Three-dimensional Ultrasonography Research Articles

Prediction of birth weight in twin pregnancies using fractional limb volumes by three-dimensional ultrasonography

Objective: To predict birth weight using fetal fractional limb volumes (FLVs) by three-dimensional (3D) ultrasonography in twin pregnancies.Method: This prospective observational cohort study evaluated 51 twin pregnancies, including 28 dichorionic and 23 monochorionic pregnancies. Ultrasound examinations were performed up to 5 d before delivery. Birth weight prediction models were developed using the fractional arm volume (FAV), fractional thigh volume (FTV), and Hadlock’s formula and were compared with the actual birth weight.Results: The mean gestational age at the time of ultrasound examination was 35.3 weeks. The mean birth weight was slightly higher in dichorionic than in monochorionic pregnancies 2391.2 versus 2352.4 g. The measurements using FTV were the closest to actual birth weights. For the total group, the Hadlock formula had mean percentage change of 7.18% while the FTV model presented mean percentage change of 6.62% in relation to birth weight. However, no significant difference was noted between Hadlock’s formula and FTV p = .363 and .678 for dichorionic and monochorionic pregnancies, respectively.Conclusions: FTV accurately predicted birth weight in twin monochorionic and dichorionic pregnancies. However, Hadlock’s formula should still be used.

Three-dimensional Ultrasonography and Three-dimensional Power Doppler in the Evaluation of Placenta Accreta Spectrum

Three-dimensional Ultrasonography and Three-dimensional Power Doppler in the Evaluation of Placenta Accreta Spectrum

Value of Three-Dimensional Ultrasound in Differentiating Malignant From Benign Breast Tumors: A Systematic Review and Meta-Analysis.

Currently, the aim of differentiating malignant from benign breast tumors and diagnosing early breast cancer is more accurately fulfilled with the addition of ultrasound (US) scans. Some studies have shown that three-dimensional (3D) imaging opens a new diagnostic window because of a better and more detailed impression of the spatial arrangement of focal breast masses. Therefore, we carried out this study to assess the efficacy of 3D-US diagnostic techniques for the detection of breast cancer using systemic analyses. We searched the MEDLINE, Pubmed, EMBASE, and Cochrane Library for using 3D-US for the diagnosis of breast cancer. The terms used were “three-dimensional ultrasound”, “breast neoplasms”, “sensitivity and specificity”, and “accuracy”. Patients were adults. The quality of the studies was checked according to Quality Assessment of Diagnostic Accuracy Studies criteria. We calculated the diagnostic accuracy rates and developed a meta-analysis to synthesize the results. Twelve studies of diagnostic tests were selected, which were of moderate to high quality. The pooled sensitivity was 0.923 (95% confidence interval [CI], 0.896–0.945), and the pooled specificity was 0.872 (95% CI, 0.849–0.893). The meta-analysis detected a threshold effect and heterogeneity between studies. The pooled positive likelihood ratio was 6.965 (95% CI, 5.242–9.255), the negative likelihood ratio was 0.106 (95% CI, 0.079–0.142), and the diagnostic odds ratio was 84.239 (95% CI, 52.237–135.84). This meta-analysis indicates that 3D-US has acceptable diagnostic accuracy rates in differentiating malignant from benign breast tumors.

Reference range of fetal myocardial area by three-dimensional ultrasonography and its applicability in fetuses of pre-gestational diabetic women

Objective To determine the reference range for the myocardial area in healthy fetuses using three-dimensional (3D) ultrasonography and validate these results in fetuses of pregnant women with pre-gestational diabetes mellitus (DM). Methods This cross-sectional retrospective study included 168 healthy pregnant women between gestational weeks 20 and 33+6 days. The myocardial area was measured using spatio-temporal image correlation (STIC) in the four-chamber view. Polynomial regression models were used, and the goodness of fit of the models were evaluated by the coefficient of determination (R2). Intra- and inter-observer reproducibility was determined using the concordance correlation coefficient (CCC). Validation was performed in 30 pregnant women with pre-gestational DM. Results There was a strong correlation (R2=0.71, P<0.0001) between myocardial area and gestational age. There was good intra- and inter-observer reproducibility, with a CCC of 0.86 and 0.83, respectively. However, there was no significant difference in the mean myocardial area between healthy fetuses and fetuses of women with pre-gestational DM (0.11 cm2, P=0.55). Conclusion The reference range was determined for the myocardial area in fetuses, and there was no significant difference in this variable between healthy fetuses and the fetuses of women with pre-gestational DM.

