B −51.98 g, 95% CI −88.13,−15.84, p = 0.005). In conclusion, high maternal homocysteine within the reference range is negatively associated with first trimester embryonic growth and birth weight, and the effects of homocysteine are dependent on conception mode.

Periconceptional maternal social, lifestyle and medical risk factors impair embryonic growth: The Rotterdam Periconceptional Cohort

Research question:What is the association between the degree of a state of maternal vulnerability, determined by suboptimal periconceptional social, lifestyle and medical exposures and embryonic growth? Design:In total, 555 pregnancies, comprising 324 naturally conceived pregnancies and 231 pregnancies conceived after IVF and intracytoplasmic sperm injection (ICSI) were included from the Rotterdam Periconceptional Cohort (Predict Study) between November 2010 and August 2018. Data on periconceptional social, lifestyle and medical exposures, i.e. vulnerability markers, were collected through self-administered questionnaires. To estimate embryonic growth, crown–rump length (CRL) and embryonic volume measurements were taken at 7, 9 and 11 weeks of gestation using three-dimensional ultrasound scans and virtual reality techniques. Results:Exposure to two or more vulnerability markers was negatively associated with embryonic growth in naturally conceived pregnancies. The CRL and embryonic volume trajectories of embryos of women exposed to two vulnerability markers were reduced compared with those of women exposed to zero or one vulnerability marker (√CRL: β = –0.29 mm, 95% CI –0.56 to –0.02; 3√EV: β = –0.14 cm3, 95% CI –0.27 to –0.01). These associations were not found in pregnancies conceived after IVF or ICSI. Conclusions:This study showed that a higher degree of the periconceptional state of maternal vulnerability is associated with reduced embryonic growth (CRL and embryonic volume) in naturally conceived pregnancies.

Periconceptional maternal folate status and the impact on embryonic head and brain structures: the Rotterdam Periconceptional Cohort

Research questionDoes periconceptional maternal folate status influence the size of human embryonic head and brain structures? DesignThe study population was selected from the Rotterdam Periconceptional Cohort conducted at the Erasmus MC. Three-dimensional (3D) ultrasound scans were performed at 9 and 11 weeks of gestational age. Using 3D ultrasound datasets, head volume, head circumference, diencephalon (DTD), mesencephalon (MTD) and left/right telencephalon (TTL/TTR) measurements were performed offline using a virtual reality technique and specialized 3D software. Maternal venous blood samples were taken at study entry to determine red blood cell (RBC) folate. Linear regression models were applied to investigate associations between RBC folate status and embryonic head and brain structures adjusted for gestational age, alcohol use, smoking, maternal age and mode of conception. ResultsRBC folate measurements were available for 144 of the 166 singleton pregnancies eligible for analysis. RBC folate quartiles were defined: 466–1078 nmol/l (Q1), 1079–1342 nmol/l (Q2), 1343–1594 nmol/l (Q3), 1595–2919 nmol/l (Q4), with Q3 being used as reference. At 11 weeks of gestational age, head volume was largest in Q1 (β = 0.866; P = 0.004) and Q4 (β = 0.764; P = 0.007). In addition, head circumference at 11 weeks of gestational age was significantly larger in Q4 (β = 2.745; P = 0.03). There were no statistical significantly associations between the RBC folate quartiles and the sizes of the DTD, MTD, TTL and TTR. ConclusionsU-shaped associations were shown between the periconceptional maternal RBC folate status and embryonic head volume and head circumference. The clinical implication of these findings needs further investigation.

