Vascularization Flow Index Research Articles

Endometrial and Subendometrial Vascularity by Three-Dimensional (3D) Power Doppler and Its Correlation with Pregnancy Outcome in Frozen Embryo Transfer (FET) Cycles.

To study the role of endometrial and subendometrial blood flow measured by 3D power Doppler as predictors of pregnancy in frozen embryo transfer (FET) cycles. A hospital-based prospective study of two hundred and twenty-one (221) women undergoing FET cycles with a triple-line endometrium ≥7mm on day 14 endometrial and subendometrial blood flow was assessed using 3D power Doppler, and various indices endometrial volume, subendometrial volume and their vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was clinical pregnancy. Out of 221 women, 97(43.89%) became pregnant, while 124 (56.10%) failed to become pregnant. The endometrial volume was comparable between the two groups. Endometrial VI, FI and VFI were significantly higher in the pregnant as compared to the non-pregnant group. There was a significant difference in subendometrial VI and VFI between the two groups, but FI was similar. Endometrial and subendometrial vascularity by 3D power Doppler can be a useful parameter in predicting pregnancy in FET cycles.

Three-dimensional ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding.

BackgroundUltrasonography has been extensively used in women suspected of having a gynecological malignancy. The aim of this study is to evaluate the efficacy of 3D ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding.MethodsThis cross-sectional study included 78 premenopausal women with abnormal uterine bleeding scheduled for hysteroscopy and endometrial curettage. The endometrial thickness (ET), uterine artery pulsatility index (PI) and resistance index (RI), and endometrial volume (EV) and 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured and compared with hysteroscopic and histopathologic findings.ResultsThe ET (P <0.001), EV (P <0.001), and endometrial VI (P <0.001) and VFI (P = 0.043) were significantly increased in patients with atypical endometrial hyperplasia and endometrial carcinoma (n = 10) than those with benign endometrium (n = 68); whereas, the uterine artery PI and RI and endometrial FI were not significantly different between the two groups. The best marker for discrimination between benign and malignant endometrium was the VI with an area under the ROC curve of 0.88 at a cutoff value of 0.81 %.Conclusion3D ultrasonography and power Doppler, especially endometrial VI, may be useful for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding.

Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study

IntroductionPreeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental...

Effect of hydrosalpinx on uterine and ovarian hemodynamics in women with tubal factor infertility

ObjectiveTo evaluate the effect of hydrosalpinx on uterine and ovarian blood flows in women with tubal factor infertility. Study designIn a cross-sectional study at a university teaching hospital, 60 women with hydrosalpinx-related tubal infertility (hydrosalpinx group) were compared with 60 women with male or unexplained infertility (non-hydrosalpinx group). In the mid-luteal (peri-implantation) phase of the cycle, endometrial thickness, uterine and ovarian artery pulsatility index (PI) and resistance index (RI), and endometrial and ovarian volume and 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured in both groups. ResultsThe endometrial VI (p=0.002), FI (p=0.041), and VFI (p=0.018), and ovarian VI (p=0.011), and VFI (p=0.015) were significantly lower in the hydrosalpinx group than in the non-hydrosalpinx group. However, the endometrial thickness, uterine artery PI and RI, ovarian artery PI and RI, endometrial volume, and ovarian volume and FI were not significantly different between the two groups. ConclusionHydrosalpinx is associated with impaired endometrial and ovarian blood flows which may adversely affect endometrial receptivity and oocyte quality.

Application of SonoVue combined with three-dimensional color power angiography in the diagnosis and prognosis evaluation of intrauterine adhesion