Individual 17-Hydroxyprogesterone Responses to hCG Are Not Correlated With Follicle Size in Polycystic Ovary Syndrome.

ContextIn women with polycystic ovary syndrome (PCOS), 17-hydroxyprogesterone (17-OHP) responses to gonadotropin stimulation vary from increased to indistinguishable compared with normal controls.ObjectiveTo determine whether 17-OHP responses to recombinant-human chorionic gonadotropin (r-hCG) are individually correlated to the size of antral follicles among women with PCOS.Design, Setting, and ParticipantsA prospective study conducted in 19 women with PCOS and 20 normal controls at an academic medical center.InterventionsBlood samples were obtained before and 24 hours after administration of 25 μg of r-hCG. Ovarian imaging was conducted with three-dimensional pelvic ultrasonography. Each subject underwent a 2-hour oral glucose tolerance test.Main Outcome MeasuresBasal and stimulated levels of 17-OHP, androgens, estradiol, progesterone, anti-Mullerian hormone (AMH), insulin, glucose, follicle number, and size.ResultsIn women with PCOS, mean antral follicle count (AFC) was greater than that of controls, although the size of cohort follicles within individual subjects was not correlated to 17-OHP responses. The numbers of 2- to 3-mm and 3- to 4-mm follicles in PCOS were significantly greater than in controls, whereas differences between larger follicles were not observed. Increased AMH in PCOS was correlated to AFC, but not 17-OHP responses. Insulin sensitivity did not correlate to r-hCG‒stimulated 17-OHP after adjustment for body mass index.Conclusions17-OHP responses to hCG in individuals with PCOS were not correlated to the distribution of antral follicles. Greater numbers of small antral follicles in women with PCOS than in controls suggest an extension of accelerated growth from the preantral stage.

Three-dimensional ultrasonography of the breast; An adequate replacement for MRI in neoadjuvant chemotherapy tumour response evaluation? – RESPONDER trial

Background. Accurate measurement of tumour response during and after neoadjuvant chemotherapy (NAC) is important and may influence treatment decisions in invasive breast cancer patients. Breast MRI forms the gold standard but is more burdensome, time consuming and costly. In this study response measurement was done with 3-D ultrasound by Automated Breast Volume Scanner (ABVS) and compared to breast MRI. Moreover, patient satisfaction with both techniques was compared.

Surface‐based registration between CT and US for image‐guided percutaneous renal access – A feasibility study

As a crucial step in accessing the kidney in several minimally invasive interventions, percutaneous renal access (PRA) practicality and safety may be improved through the fusion of computed tomography (CT) and ultrasound (US) data. This work aims to assess the potential of a surface-based registration technique and establish an optimal US acquisition protocol to fuse two-dimensional (2D) US and CT data for image-guided PRA. Ten porcine kidney phantoms with fiducial markers were imaged using CT and three-dimensional (3D) US. Both images were manually segmented and aligned. In a virtual environment, 2D contours were extracted by slicing the 3D US kidney surfaces and using usual PRA US-guided views, while the 3D CT kidney surfaces were transformed to simulate positional variability. Surface-based registration was performed using two methods of the iterative closest point algorithm (point-to-point, ICP1; and point-to-plane, ICP2), while four acquisition variants were studied: (a) use of single-plane (transverse, SPT ; or longitudinal, SPL ) vs bi-plane views (BP); (b) use of different kidney's coverage ranges acquired by a probe's sweep; (c) influence of sweep movements; and (d) influence of the spacing between consecutive slices acquired for a specific coverage range. BP view showed the best performance (TRE=2.26mm) when ICP2 method, a wide kidney coverage range (20°, with slices spaced by 5°), and a large sweep along the central longitudinal view were used, showing a statistically similar performance (P=0.097) to a full 3D US surface registration (TRE=2.28mm). An optimal 2D US acquisition protocol was evaluated. Surface-based registration, using multiple slices and specific sweep movements and views, is here suggested as a valid strategy for intraoperative image fusion using CT and US data, having the potential to be applied to other image modalities and/or interventions.

Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study.

To estimate the diagnostic accuracy of three-dimensional ultrasonography (3D US) compared to hysteroscopy/laparoscopy, in the investigation of uterine congenital anomalies using the ESHRE/ESGE classification of female genital tract congenital anomalies. Prospective blind, comparative, cohort study. University Tertiary Hospital and affiliated private Hospital. Sixty-two women consecutively referred with a suspected diagnosis of uterine congenital anomalies. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for the description of abnormal findings. All patients underwent (1) 3D US and (2) hysteroscopy with laparoscopy to establish the final diagnosis. Concordance between 3D US and hysteroscopy with laparoscopy about the type and the classification of uterine anomaly was verified in 61 cases, including all those with septate uterus, dysmorphic uterus, bicorporeal, hemi-uterus or unicorporeal, and aplastic uterus and one out of two with normal uterus. For the diagnosis of septate uteri, which was the most common anomaly, the sensitivity of 3D US was 100%, the specificity was 92.3%, the PPV was 98% and the NPV was 100%, with kappa index 0.950. For bicorporeal, dysmorphic uterus, hemi-uteri or unicorporeal and aplastic uterus the sensitivity, specificity, PPV and NPV were all 100% with K = 1.00. Overall, 3D US showed perfect diagnostic accuracy (Kappa index = 0.945) in the detection of congenital uterine anomalies. 3D US appears to be a very accurate method for the diagnosis of congenital uterine anomalies.

Catheter segmentation in three-dimensional ultrasound images by feature fusion and model fitting

Ultrasound (US) has been increasingly used during interventions, such as cardiac catheterization. To accurately identify the catheter inside US images, extra training for physicians and sonographers is needed. As a consequence, automated segmentation of the catheter in US images and optimized presentation viewing to the physician can be beneficial to accelerate the efficiency and safety of interventions and improve their outcome. For cardiac catheterization, a three-dimensional (3-D) US image is potentially attractive because of no radiation modality and richer spatial information. However, due to a limited spatial resolution of 3-D cardiac US and complex anatomical structures inside the heart, image-based catheter segmentation is challenging. We propose a cardiac catheter segmentation method in 3-D US data through image processing techniques. Our method first applies a voxel-based classification through newly designed multiscale and multidefinition features, which provide a robust catheter voxel segmentation in 3-D US. Second, a modified catheter model fitting is applied to segment the curved catheter in 3-D US images. The proposed method is validated with extensive experiments, using different in-vitro, ex-vivo, and in-vivo datasets. The proposed method can segment the catheter within an average tip-point error that is smaller than the catheter diameter (1.9mm) in the volumetric images. Based on automated catheter segmentation and combined with optimal viewing, physicians do not have to interpret US images and can focus on the procedure itself to improve the quality of cardiac intervention.

Ultrasonographic Assessment with Three-Dimensional Mode of the Urethral Compression Effect following Sling Surgery with and without Mesh Surgery.

Background The aim of this study was to assess anatomical changes in the urethra at rest and during straining following sling surgery with and without transvaginal mesh surgery (TVM) in women with stress urinary incontinence (SUI) with or without pelvic organ prolapse (POP) using three-dimensional ultrasonography. Methods 76 women with SUI with or without pelvic organ prolapse after sling surgery. They underwent sling surgery alone (S group, n=36) or concomitant TVM (M group, n=40). All patients underwent urinalysis, pelvic examinations, urodynamic study, 3D perineal ultrasonography, and personal interviews before and 1 year after surgery. The urethral area was calculated from the axial plane of perineal ultrasonography by multiplying π by the long and short axes of the urethral lumen. Results The axial area of the middle and distal urethra during straining was significantly smaller than at rest in both groups (P<0.001). In addition, the length of the short axis of the proximal urethra was significantly shorter in those undergoing sling surgery alone during straining compared with those undergoing concomitant sling and mesh surgery (P<0.001). Conclusions There was a greater impact on the proximal urethra in women who underwent sling surgery alone than those who underwent sling and TVM surgery together.

