Transvaginal Power Doppler Ultrasonography Research Articles

Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: by using transvaginal power Doppler

The aim of study was to asses any potential relationship between perifollicular vascularity and fetal outcome in an invivo environment following ovarian stimulation and intrauterine insemination. A total of 75 unselected consecutive patients undergoing stimulated intrauterine insemination cycles (with clomid) was recruited where the perifollicular vascularity of the follicles ≥16 mm was studied using subjective grading system by transvaginal power Doppler ultrasonography 24 h after HCG administration. 36 hours after H.C.G administration we did intrauterine insemination and two weeks later we did pregnancy test for our patients. A total 75 mature follicles ( > 16 mm ) was studied. According to the result of Doppler study we found that we had 54.6% of follicles having grade III perfollicular vascularity , 32% having grade II , and 13.3% grade I. The follicles of high grade vascularity were associated with higher pregnancy rate (grade 3= 19.5%) than cycles with low grade vascularity (grade2 =12.5%), with no pregnancy occur in grade 1 vascularity group. Early pregnancy loss rate was significantly higher in grade2 follicular vascularity (33.3%) than grade 3 (12.5%) . The mean age and duration of subfertility were significantly higher (P<0.05), with low follicular vascularity grades compared with grade II, III. These data would suggest that perfollicular vascularity and PI (pulsatility index ) of uterine artery has an important role to play in the outcome of IUI cycles. And that the power Doppler has the potential to refine the management of assisted reproduction treatment cycles.

Correlation between Perifollicular Vascularity and Outcome in Stimulated Intrauterine Insemination Treatment Cycles: A Study Using Two-Dimensional Transvaginal Power Doppler Ultrasound

Objective: The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography. Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group; 2 cases in mixed grades group and no cases got pregnant in low grade group). There was statistically significant difference among the 3 groups as regarding the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.

The Diagnostic Value of a Multivariate Logistic Regression Analysis Model with Transvaginal Power Doppler Ultrasonography for the Prediction of Ectopic Pregnancy

A multivariate logistic regression analysis model for predicting ectopic pregnancy in women with pregnancy of unknown location was designed and evaluated clinically. Endometrial thickness, symmetry, resonance, pattern of echogenicity, helicine artery blood flow and blood flow resistance index (RI) in 129 patients with suspected early ectopic pregnancy were assessed by transvaginal power Doppler ultrasonography. Variables significant in univariate logistic regression analysis were included in a multivariate predictive logistic regression analysis model. The final predictive model included three factors: endometrial thickness≤9 mm; a multilayered endometrial echogenicity pattern with prominent outer and midline hyperechogenic lines and an inner hypoechogenic region; and visible endometrial arterial blood flow. The area under the receiver operating characteristic curve of the model was 0.980. When RI was >0.65 and the predictive probability>0.50, diagnostic accuracy was high. The model correctly diagnosed 52/55 (94.5%) clinically confirmed ectopic pregnancy cases. This multivariate predictive logistic regression analysis model has clinical value for the differential diagnosis of early ectopic pregnancy when the pregnancy location is unknown.

Transvaginal power Doppler sonography can discriminate between benign and malignant endometrial conditions in women with postmenopausal bleeding

Abstract Objective To evaluate the role of transvaginal power Doppler sonography in differentiation between benign and malignant endometrial conditions in women with postmenopausal bleeding. Setting OB/GYN Dept., Suzan Mubarak University Hospital and Radiology Dept., Minia University Hospital, Minia University, Minia, Egypt. Study design Prospective observational study. Patients Eighty patients with postmenopausal bleeding. Intervention(s) Grey scale transvaginal sonography, power Doppler study of the endometrium and endometrial-myometrial interface, and office hysteroscopy and the final diagnosis by histopathological examination of hysteroscopic guided biopsy. Results Endometrial power Doppler signals were positive in 69 out of the eighty patients (86.25%): 8 cases showed multiple vessel pattern -A- (10%); 19 cases with single vessel pattern -B- (23.75%); 42 cases with scattered vessel pattern -C- (52.5%) while in the remaining 11 cases (13.75%), no power Doppler signals were detected. The hysteroscopic findings were endometrial polyp in 16 cases (20%), atrophic endometrium in 14 cases (17.5%), hyperplasic endometrium in 32 cases (40%), submucus fibroid in 6 cases (7.5%), cervical polyp in 3 cases (3.75%) and suspicious endometrium for malignancy in 8 cases (10%). Hysteroscopy was more accurate in cases with intra-cavitary masses (polyps and submucous fibroids) than power Doppler, but power Doppler had a more predictive value for malignant endometrium. Conclusion Power Doppler blood flow mapping of the endometrium in women with postmenopausal bleeding is useful to discriminate carcinoma from other endometrial pathologies.