ObjectiveTo investigate the significance of the related indexes of three-dimensional color power angiography (3D-CPA) combined with SonoVue angiography in the diagnosis and prognosis evaluation of intrauterine adhesion (IUA). MethodsThe accuracy, sensitivity, and specificity were evaluated between 3D-TVS and hysteroscopy. Endometrial thickness, volume (V), mean gray value (MG), vascularization index (VI), flow index (FI), vascularization flow index (VFI), and other related indexes before and after the angiography were compared. According to the hysteroscopy findings, the patients were divided into three groups: mild, medium, and severe. The endometrial thickness at 3 months postoperatively and the pregnancy rates at 1 year postoperatively were compared. ResultsCompared with the hysteroscopy, sensitivity: 0.970 (0.021), specificity: 0.667 (0.086), (the values inside the bracket were the standard error), positive likelihood ratio: 2.909, negative likelihood ratio: 0.045. There was a significant difference in endometrial thickness and V between the three groups (P<0.05), and there was a significant difference in MG, VI, FI, and VFI between the mild and severe group (P>0.05). During intravenous injection of SonoVue, the blood flow of each group increased (P<0.001), and the VI, FI, and VFI of each group were significantly different (P<0.05). Compared with the preoperative values, the endometrial thickness, V, MG, VI, FI, and VFI significantly changed at 3 months postoperatively (P<0.05). The mild group and high VI group had a higher pregnancy success rate at one year postoperatively. Conclusion3D-CPA can indirectly diagnose IUA, and may play an important role in prognosis assessment.

Role of three-dimensional ultrasound and three-dimensional doppler in imaging of endometrium for diagnosis of bleeding in women with post-menopausal bleeding

Objective: To determine whether the Three-Dimensional Ultrasound and Three Dimensional Doppler have a role in detection of Endometrial lesions in woman with post menopausal bleeding. Methods: 36 woman in Zagazig University Obstetrics and Gynaecology Department outpatient clinics were recruited. Three-Dimensional Ultrasound and Doppler were done. Then after one week endometrial sampling was done & histological diagnosis was made. After tabulation, all data were analyzed using statistical procedures were carried with SPSS software. Result: Twenty four patients were negative for atypia or cancer and Twelve patients were positive for atypia or cancer. Mean age was 58.1 years in benign endometrium and 62.2 year in malignant endometrium (p=0.1). The mean BMI was 24 in benign and 31.75 in malignant endometrium (p Conclusion: The Three-Dimensional Ultrasound scanning of endometrial volume (3D-US) and Three-Dimensional Doppler Angiography (3D-DA) of the Vascular Indices (vascularization index percent, flow index, and vascularization-flow index), might predict endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline ultrasound scanning.

Reduced placental volume and flow in severe growth restricted fetuses

OBJECTIVES:To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries.METHODS:Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries.RESULTS:The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index.CONCLUSIONS:Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

3D power Doppler ultrasound in early diagnosis of preeclampsia.

Preeclampsia is a known cause of maternal, fetal and neonatal morbidity and mortality. Thus, evaluation of the predicting value of comparing 3D power Doppler indices (3DPD) of uteroplacental circulation (UPC) in the first and second trimester in patients who developed preeclampsia (PE) and those who did not and testing the hypothesis that the parameters of vascularization and placenta flow intensity, as determined by three-dimensional ultrasound (3D), are different in normal pregnancies compared with preeclampsia, could be a suitable screening method. A prospective observational study using 3D power Doppler were performed to evaluate the placental perfusion in 96 pregnant women who came to do the ultrasound routine between 11 and 14 weeks. The placental vascular index (VI), flow index (FI), blood vessels and blood flow index (VFI) by three-dimensional Doppler histogram were calculated. All patients repeated the exam between 16 and 20 weeks. The outcome was scored as normal or preeclamptic. Placental vascular indices including VI, FI and VFI were significantly lower in preeclamptic placentas compared with controls in the study performed in the second trimester (p<0.001). There was not any statistical difference in the patients examined in the first trimester. Our findings suggest that 3D-power Doppler assessment of placental vascular indices in the second trimester has the potential to detect women at risk for subsequent development of PE.

Importance of Pulse Repetition Frequency Adjustment for 3‐ and 4‐Dimensional Power Doppler Quantification