Evaluation of the Application Effect of Contrast-Enhanced Ultrasound Image Technology Based on Three-Dimensional Image Fusion Algorithm in the Diagnosis of Adenomyosis

In this paper, the effect of ultrasound images based on a 3-dimensional image fusion algorithm in the diagnosis of adenomyosis was evaluated. 88 patients with adenomyosis who were treated in the hospital from February 2019 to May 2020 were selected as the research subjects. They were rolled into localized type (Group A), with 40 cases, and diffuse type (Group B), with 48 cases. At the same time, 45 women of normal childbearing age who underwent physical examination in the outpatient clinic were rolled into the control group (Group C). Three-dimensional ultrasound scans of the uterus were performed on all patients, to observe the enhancement methods and characteristics. Then, the image characteristics of adenomyosis were studied through the time-intensity curve (TIC). Arise time ATs of three groups of patients were not different greatly ( P &gt; 0.05 ). It was found that the enhancement method, enhancement uniformity, and enhancement level of ultrasound scan in Groups A and B were significantly different from Group C ( P &lt; 0.05 ). In contrast with Group C, the rise time (RT) of the ultrasound scan of the two groups was less, the time-to-peak (TTP) was faster, and the image maximum (IMAX) was higher ( P &lt; 0.05 ). What is more, contrast-enhanced ultrasonic (CEUS) detection in patients with adenomyosis showed centrality and nonuniform high enhancement. Besides, less RT, faster TTP, and higher IMAX than the normal population can be the key evidence for the clinical diagnosis of adenomyosis. In conclusion, according to the blood supply characteristics of adenomyosis and other gynecological diseases, the enhancement method and enhancement time of ultrasound images are significantly different. TIC can reflect the hemodynamic difference between the lesion and the normal ones. Therefore, the CEUS based on the three-dimensional image fusion algorithm can be applied to the image diagnosis of adenomyosis.

The Impact of Vendor-Specific Ultrasound Beam-Forming and Processing Techniques on the Visualization of In Vitro Experimental “Scar”: Implications for Myocardial Scar Imaging Using Two-Dimensional and Three-Dimensional Echocardiography

Myocardial scar appears brighter compared with normal myocardium on echocardiography because of differences in tissue characteristics. The aim of this study was to test how different ultrasound pulse characteristics affect the brightness contrast (i.e., contrast ratio [CR]) between tissues of different acoustic properties, as well as the accuracy of assessing tissue volume. An experimental invitro "scar" model was created using overheated and raw pieces of commercially available bovine muscle. Two-dimensional and three-dimensional ultrasound scanning of the model was performed using combinations of ultrasound pulse characteristics: ultrasound frequency, harmonics, pulse amplitude, steady pulse (SP) emission, power modulation (PM), and pulse inversion modalities. On both two-dimensional and three-dimensional imaging, the CR between the "scar" and its adjacent tissue was higher when PM was used. PM, as well as SP ultrasound imaging, provided good "scar" volume quantification. When tested on 10 "scars" of different size and shape, PM resulted in lower bias (-9.7 vs 54.2mm3) and narrower limits of agreement (-168.6 to 149.2mm3 vs -296.0 to 404.4mm3, P=.03). The interobserver variability for "scar" volume was better with PM (intraclass correlation coefficient=0.901 vs 0.815). Two-dimensional and three-dimensional echocardiography with PM and SP was performed on 15 individuals with myocardial scar secondary to infarction. The CR was higher on PM imaging. Using cardiac magnetic resonance as a reference, quantification of myocardial scar volume showed better agreement when PM was used (bias, -645mm3; limits of agreement, -3,158 to 1,868mm3) as opposed to SP (bias, -1,138mm3; limits of agreement, -5,510 to 3,233mm3). The PM modality increased the CR between tissues with different acoustic properties in an experimental invitro "scar" model while allowing accurate quantification of "scar" volume. By applying the invitro findings to humans, PM resulted in higher CR between scarred and healthy myocardium, providing better scar volume quantification than SP compared with cardiac magnetic resonance.

A New Semi-automated Algorithm for Volumetric Segmentation of the Left Ventricle in Temporal 3D Echocardiography Sequences.