1187: The Diagnostic Value of Multivariate Logistic Model with Transvaginal Power Doppler Ultrasonography for the Prediction of Ectopic Pregnancy

This study established a regression model with the relative factors, evaluated its clinical applied value, and explored the diagnostic criterias of transvaginal power Doppler ultrasonography (TV-PDU) in predicting ectopic pregnancy (EP) of the women with pregnancy of unknown location (PUL).

The Power Doppler Velocity Index, Pulsatility Index, and Resistive Index Can Assist in Making a Differential Diagnosis of Primary Ovarian Carcinoma and Krukenberg Tumors

The aim of this study was to compare the effectiveness of transvaginal power Doppler sonography with spectral Doppler analysis as an aid in preoperatively distinguishing primary ovarian carcinoma and metastatic carcinoma to the ovary (Krukenberg tumors). Fifty women with ovarian disease were preoperatively examined with transvaginal power Doppler sonography. Six basic parameters were measured, including intratumoral peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, pulsatility index (PI), resistive index (RI), and velocity index (VeI). Blood flow analyses were detectable in all patients. Twelve patients with metastatic carcinoma to the ovary were classified as group 1; 38 patients with primary ovarian carcinoma were classified as group 2. Comparison of intratumoral blood flow analyses between the two groups was performed. The PI, RI, and VeI were significantly lower in patients with metastatic carcinoma to the ovary than those with primary ovarian carcinoma (P < .05). There were no significant differences in the peak systolic velocity (P = .871), end-diastolic velocity (P = .508), and time-averaged maximum velocity (P = .850) between the two groups. Transvaginal power Doppler sonography with spectral Doppler analysis is an effective method in evaluating intratumoral blood flow of Krukenberg tumors. Low impedance (PI, RI, and VeI) might assist us in making differential diagnoses between primary ovarian carcinoma and Krukenberg tumors according to our preliminary results.

Reproducibility of Endometrial Vascular Patterns in Endometrial Disease as Assessed by Transvaginal Power Doppler Sonography in Women With Postmenopausal Bleeding

The purpose of this study was to assess the intraobserver and interobserver agreement for identifying different endometrial vascular patterns using power Doppler sonography in women with postmenopausal bleeding and a thickened endometrium. Digitally stored sonographic images from a random sample of 65 patients with postmenopausal bleeding and a thick endometrium (>5 mm) on B-mode sonography and evaluated by transvaginal power Doppler sonography for assessment of endometrial blood flow mapping were evaluated by 5 different examiners with different levels of expertise in Doppler sonography. Intraobserver and interobserver agreement according to the level of experience were assessed by calculating the kappa index. Intraobserver agreement was good or very good for all experienced examiners (kappa = 0.78-0.96) and moderate (kappa = 0.52) for the inexperienced examiner. Interobserver agreement was moderate among all experienced examiners (kappa = 0.45-0.80). The inexperienced examiner showed fair or moderate interobserver agreement (kappa = 0.32-0.45). Our results indicate that endometrial blood flow mapping using transvaginal power Doppler sonography is acceptably reproducible. More experience was associated with better intraobserver and interobserver agreement.

Adenomyosis

The present study confirms the potential use of transvaginal power Doppler sonography in the field of pelvic inflammatory disease such as endometriosis, as well as its usefulness in the subtle differential instrumental diagnosis between adenomyosis and leiomyomata. Transvaginal power Doppler application is critical in studying the vascular tree of such lesions and can aid clinicians in planning the most appropriate therapeutic strategy. The differential diagnosis using power Doppler sonography is based on vascular characteristics. Adenomyosis is characterized by a preserved vascular texture supply that results in dilated spiral arteries running perpendicular toward the myometrium into the endometrial surface. Leiomyomata exhibits a vascular tree that typically circumscribes the solid mass. Nodular stage II adenomyosis in young, infertile patients may be treated with a conservative hysteroscopic resection of the myometrium under laparoscopic guidance. 2D or 3D transvaginal power Doppler angiography should be used to improve diagnostic sensitivity and facilitate appropriate therapeutic intervention.