To determine the influence of the pulse repetition frequency (PRF) and wall motion filter on the 3-dimensional (3D) power Doppler vascularization-flow index (VFI) and volumetric pulsatility index (PI) obtained from spatiotemporal image correlation (STIC) data sets acquired from a common carotid artery of a healthy participant. We acquired 11 STIC data sets, 1 for each PRF value ranging from 0.6 to 9.0 kHz. Vascularization-flow index and volumetric PI values were determined from the 440 static 3D data sets contained in these STIC data sets. Additionally, 3 sets of radio-frequency data were acquired for offline processing of different wall motion filter values for PRF values of 0.6, 3.3, and 10 kHz. We constructed VFI curves and observed 2 patterns: a flattened pattern with a low PRF and a triphasic pattern with a high PRF, correlating with the known pulsed wave Doppler profile of this vessel. Volumetric PI values were around 0 for low PRF settings and increased with increasing PRF. Analysis of the radiofrequency data showed that increasing wall motion filter values gradually filtered out the low-velocity power Doppler signals while retaining the higher-velocity ones, allowing the distinction of integrated power Doppler signal velocity throughout the cardiac cycle. We conclude that the PRF and wall motion filter dramatically influence 3D power Doppler indices and the volumetric PI, and the use of PRF values in which minimum VFI values are measured during the diastolic phase in the spectral Doppler wave may validate the use of the volumetric PI.

Role of 3D power Doppler ultrasound in the further characterization of suspicious breast masses

PurposeTo investigate effectiveness of vascular indices obtained with 3D power Doppler ultrasound in the further characterization of breast masses and prevention of unnecessary biopsies. Materials and methodsBetween April 2013 and March 2014, 109 patients (age range, 17–85 years; mean age, 47 years) with 117 radiologically or clinically suspicious breast masses were prospectively evaluated with 3DPDUS before biopsy. Mass volume (MV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using Virtual Organ Computer-aided Analysis (VOCAL) software and they were correlated with the final diagnosis. Cutoff values of vascular indices were determinated and diagnostic efficacy was calculated with receiver operating curve (ROC) analysis. ResultsAll vascular indices, age of patients and tumor volume were significantly lower in benign masses compared with malignant ones (p<0.001). AUCs were 0.872, 0.867 and 0.789 for VI, VFI and FI, respectively. The diagnostic efficacy of VI (for cutoff 1.1; 83% sensitivity, 82% specificity and 82% accuracy) and VFI (for cutoff 0.4; 80% sensitivity, 83% specificity and 80% accuracy) were significantly higher than FI (for cutoff 33,9; 73% sensitivity, 69% specificity and 71% accuracy). It was found that with the use of vascular indices of 3DPDUS in the further characterization of suspicious breast masses between 24% to 37% of unnecessary biopsies could have been avoided. ConclusionThe vascular indices obtained with 3DPDUS seem reliable in the further characterization of suspicious breast masses and might be used to decrease unnecessary biopsies.

Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study

BackgroundHypertensive disorders complicating pregnancy (HDCP) continues to be a leading cause of maternal and neonatal mortality and morbidity. The clinical value of placental three-dimensional power Doppler (3DPD) in assessing HDCP requires further confirmation. The research was developed to assess changes of placental vascularity in HDCP using 3DPD and to investigate the placental vascularity in small for gestational age (SGA) compared with not-SGA in patients with HDCP.MethodsThere were 126 normotensive and 128 hypertensive pregnant women included in this prospective case–control study from March 2011 to March 2013. Pregnant women underwent 3DPD. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained. The placental 3DPD indices, umbilical artery systolic and diastolic ratio (S/D) and pregnancy outcomes were compared between the groups.ResultsThe placental VI and VFI were significantly lower in hypertensive women compared with normotensive women (P < 0.001 and P = 0.014, respectively), and these parameters were significantly reduced in severe preeclampsia (P < 0.001 and P = 0.003, respectively). A weak correlation was found between VI and umbilical artery S/D in HDCP group (r = -0.277, P = 0.001). In HDCP population, neonates who were postnatally diagnosed with SGA had lower VI (P = 0.041) and higher S/D (P < 0.001).DiscussionThe placental vascularity indices decreased in hypertensive women and the reduction inplacental perfusion was consistent with the severity of the hypertensive disorder. The associations betweenplacental vascularization and umbilical artery impedance may be valuable for further researches and arerequired confirmation. The significant differences in the 3DPD placental vascularization between SGA andnot-SGA in hypertensive pregnancy population may show some clinical importance that we could use tobetter assess or predict the progression and adverse outcomes in the future. Although 3DPD quantificationhas been widely used in multiple publications, we have to acknowledge its limitations.ConclusionsThe intraplacental vascularization was poor in HDCP, and especially in severe preeclampsia. Neonates with SGA had poor placental vascularization and higher umbilical artery S/D. Further studies should focus on the clinical assessment of placental 3DPD as well as a combination of placental 3DPD and other fetal Doppler indices to better predict the development and outcomes of preeclampsia.