Should 3D be part of a routine obgyn ultrasound exam?

Ultrasound (US) is, arguably, the most commonly used diagnostic technology in obstetrics and gynecology. Several applications are commonly employed in daily practice, such as M-mode, color and spectral Doppler. A more recent development is three-dimensional (3D) US. This is considered a very good (but complementary) tool to evaluate the face, brain, palate, spine, skeleton and heart, among others. Artificial intelligence software may allow automatic extraction of various parameters, including, for instance, semi-automated detection of specific facial features in syndromes associated with dysmorphism. All of the above, however, is relevant in the hands of the ultrasound specialist, performing advanced studies (so-called “level II”) and not in the routine obstetric practice The situation is slightly different in gynecology. While advanced practitioners may create mapping of the pelvic floor or myoma localization, or verify location of masses with 3D US, a routine pelvic ultrasound is not complete, nowadays, without a coronal view of the uterus. This view is rarely, if ever, possible with 2D ultrasound, but is easily obtainable with a quick sweep and 3D reconstruction. It allows for clearly depiction of the endometrial cavity, in cases of suspected Mullerian anomalies or “lost” string to verify the position of the IUD.

A Novel Design of N-Fiducial Phantom for Automatic Ultrasound Calibration.

Background:Freehand ultrasound (US) is a technique used to acquire three-dimensional (3D) US images using a tracked 2D US probe. Calibrating the probe with a proper calibration phantom improves the precision of the technique and allows several applications in computer-assisted surgery. N-fiducial phantom is widely used due to the robustness of precise fabrication and convenience of use. In principle, the design supports single-frame calibration by providing at least three noncollinear points in 3D space at once. Due to this requirement, most designs contain multiple N-fiducials in unpatterned and noncollinear arrangements. The unpatterned multiple N-fiducials appearing as scattered dots in the US image are difficult to extract, and the extracted data are usually contaminated with noise. In practice, the extraction mostly relied on manual interventions, and calibration with N-fiducial phantom has not yet achieved high accuracy with single or few frame calibrations due to noise contamination.Aims:In this article, we propose a novel design of the N-fiducial US calibration phantom to enable automatic feature extraction with comparable accuracy to multiple frame calibration.Materials and Methods:Along with the design, the Random Sample Consensus (RANSAC) algorithm was used for feature extraction with both 2D and 3D models estimation. The RANSAC feature extraction algorithm was equipped with a closed-form calibration method to achieve automatic calibration.Results:The accuracy, precision, and shape reconstruction errors of the calibration acquired from the experiment were significantly matched with the previous literature reports.Conclusions:The results showed that our proposed method has a high efficiency to perform automatic feature extraction compared to conventional extraction performed by humans.

The Role of Three-Dimensional Ultrasound in Gynecology

3D volume imaging is the most important advantage in modern sonography after the introduction of the vaginal probe. The great use of 3D ultrasound in obtaining valuable medical details is undoubted and it could replace MRI scans in gynecology patients as it is able to provide the same or even better views. The review article addresses how to obtain optimum 3D images and some of the possible clinical applications of this technique. The review also addresses in more detail the three major steps in obtaining 3D images, which are volume acquisition, volume display, and volume analysis.

Influence of Traditional Cardiovascular Risk Factors on Carotid and Femoral Atherosclerotic Plaque Volume as Measured by Three-Dimensional Ultrasound.