Placental blood flow mapping in the first trimester of human pregnancy

Human placental circulation in the first trimester of pregnancy remains a subject of scientific debate. Most of the acquired knowledge on the physiological background of maternal-fetal interface relies on old studies, most of them performed in non-hemochorial placentas and using light and electron microscopy for the pathological specimens' evaluation. Recently, some ultrasonographic research in this field, using pulsed-wave and/or colour Doppler, yielded contradictory results. The availability of these non-invasive methods should allow the in vivo investigation of placental circulation since early phases of human pregnancy. A more recent technique – Power Doppler – should be preferred considering its resolution, angle-independence, higher sensitivity for lower velocities and absence of known harmful bioeffects in the early periods of gestation. We provide an overview on first trimester maternal-fetal circulation, assessed by non-invasive techniques, namely by transvaginal power Doppler ultrasonography, tr...

Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium.

To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included. Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%. Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.

Doppler evaluation of the uterine, intraovarian, stromal and spiral arteries on the day of human chorionic gonadotrophin administration in controlled ovarian hyperstimulation

The aim of this prospective study was to investigate the ability of transvaginal power Doppler ultrasonography to assess the relationship between the pulsatility indices (PI) of uterine, spiral and ovarian arteries and endometrial thickness on the day of, but just before, human chorionic gonadotrophin administration and the relationship to pregnancy outcome. Fifty-seven patients were recruited to the study. The mean PI values of the uterine arteries demonstrate significant differences between the women who conceived and those who did not. The mean PI values of the intraovarian flow also demonstrated significant differences between the left and right PI values and between the PI of the women who conceived and those who did not. Mean PI values of the spiral arteries and endometrial thickness did not demonstrate any significant difference between the women who conceived and those who did not. The parameters used currently in colour Doppler assessment of ovarian stromal, uterine and spiral artery perfusion are clinically helpful in discriminating prospectively which patients will and will not become pregnant in controlled ovarian hyperstimulation, insemination programme.

Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: a study using transvaginal power Doppler

The aim of the present study was to assess any potential relationship between perifollicular vascularity and outcome in an in-vivo environment following human chorionic gonadotrophin (HCG) administration. A total of 182 unselected consecutive patients undergoing stimulated intrauterine insemination (IUI) cycles was recruited where the perifollicular vascularity of follicles > or =16 mm was studied using a subjective grading system and transvaginal power Doppler ultrasonography, 36 h after HCG administration. A total of 601 follicles was studied. The incidence of follicles showing high-grade perifollicular vascularity (3 and 4) was higher than those with low-grade vascularity (1 and 2) (80 versus 20%). Treatment cycles were divided according to uniformity of vascularity grades of follicles > or =16 mm on the day of IUI [55% all high (3/4) grade; 33% mixed (1/2 and 3/4) and 12% all low (1/2) grade]. The mean age and duration of subfertility were significantly higher (P < 0.05), whereas the number of follicles > or =16 mm pre/post HCG, serum oestradiol and incidence of ultrashort gonadotrophin-releasing hormone (GnRH) agonist use were all significantly lower (P < 0.05) in treatment cycles with uniformly low follicular vascularity grades compared with mixed or uniformly high-grade cycles. However, on subjecting the data to multiple logistic regression analysis, the only independent variables that affected pregnancy rates appeared to be serum oestradiol (OR 1.28, 1.01--1.62) and high-grade follicular vascularity (OR 2.41, 1.08--5.40). These data would suggest that perifollicular vascularity has an important role to play in the outcome of IUI cycles, and that power Doppler has the potential to refine the management of assisted reproduction treatment cycles.

The potential effect of controlled ovarian hyperstimulation on follicular vascular perfusion: a study applying power Doppler ultrasonography within a treatment programme using donor sperm

This was a prospective observational study to evaluate the effect of controlled ovarian hyperstimulation on follicular vascularity. A subjective grading system was applied to assess vascularity using transvaginal power Doppler ultrasonography on the day of insemination (32-36 hours post-HCG administration) in donor treatment cycles undergoing either controlled ovarian hyperstimulation (COH group) with gonadotrophin and intrauterine insemination or intracervical insemination with/without clomiphene stimulation (non-COH group). The incidence of follicles (81% vs. 53%; P < 0·05) as well as cycles (63% vs. 49%; P < 0·05) with uniformly high grade vascularity was significantly higher in treatments that had controlled ovarian hyperstimulation compared with unstimulated or clomiphene induced donor cycles. Pregnancy rates were higher and early pregnancy loss rates lower, in cycles with uniformly high grade follicular vascularity in both treatment groups compared with other vascularity grades. Using multiple logistic regression analysis, the only independent variable that was significantly related to pregnancy rates in this treatment programme was follicular vascularity. Controlled ovarian hyperstimulation appears to have an effect on follicular vascularity and this may contribute to improved outcome in donor insemination treatment programmes.

The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles.