Echocardiography is commonly used as a non-invasive imaging tool in clinical practice for the assessment of cardiac function. However, delineation of the left ventricle is challenging due to the inherent properties of ultrasound imaging, such as the presence of speckle noise and the low signal-to-noise ratio. We propose a semi-automated segmentation algorithm for the delineation of the left ventricle in temporal 3D echocardiography sequences. The method requires minimal user interaction and relies on a diffeomorphic registration approach. Advantages of the method include no dependence on prior geometrical information, training data, or registration from an atlas. The method was evaluated using three-dimensional ultrasound scan sequences from 18 patients from the Mazankowski Alberta Heart Institute, Edmonton, Canada, and compared to manual delineations provided by an expert cardiologist and four other registration algorithms. The segmentation approach yielded the following results over the cardiac cycle: a mean absolute difference of 1.01 (0.21) mm, a Hausdorff distance of 4.41 (1.43) mm, and a Dice overlap score of 0.93 (0.02). The method performed well compared to the four other registration algorithms.

Detection of exact and near duplicates in phased-array ultrasound weld scan

Finding duplicates in phased-array ultrasound weld scans is typically done by certified analysts. Due to the vast amount of data involved, this task is time-consuming and error-prone. Some automated analysis software exists but are still inefficient. In this paper, two types of duplicates are defined. A method to detect each type in a database of three-dimensional ultrasound weld scans is presented. The duplicate detection process is implemented in a cloud-computing service enabling near real-time processing in industrial applications. Experiments are performed to expose the detection accuracy of both methods.

The effect of vaginal delivery and Caesarean section on the anal Sphincter complex of Primipara based on optimized three-dimensional ultrasound image and nuclear regression Reconstruction Algorithm.

Objective:The study used the optimized nuclear regression reconstruction algorithm to explore the value of three-dimensional perineal ultrasound evaluation of the effect of caesarean delivery and caesarean section on the anal sphincter complex of primipara.Methods:This study performed three-dimensional perineal ultrasound scanning of the anal sphincter complex of 157 primiparas 42 days after delivery. Among them, 77 were in caesarean delivery (spontaneous delivery group) and 80 were in caesarean section (caesarean delivery group) from September 2018 to December 2020 in our hospital. The thickness of the end plane, the middle plane, the distal plane and the distal plane of the external anal sphincter at 3, 6, 9, 12 o’clock direction, and measure the thickness of the central plane of the pubic rectum muscle at 4, 8 o’clock direction. At the same time, the study used tomography and volume contrast imaging to observe the morphology and integrity of the anal sphincter complex.Results:The thickness of the distal anal sphincter at the 12 o’clock direction, the proximal anal sphincter at 6, 12 o’clock, and the central plane at 9 and 12 o’clock in the obstetric group were smaller than those in the caesarean section group (all P < 0.05). There were no significant differences in the thickness of the remaining anal internal and external anal sphincter and puborectalis muscles between the two groups in different directions (all P> 0.05). In the obstetric group, a perineal sphincter defect was found via three-dimensional perineal ultrasound.Conclusion:The delivery method has a certain influence on the shape of the anal sphincter complex. The thickness of the internal and external anal sphincter of the primiparous women in a certain direction is significantly smaller than that of caesarean section. Transperineally three-dimensional ultrasound can clearly show the morphological characteristics and integrity of the anal sphincter complex, and diagnose the defect of the anal sphincter complex.

Growth trajectories of the human fetal brain in healthy and complicated pregnancies and associations with neurodevelopmental outcome in the early life course