Background: Atherosclerosis is a systemic multifocal disease with a preference for the branching points of the arteries. In this study, we quantitatively measured carotid and femoral plaque volume in subjects with cardiovascular risk factors (CVRF) and/or established atherosclerotic disease using a 3D ultrasound technique. Methods: In this prospective, single-centre study, we included 404 patients (median age 64; 56.9% men) with at least one CVRF or established cardiovascular disease. Plaque volume was measured using 3D ultrasound equipped with an automated software. Results: We found a strong correlation of plaque volume with CVRF and the number of vascular beds involved. The strongest associations with total and femoral plaque volume were noted for smoking, hypertension, age, as well as for the presence of peripheral arterial occlusive disease (p < 0.05). Carotid plaque volume was best predicted by hyperlipidaemia, hypertension, age, as well as the presence of cerebrovascular disease and coronary artery disease (p < 0.05). Conclusion: We conclude that smoking appears to be associated with total and femoral plaque volume, whereas hyperlipidaemia seems to be associated with carotid plaque volume. Measurement of 3D plaque volume is a practical and reproducible technique with the potential to become an additional screening tool in cardiovascular risk stratification.

Three-dimensional Doppler ultrasonography for the assessment of fetal liver vascularization in fetuses with intrauterine growth restriction.

To demonstrate changes in hepatic volume and vascular indices in fetuses with intrauterine growth restriction (IUGR) compared with normal-growth fetuses, using a noninvasive method (three-dimensional power Doppler ultrasound). The present cross-sectional study was conducted between September 1 and November 30, 2014, at a maternal-fetal medicine unit in Bogotá, Colombia; it included consecutive women at 24-34weeks of pregnancy. The fetal liver volume and indices of hepatic vascularization were determined with three-dimensional power Doppler ultrasonography and compared between fetuses with and without a diagnosis of IUGR. Results A total of 119 women met study inclusion criteria; 97 fetuses had no growth restriction, whereas 22 fetuses had IUGR. The latter group had decreased liver volume (57.85±29.71mL vs 86.99±31.24mL; P=0.010) and increased vascular indices (vascularization index, 47.92±34.44 versus 22.46±18.95; flow index, 71.39±42.01 versus 41.11±23.24; vascularization flow index, 47.94±47.96 versus 13.67±22.38; P=0.003 for all comparisons). Liver volume was decreased and liver vascular indices values were increased in fetuses with IUGR. These findings imply that evaluation of hepatic vascularization with three-dimensional hepatic Doppler could be useful in the diagnosis ofIUGR.

Evaluation of three-dimensional sonography for antral follicle count in cycling dairy cows

The objective of the present study was to investigate reliability of transrectal three-dimensional ultrasound (3D-S) for antral follicle count (AFC) in dairy cows. Furthermore individual differences of AFC between cows and the fluctuation of AFC within and between different cycles were evaluated. To test the reliability of 3D-S, AFC was determined on the ovaries of 10 cows in vivo and compared with counts obtained after slaughter using computer tomography. To evaluate cyclic follicle dynamics, six cows were repeatedly examined with 3D-S over a period of two cycles. Using 3D-S, follicles with a mean diameter greater than 2 mm could be recorded. AFC determined with 3D-S and computer tomography showed a significant correlation (r ≥ 0.86, p < 0.05) and values were similar (p ≥ 0.05). AFC differed between individuals (p < 0.0001) and a moderate fluctuation within and between two cycles within the same cow was apparent (p < 0.05). In conclusion, 3D-S is a suitable method for determination of AFC in cattle. AFC differs between cows and cyclic fluctuations are apparent in a lesser extent.

Two- and three-dimensional ultrasonographic features related to histopathology of the uterine endometrial-myometrial junctional zone.