The aim of this prospective study of the use of transvaginal power Doppler ultrasound was to assess the subjectivity of the grading system and to elucidate, on a much larger series (200) of treatment cycles, the findings of previous authors. Vascular perfusion was studied using a grading system based on the percentage of follicular circumference (grade 1 < 25%, grade 2 < 50%, grade 3 < 75% and grade 4 > 75%) that depicted an echo signal. Interobserver variation was low (k = 0.81 + 0.08). A total of 1285 follicles were studied, of which 64% were of high (grades 3 or 4) and 36% were of low (grades 1 or 2) grade vascularity. Mean follicular diameter, oocyte retrieval rate, number of mature oocytes recovered and fertilization rates were all significantly higher (P < 0.05) and triploidy rate significantly lower (P < 0.05) from the cohort of follicles with high grade vascularity. There was no correlation between embryo morphology and vascularity grade. The pregnancy rate for cycles where the embryos transferred were derived from follicles with uniformly high grade (3 or 4 only) vascularity was significantly higher than for those cycles where the embryos transferred were derived from mixed (1 to 4) or low (1 or 2 only) grade follicles [24/72 (34.7%) versus 22/122 (18%); P < 0.05]. There were no significant differences in uterine artery or intraovarian pulsatility index values between the pregnant and non-pregnant treatment cycles. This study suggests that follicles with high grade vascularity are associated with better outcome variables. Thus, follicular assessment may be used prospectively to improve the outcome in in-vitro fertilization treatment cycles.

Uterine blood flow velocity waveforms during early postpartum course following Caesarean section

Objective: To assess the change of uterine blood flow after Caesarean section. Study Design: Doppler flow velocity waveforms were acquired from the uterine arteries and small arteries near the myometrial wound detected by transvaginal power Doppler ultrasonography in 23 patients on the 3rd, 6th and 9th postoperative days. Results: The resistance index for the uterine artery did not show any change during the study period, while that for the small arteries slightly decreased. Conclusion: Uterine blood flow resistance after Caesarean section did not show any change during the early postpartum period.

Follicular vascularity--the predictive value of transvaginal power Doppler ultrasonography in an in-vitro fertilization programme: a preliminary study.

The aim of this prospective study was to investigate the ability of transvaginal power Doppler ultrasonography to assess the relationship between follicular vascularity and outcome in women undergoing in-vitro fertilization. Each of 38 subjects underwent a single transvaginal power Doppler ultrasound scan on the day of oocyte collection, where the vascularity of individual ovarian follicles was assessed, using a subjective system, and graded 1 to 4. In addition, conventional pulsatility indices (PI) of the uterine and intra-ovarian (stromal) arteries were calculated, which showed no significant differences between the pregnant and non-pregnant groups. Using power Doppler ultrasonography, a total of 188 follicles was studied. The follicular vascularity grade was found to be independent of follicular size and there was no significant difference in fertilization rates with different degrees of vascularity, although there was a trend towards higher fertilization rates with higher grade vascularity. There were 10 pregnancies, giving a pregnancy rate of 26.3% per embryo transfer. Pregnancies were confined to those women whose embryos were derived from follicles with grade 3 and 4 vascularity (pregnancy rates per embryo transfer of 12.5 and 61.5% respectively), with only those from grade 4 follicles resulting in livebirths. This preliminary study suggested that high grade follicular vascularity is associated with increased pregnancy rate and that there is a possible link between follicular vascularity and implantation potential.

Transvaginal power Doppler angiography of the fetal brain.

Using transvaginal B-mode sonography combined with power Doppler flow mapping on a total of 65 fetuses between 12 and 30 weeks of gestation, fetal intracerebral arteries and veins and blood flow were demonstrated in the coronal and sagittal planes. Clear images of the fetal brain and intracerebral vascular flow were obtained in 36 of the 65 cases. Bilateral vertebral arteries, the basilar artery and posterior cerebral arteries were imaged in the coronal plane at 12 weeks of gestation. Bilateral carotid and middle cerebral arteries were also depicted in the coronal plane at 13 weeks of gestation. The middle cerebral arteries and their branches were depicted via the anterior fontanelle in the coronal plane at 20 weeks of gestation. The anterior cerebral artery and its branches were demonstrated in the sagittal plane at 26 weeks of gestation. The fetal cerebral venous systems of the superior sagittal sinus, internal cerebral vein, vein of Galen and straight sinus were clearly imaged in the mid-sagittal plane. Although we encountered several problems with this new technology of transvaginal power Doppler sonography, we were able to demonstrate its potential to assess fetal intracranial blood flow during pregnancy.