BackgroundThere is a need for non-invasive prenatal markers of the brain to assess fetuses at risk for poor postnatal neurodevelopmental outcome. Periconceptional maternal conditions and pregnancy complications impact prenatal brain development. AimsTo investigate associations between growth trajectories of fetal brain structures and neurodevelopmental outcome in children in the early life course. Study designPericonceptional prospective observational cohort. SubjectsSingleton pregnancies were included in the Rotterdam periconception cohort. Two- and three-dimensional ultrasound scans at 22, 26 and 32 weeks gestational age were analysed. Outcome measuresHead circumference (HC), cerebellum, corpus callosum (CC), Sylvian fissure, insula and parieto-occipital fissure (POF) were measured. Neurodevelopment was evaluated using the Age-and-Stages-questionnaire-3 (ASQ-3) and the Child-Behaviour-Checklist (CBCL) at 2 years of age. Linear mixed models, used to estimate the prenatal brain growth trajectories, and linear regression models, used to evaluate the associations between prenatal brain structures and neurodevelopmental outcomes, were applied in the total study population, and in subgroups: fetal growth restriction (FGR), preterm birth (PTB), fetal congenital heart disease (CHD), and uncomplicated controls. ResultsConsent for participation was received from parents on behalf of their child 138/203 (68%). ASQ-3 was completed in 128/203 children (63%) and CBCL in 93/203 children (46%). Significant smaller subject-specific growth trajectories (growth rate of CC, HC, left insula, left POF and right POF and the baseline size of CC, HC, left POF and right POF) were found in the FGR subgroup, compared to the other subgroups (all p-values <0.05). In the total group (n = 138), the growth rate of the left insula was associated with poorer ASQ-3 score (β = −869.51; p < 0.05). Healthy controls (n = 106) showed a comparable association (β = −1209.87; p < 0.01). FGR (n = 10) showed a larger baseline size of the right Sylvian fissure in association with poorer CBCL-score (β = 4.13; p < 0.01). In CHD (n = 12) the baseline size of the left Sylvian fissure and its growth rate were associated with respectively poorer and better CBCL-scores (β = 3.11; p < 0.01); (β = −171.99; p < 0.01). In PTB (n = 10) no associations were found. ConclusionsThis explorative study suggests associations between ultrasound measurements of fetal brain growth and neurodevelopmental outcome at 2 years of age. In future, this non-invasive technique may improve early identification of fetuses at risk for neurodevelopmental outcome and follow-up postnatal clinical care.

Effect of human embryonic morphological development on fetal growth parameters: the Rotterdam Periconceptional Cohort (Predict Study).

Is embryonic morphological development according to the Carnegie stages associated with pregnancy outcome? In a tertiary hospital-based cohort, 182 singleton non-malformed pregnancies were selected. Serial transvaginal three-dimensional ultrasound (3D-US) scans were carried out between 6+0 and 10+2 gestational weeks. Embryonic development was annotated according to the morphological criteria of the Carnegie classification using a virtual reality system. Second-trimester biparietal diameter, head circumference, abdominal circumference and femur length measurements were retrieved from medical records. Z-scores were calculated for mid-pregnancy estimated fetal weight (EFW) and newborn birth weight. Associations between longitudinal Carnegie stages and fetal growth parameters were investigated using linear mixed models, with subgroup analysis based on fetal gender. A total of 576 first-trimester 3D-US scans were analysed (median of three scans per pregnancy). Embryonic development was positively associated with EFW z-score (β = 0.69; 95% CI 0.51 to 0.86; P < 0.001), biparietal diameter and femur length, but not with head circumference, abdominal circumference and birth weight z-score. After stratification for fetal gender, positive associations for both males and females were confirmed between embryonic development and EFW z-scores. Moreover, opposite gender-specific associations were detected between embryonic development and birth weight z-scores (males: β = 0.37; 95% CI 0.04 to 0.70; P < 0.05; females: β = -0.36; 95% CI -0.62 to -0.10; P < 0.01). Human embryonic development according to the Carnegie stages is associated with fetal growth parameters with gender-specificity of birth weight. These results emphasize the importance of the first-trimester of pregnancy, raising the morphological staging of the embryo as a new methodology for early risk assessment and improvement of subsequent fetal growth parameters.

Ultrasound screening for pyelectasis in pregnant women. Clinical necessity or "art for art's sake"?