Decreased endometrial vascularity and receptivity in unexplained recurrent miscarriage patients during midluteal and early pregnancy phases

ObjectiveTo evaluate the predictive value of three-dimensional (3D)-power Doppler sonography on recurrent miscarriage. Materials and methodsThe study patients were divided into a recurrent miscarriage group (30 cases) and a normal pregnancy group (21 cases). Measurement of endometrial thickness was performed using two-dimensional transvaginal ultrasound in the midluteal phase. The endometrial volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) in midluteal and placenta volume, as well as the VI, FI, and VFI of early pregnancy were measured using Virtual Organ Computer-aided Analysis of 3D-power Doppler ultrasound. ResultsEndometrial thickness, endometrial volume, endometrial vascular data, VI, FI, and VFI of the midluteal phase were lower in the recurrent miscarriage group compared with the normal pregnancy group (p < 0.05). Placental volume, VI, and VFI during early pregnancy were lower in the miscarriage group compared with the normal pregnancy group (p < 0.05). There was no significant change in FI between the recurrent miscarriage and control groups during early pregnancy (p > 0.05). The predictive accuracy of endometrial thickness, endometrial volume, VI, FI, and VFI in the midluteal phase, and placenta volume, VI, FI, and VFI in early pregnancy as measured by the receiver operating characteristic curve to predict miscarriage before 12 gestational weeks in participants was 0.681, 0.876, 0.770, 0.720, 0.879, 0.771, 0.907, 0.592, respectively. ConclusionThe 3D-power Doppler ultrasound is a more comprehensive and sensitive method for evaluating endometrial receptivity. Endometrial volume, VI, FI, and VFI in the midluteal phase, as well as VI in early pregnancy, can be considered as predictive factors for recurrent miscarriage.

Can Three-dimensional (3D) power Doppler and uterine artery Doppler differentiate between fibroids and adenomyomas?

Purpose: To determine if the three-dimensional power Doppler and uterine arteries Doppler were able to differentiate between fibroids and adenomyomas. Methods: 123 patients who were scheduled for hysterectomy were enrolled in the study. They were evaluated by ultrasound before hysterectomy. We included only cases with either fibroids or adenomymas. For each benign myometrial mass, mass volume, 3D power Doppler vascularization index (VI), flow index (FI) and vascularization flow index (VFI) and uterine artery Doppler indices were measured. The results were compared with the histopathological examination. Results: No significant difference was detected between the volume of the fibroids or the adenomyomas (P = 0.896). There was significant difference in the vascular location of the power Doppler flow between fibroids and adenomyomas being more scattered in adenomyoma and more peripheral in fibroids (P < 0.00). In fibroids, higher 3D power Doppler vascular flow (VI = 2.42 ± 2.0, FI = 39.931 ± 5.8 and VFI = 1.29 ± 1.54) than adenomyomas (VI = 1.19 ± 1.04, FI = 28.33 ± 6.88, VFI = 0.89 ± 0.49). That was statistically significant (P = 0.005, 0.00, 0.004) respectively. The uterine artery Doppler indices (RI, PI) showed no significant difference between fibroids and adenomyoma (P = 0.349, 0.067). Conclusion: 3D power Doppler can differentiate between fibroids and adenomyomas. The uterine arteries Doppler Can’t differentiate between fibroids and adenomyomas.

P05.05: Reduced placental vascularisation at 12 weeks is associated with a specific cluster of serum proteins

We hypothesise that women with poor placental vascularisation at 12 weeks differ from women with normal vascularisation by a different profile of serum markers and a higher incidence of placental syndrome later in pregnancy. 41 women were included. Placental vascularisation measured with 3D Power Doppler. Using VOCAL the vascularisation index (VI), the vascularisation flow index (VFI) and placental volume (PV) were analysed. Women presented with a ‘poor VFI’ (lowest quartile) and a ‘normal VFI’ (highest quartile). We measured 23 cytokines/chemokines and growth factors with a multiplex immuno-assay. Table 1 lists demographic features and pregnancy outcome. The angiotensin 1/angiotensin 2 (ang1/ang2) ratio and VEGF/VEGF-R ratio was elevated (2-fold increase; p < 0.05 and 2.5-fold increase; p < 0.05) in woman with poor VFI (figure 1) Serum leptin was also increased by 2.8 fold in women with poor VFI (p < 0.05). Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial

To study the effects of the wide excision of soft tissues adjacent to the ovary and fallopian tube on ovarian function and surgical outcomes in women undergoing laparoscopic bilateral prophylactic salpingectomy. Randomized, controlled trial. Teaching hospital. One hundred eighty-six women undergoing laparoscopic surgery for uterine myoma (n = 143) or tubal surgical sterilization (n = 43). Patients were randomly divided into two groups. In group A (n = 91), standard salpingectomy was performed. In group B (n = 95), the mesosalpinx was removed within the tubes. Prior to and 3 months after surgery, antimüllerian hormone (AMH), FSH, three-dimensional antral follicle count (AFC), vascular index (VI), flow index (FI), vascular-flow index (VFI), and OvAge were recorded for each patient. Ovarian reserve modification (Δ) before and after surgery was assessed as the primary outcome. Operative time, variation of the hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were assessed as secondary outcomes. No significant difference was observed between groups for ΔAMH, ΔFSH, ΔAFC, ΔVI, ΔFI, ΔVFI, and ΔOvAge. Moreover, the groups were similar for operative time, ΔHb, postoperative hospital stay, postoperative return to normal activity, and complication rate. Even when the surgical excision includes the removal of the mesosalpinx, salpingectomy does not damage the ovarian reserve. Moreover, wide salpingectomy with excision of the mesosalpinx did not alter blood loss, hospitalization stay, or return to normal activities. NCT02086370.

Morbid adherence of the placenta-a disease of nonvillous trophoblast?

Morbid adherence of the placenta-a disease of nonvillous trophoblast?

4-D Assessment of Endometrial Vascularity Using Spatiotemporal Image Correlation: A Study Comparing Spherical Sampling and Whole-Tissue Analysis

Our aim in the study described here was to assess the feasibility of spatiotemporal image correlation power Doppler quantification of the endometrium with two techniques: spherical samples and whole tissue. We scanned 51 women in the midluteal phase of the menstrual cycle: STIC assessment of the whole endometrium was not possible in 10% of cases, whereas spherical analysis was possible in all. The time taken for data set analysis was much longer for the whole endometrium compared with spherical analysis (1478.9 ± 291 s vs. 266.8 ± 39.3 s, p < 0.05). Intra-class correlation coefficients for the vascularization flow index (VFI) were similar for both methods. Volumetric vascularity indices were higher when spherical sampling was conducted. Significant cycle-to-cycle variability in the vascularity indices was present, with coefficients of variation exceeding 20% for both techniques. We found that STIC power Doppler quantification of the whole endometrium is possible in the majority of cases, however, it is time consuming and limited by significant cycle-to-cycle variability.

Placental volume, vasculature and calcification in pregnancies complicated by pre-eclampsia and intra-uterine growth restriction

ObjectivePre-eclampsia (PET) and intrauterine growth restriction (IUGR), often associated with impaired placental function, are among the most common conditions contributing to increased perinatal mortality and morbidity. This study investigates if three dimensional power Doppler (3DPD) of the placenta and computerised analysis of placental calcification is different between PET/IUGR and normal pregnancies. Study designThis was a prospective cohort study involving 50 women with pre-eclampsia and/or IUGR, or with IUGR only from 24 to 40 weeks’ gestation. 3DPD ultrasound was used to calculate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Following each scan the percentage of placental calcification was also calculated, by computer analysis. Results were compared with normal (control) values, and findings correlated with maternal and fetal Doppler parameters and placental histology. ResultsVolume, VI, and VFI are not influenced by gestational age in PET/IUGR pregnancies. FI was found to increase with gestational age (p=0.009) and was lower than normal in the total study group from 24 to 30 weeks (p=0.006). In the pregnancies affected by PET, whether or not IUGR was present, all three indices were lower than normal values between 24 and 30 weeks (VI: p=0.038, FI: p=0.004, VFI: p=0.015). Vascularisation and flow indices were less than the normal 50th centile in the majority of cases of utero-placental insufficiency (p=0.047), and vascularisation and vascularisation flow indices were lower in cases of accelerated placental maturation (p=0.016 and 0.041 respectively). Placental volume greater than the 50th centile between 24 and 30 weeks was associated with the presence of infarction on histology (p=0.021). Flow index (p=0.002) and vascularisation flow index (p=0.036) were lower in the presence of bilateral uterine artery notches. Calcification, similar to the control group, was related to an increasing UAPI (p=0.041) and MCA PI <5th centile (p=0.010). ConclusionsThe study findings suggest that there may be a role for 3DPD placental assessment of volume, vascularisation and blood flow and computer analysis of placental calcification in the identification and management of PET/IUGR pregnancy.