Our aim was to correlate junctional zone thickening and irregularity (junctional zone disease) and other ultrasonographic features of adenomyosis with the histopathology of the endometrial-myometrial junctional zone. Consecutively enrolled premenopausal women (n=110) scheduled for hysterectomy or transcervical endometrial resection due to abnormal uterine bleeding and/or menstrual pain, underwent two- and three-dimensional transvaginal ultrasonography on the day of surgery with the observer blinded to previous diagnosis. Junctional zone maximum thickness (JZmax ), junctional zone maximum irregularity (JZdif ) and ultrasonographic characteristics of adenomyosis were compared with histopathology of the junctional zone defined as (1) adenomyosis of the inner myometrium, ≥2mm myometrial invasion without contact to the basal endometrium, (2) serrated junctional zone, >3mm myometrial invasion with contact to the basal endometrium or (3) linear junctional zone, no or marginal myometrial invasion ≤3mm with contact to the basal endometrium. Adenomyosis of the inner myometrium, serrated junctional zone and linear junctional zone was present in 29%, 35% and 35% of the women, respectively. Median JZmax and median JZdif expanded from linear junctional zone (8.5 and 3.3mm) to serrated junctional zone (10.1 and 4.1mm) to adenomyosis of the inner myometrium (14.6 and 9.2mm) (P<0.05). In addition, the median number of characteristic adenomyosis-like ultrasonographic features increased from the linear junctional zone to the serrated junctional zone to adenomyosis of the inner myometrium (P<0.05). A slightly thickened and/or irregular junctional zone corresponds to a histopathologically defined serrated junctional zone. This study emphasizes three distinct appearances of the junctional zone: adenomyosis of the inner myometrium, junctional zone disease (serrated junctional zone) and linear junctional zone. This classification may be useful in future clinical studies.

Use of Three-Dimensional Ultrasound for Daily Positioning in Patients Treated with Partial Breast Radiation Therapy: Results from a Prospective Clinical Trial

Use of Three-Dimensional Ultrasound for Daily Positioning in Patients Treated with Partial Breast Radiation Therapy: Results from a Prospective Clinical Trial

Correlation Between Anti Mullerian Hormone Level and Antral Follicle Count Using Three-Dimensional Ultrasound in Cases of Recurrent Spontaneous Abortion

Background: abortion is one of the most common complications of pregnancy, occurring in 10–15% of pregnant women, whiles recurrent spontaneous abortion, rate of 2–5%, is defined as ≥ 3 spontaneous abortions. Aim of the Work: was totry to find relationship between serum AMH concentration which represent ovarian reserve, Antral Follicular count and any pelvic Structural abnormality using 3D ultrasound in assessment cases with spontaneous recurrent abortion. Patients and Methods: A multicenter, randomized trial included 100 women who were divided into 2 groups; Group 1, included 50 patients with ≥ 3 recurrent abortions and Group 2, included 50 parous women with regular menstrual cycles and having one or more living child without any history of pregnancy loss or pelvic structural abnormality. Every subject was subjected to assessing hormonal profile including anti-mullerian hormone (AMH) and Transvaginal ultrasonography. Results: AMH was found to have negative correlation with age, number of abortions, FSH and LH. Conclusion: It could be concluded that Anti-Mullerian hormone is the best indicator of ovarian reserve with a high sensitivity and specificity, so ovarian reserve of women with recurrent spontaneous abortions is not defective.

Correlation Between Anti Mullerian Hormone Level and Antral Follicle Count Using Three-Dimensional Ultrasound in Cases of Recurrent Spontaneous Abortion

Background: abortion is one of the most common complications of pregnancy, occurring in 10–15% of pregnant women, whiles recurrent spontaneous abortion, rate of 2–5%, is defined as ≥ 3 spontaneous abortions. Aim of the Work: was totry to find relationship between serum AMH concentration which represent ovarian reserve, Antral Follicular count and any pelvic Structural abnormality using 3D ultrasound in assessment cases with spontaneous recurrent abortion. Patients and Methods: A multicenter, randomized trial included 100 women who were divided into 2 groups; Group 1, included 50 patients with ≥ 3 recurrent abortions and Group 2, included 50 parous women with regular menstrual cycles and having one or more living child without any history of pregnancy loss or pelvic structural abnormality. Every subject was subjected to assessing hormonal profile including anti-mullerian hormone (AMH) and Transvaginal ultrasonography. Results: AMH was found to have negative correlation with age, number of abortions, FSH and LH. Conclusion: It could be concluded that Anti-Mullerian hormone is the best indicator of ovarian reserve with a high sensitivity and specificity, so ovarian reserve of women with recurrent spontaneous abortions is not defective.