Renal pelvicalyceal dilatation is caused by urine retention in the upper urinary tract. It is referred to as pyelectasis in medical literature. This term does not indicate the cause that leads to the dilatation of and urine retention in the renal pelvicalyceal system. Mild pelvicalyceal dilatation during pregnancy is usually considered to be physiological in nature – it can occur in up to 90% of pregnant women. Retention is more common in the right kidney, in primigravidae, in the second half of pregnancy and in multiple pregnancies. Pyelectasis during pregnancy rarely causes clinical symptoms and often does not require treatment. Nevertheless, urine retention in the renal pelvicalyceal system is conducive to the development of asymptomatic bacteriuria and may be a risk factor for recurrent urinary tract infections, pyelonephritis and acute kidney failure; it may also cause renal colic. In consequence, this condition can lead to intrauterine infection and premature labor in the pregnant woman and to prematurity, anemia, congenital pneumonia or sepsis in the child. In a study conducted at the 3rd Department of Gynecology of the Medical University of Lublin it was concluded that unilateral pyelectasis of more than 20 cm3 is associated with a significant increase in the risk of asymptomatic bacteriuria. This volume corresponds to grade 3 and/or 4 pelvicalyceal dilatation according to the Society for Fetal Urology/European Federation of Societies for Ultrasound in Medicine and Biology classification. The pyelectasis volume measuring method using three-dimensional ultrasound scanning included in the criteria for the assessment of asymptomatic bacteriuria was assessed as sensitive and specific. The ultrasound-based evaluation of the kidneys for the presence of pyelectasis and its grade in pregnant women has some clinical implications. It allows for identifying cases with an increased risk of asymptomatic bacteriuria, which requires treatment in pregnant women. Screening during pregnancy for pyelectasis seems to be important in preventing asymptomatic bacteriuria from progressing to symptomatic urinary tract infection.

Periconceptional maternal dairy-rich dietary pattern is associated with prenatal cerebellar growth.

BackgroundMaternal nutrition during pregnancy has been related to intrauterine brain development and neurodevelopmental disabilities in adult life. We aim to investigate associations between periconceptional maternal dietary patterns and prenatal cerebellar growth from the first trimester onwards.Materials and methods126 women with singleton non-malformed pregnancies were enrolled before 8 weeks of gestation in the Rotterdam periconceptional cohort between 2013 and 2015. Periconceptional maternal dietary patterns were extracted from food frequency questionnaires and associated with blood biomarkers and micronutrient intakes. Serial two-dimensional and three-dimensional ultrasound scans were performed at 9, 11, 22, 26 and 32 weeks of gestation for transcerebellar diameter (TCD) measurement. Linear mixed models were estimated to investigate associations between periconceptional maternal dietary patterns and longitudinal TCD measurements as a function of gestational age.ResultsWe performed a median of 4 scans per pregnancy, resulting in 570 total datasets. The success rate of TCD measurements was 87% (range 65–100%), depending on gestational age. The Mediterranean, Western, egg-rich and dairy-rich dietary patterns were extracted, explaining 37.2% of the overall variance of food intake in this population. The dairy-rich dietary pattern was positively associated with cerebellar growth trajectories (β = 0.02 (95% CI: 0.01; 0.03) √mm, p = 0.01). Maternal strong adherence to this dietary pattern increased TCD measurements by 0.8 standard deviation scores (SDs) compared to weak adherence, reflected in increased TCD estimates of 0.44 mm at 9 weeks (+6.8%), 0.88 mm at 22 weeks (+3.6%), and 1.17 mm at 32 weeks (+2.8%). No significant associations were detected for the Mediterranean, Western and egg-rich dietary patterns.ConclusionsThis study shows a positive association between periconceptional maternal adherence to a dairy-rich dietary pattern and human prenatal TCD measurements as a proxy of cerebellar growth. Next step is the investigation of the impact on neurodevelopmental outcomes in the offspring.

Early first trimester maternal 'high fish and olive oil and low meat' dietary pattern is associated with accelerated human embryonic development.