Placental vascular indices (VI, FI and VFI) in intrauterine growth retardation (IUGR). A pooled analysis of the literature.

I performed a systematic review and pooled analysis to study the utility of the placental vascular flow indices vascularization index (VI), flow index (FI) and vascularization flow index (VFI) in the prediction or identification of in-utero growth restriction (IUGR). A comprehensive literature search for relevant studies was conducted using PubMed and Web of Knowledge databases. Included were cohort or case-control studies which reported (1) the statistical position and dispersion of vascular indices in a population of normal pregnancies at various trimesters of pregnancy; (2) correlation between vascular indices and gestational age; or (3) the vascular index values stratified according to the presence of SGA/IUGR versus a population of controls. Seven studies met the criteria of inclusion, for a total of 788 controls and 82 SGA cases in the first trimester, and 169 controls and 80 IUGR cases essentially enrolled in the 3rd trimester. After normalization of the means, the pooled detection rates (DRs) at a 10% false positive rate were 32.5%, 53.8% and 51.0%, respectively, for the vascular indices VI, FI and VFI in the third trimester. No significant discriminant ability was detected in the first trimester. A significant DR for IUGR was demonstrated only in the third trimester, thus limiting the utility of vascular indices to predict IUGR. VI and VFI are more reliable and yield better DR and better performance in terms of homogeneity than FI and should be evaluated in the management of third trimester IUGR and prediction of outcome.

Three-dimensional power Doppler ultrasound with a three-dimensional multislice view

Objective To evaluate the efficacy of three-dimensional power Doppler (3DPD) and 3D multislice view in distinguishing between benign and malignant endometrial lesions in women with postmenopausal bleeding (PMB) and endometrial thickness of 5 mm or more. Study design This was a diagnostic accuracy study. Patients and methods Women with PMB and an endometrial thickness of 5 mm or more on two-dimensional transvaginal sonography were evaluated by 3DPD before endometrial sampling to make a definitive histological diagnosis of endometrial lesions. Endometrial volume (EV), vascularization index (VI), flow index (FI), and vascularization–flow index (VFI) were calculated using Virtual Organ Computer-aided AnaLysis (VOCAL) software. 3D multislice view was used to increase the diagnostic accuracy of the above parameters (EV, VI, FI, and VFI) in the diagnosis of different endometrial lesions. The women included were divided into two groups: group 1 included 28 patients who had a histological diagnosis of endometrial carcinoma and group 2 included 32 patients who had a histological diagnosis of benign endometrial disorders. Results Sixty women with PMB were finally analyzed; 32 (53.3%) women had benign endometrial lesions and 28 (46.7%) had endometrial malignancy. Women in group 1 tended to have significantly thicker endometrium (11.11±3.61 vs. 5.78±0.94 mm; P=0.0001), larger EV (4.89±3.53 vs. 2.22±1.60; P=0.001), and higher 3DPD flow indices (P=0.0001) than those with benign endometrial lesions. There was a statistically significant difference between 3DPD and 3D multislice view, with increased vasculature in different planes in malignant cases than in benign cases (P=0.0001). The best logistic regression models for predicting malignancy [i.e. the models with the largest area under the curve (AUC)] included endometrial thickness and VFI (AUC 0.984 and 0.884). Conclusion Even though histopathological examination of the endometrium is the gold standard for the final diagnosis or exclusion of endometrial malignancy, EV, 3DPD indices, and 3D multislice view are good diagnostic tools in predicting endometrial malignancy in women with PMB.