Maternal dietary patterns were associated with embryonic growth and congenital anomalies. We aim to evaluate associations between early first trimester maternal dietary patterns and embryonic morphological development among pregnancies with non-malformed outcome. A total of 228 strictly dated, singleton pregnancies without congenital malformations were enrolled in a periconceptional hospital-based cohort. Principal component analysis was performed to extract early first trimester maternal dietary patterns from food frequency questionnaires. Serial transvaginal three-dimensional ultrasound (3D US) scans were performed between 6+0 and 10+2 gestational weeks and internal and external morphological criteria were used to define Carnegie stages in a virtual reality system. Associations between dietary patterns and Carnegie stages were investigated using linear mixed models. A total of 726 3D US scans were included (median: three scans per pregnancy). The 'high fish and olive oil and low meat' dietary pattern was associated with accelerated embryonic development in the study population (β = 0.12 (95%CI: 0.00; 0.24), p < 0.05). Weak adherence to this dietary pattern delayed embryonic development by 2.1 days (95%CI: 1.6; 2.6) compared to strong adherence. The 'high vegetables, fruit and grain' dietary pattern accelerated embryonic development in the strictly dated spontaneous pregnancy subgroup without adjustment for energy intake. Early first trimester maternal dietary patterns impacts human embryonic morphological development among pregnancies without congenital malformations. The clinical meaning of delayed embryonic development needs further investigation.

Foetal fractional thigh volume: an early 3D ultrasound marker of neonatal adiposity.

The predisposition for obesity is suggested to originate in the prenatal period. Prenatal markers are needed to identify foetuses at risk for neonatal adiposity, as early marker of childhood obesity. The aim of this study is to assess the association between foetal fractional thigh volume (TVol) and neonatal percentage fat mass from mid-gestation onward. In this perinatal cohort study, singleton pregnancies with term born infants were included. Foetal TVol was measured on three-dimensional ultrasound scans (3D US) obtained at 22, 26 and 32weeks of gestation. Neonatal body composition measurement (percentage body fat (%BF)) was planned between 42+0 and 42+6 -week postmenstrual age. Cross-sectional and longitudinal linear regression analyses were performed. Seventy-nine mother-child pairs were included. Median (interquartile range) TVol increased from 7.6 (7.1; 8.5) cm3 at 22weeks to 36.5 (33.8; 40.9) cm3 at 32weeks. Median neonatal %BF was 14.3% (11.7; 17.0). TVol at 22weeks (β=-1.58, 95% CI -2.45; -0.70, explained variance 31%) was negatively associated with %BF, but no associations were found at 26 and 32weeks of gestation. TVol growth between 22 and 32weeks of gestation (explained variance 18%) was also statistically significantly negatively associated with %BF. Foetal TVol is a promising 3D US marker for prediction of neonatal adiposity from mid-gestation onward.

Cervical teratomas

Cervical teratomas

Prognostic significance of tumor volume as determined on 3D ultrasound scan in uterine cervix cancer treated by radiotherapy.

The aim of this prospective study is to evaluate prognostic significance of tumor volume determined by three-dimensional (3D) ultrasound scan in uterine cervix cancer patients treated by radiotherapy. A total of 67 patients of Stage IB2-IIIB were studied and analyzed. Cervical tumor volume was determined by 3D ultrasound scan. Two groups were made on the basis of volume on ultrasound scan (Group 1 <40 cc = 36 and Group 2 >40 cc = 31). Both groups received external beam radiotherapy (EBRT) and intracavitary radiation therapy (ICRT). Cisplatin 40 mg/m 2 every week was given concurrently with external irradiation. Tumor volumes were taken by 3D USG every week during EBRT, after each fraction of ICRT, and after 8 weeks of completion of treatment. Primary end point was disease-free survival (DFS), and secondary endpoints were 5-year survival and toxicities. After 2 months of completion of treatment, 1 out of 36 patients of Group A was having residual and 7 out of 31 of Group B were having residual diseases (P = 0.034). DFS and 5-year survival were significantly different in the groups (log rank test P = 0.0014, hazard ratio (HR) =2.3622 95% confidence interval (CI) 1.3090-4.2625 and P = 0.0421, HR = 1.9274 95% CI 0.9998-3.7156, respectively). Ultrasound is a cheap, simple, and useful in predicting the outcome of treatment and DFS based on the tumor volume.