Virtual Organ Computer-aided Analysis Research Articles

Multiethnic Growth Standards for Fetal Body Composition and Organ Volumes Derived from 3D Ultrasonography

BackgroundA major goal of contemporary obstetrical practice is to optimize fetal growth and development throughout pregnancy. To date, fetal growth during prenatal care is assessed by performing ultrasonographic measurement of two-dimensional fetal biometry to calculate an estimated fetal weight. Our group previously established two-dimensional fetal growth standards using sonographic data from a large cohort with multiple sonograms. A separate objective of that investigation involved the collection of fetal volumes from the same cohort. ObjectiveThe Fetal 3D Study was designed to establish standards for fetal soft tissue and organ volume measurements by three-dimensional ultrasonography and compare growth trajectories with conventional two-dimensional measures where applicable. Study DesignThe NICHD Fetal 3D Study included research-quality images of singletons collected in a prospective, racially and ethnically diverse, low-risk cohort of pregnant individuals at 12 U.S. sites, with up to five scans per fetus (N=1,730 fetuses). Abdominal subcutaneous tissue thickness was measured from two-dimensional images and fetal limb soft tissue parameters extracted from three-dimensional multiplanar views. Cerebellar, lung, liver and kidney volumes were measured using virtual organ computer aided analysis (VOCAL). Fractional arm and thigh total volumes, and fractional lean limb volumes were measured, with fractional limb fat volume calculated by subtracting lean from total. For each measure, weighted curves (5th, 50th, 95th percentiles) were derived from 15-41 weeks’ using linear mixed models for repeated measures with cubic splines. ResultsSubcutaneous thickness of the abdomen, arm, and thigh increased linearly, with slight acceleration around 27-29 weeks. Fractional volumes of the arm, thigh, and lean limb volumes increased along a quadratic curvature, with acceleration around 29-30 weeks. In contrast, growth patterns for two-dimensional humerus and femur lengths demonstrated a logarithmic shape, with fastest growth in the 2nd trimester. The mid-arm area curve was similar in shape to fractional arm volume, with an acceleration around 30 weeks, whereas the curve for the lean arm area was more gradual. The abdominal area curve was similar to the mid-arm area curve with an acceleration around 29 weeks. The mid-thigh and lean area curves differed from the arm areas by exhibiting a deceleration at 39 weeks. The growth curves for the mid arm and thigh circumferences were more linear with some decelerations. Cerebellar two-dimensional diameter increased linearly, whereas cerebellar three-dimensional volume growth gradually accelerated until 32 weeks and then decelerated. Lung, kidney, and liver volumes all demonstrated gradual early growth followed by a linear acceleration beginning at 25 weeks for lungs, 26-27 weeks for kidneys, and 29 weeks for liver. ConclusionGrowth patterns and timing of maximal growth for three-dimensional lean and fat measures, limb and organ volumes differed from patterns revealed by traditional two-dimensional growth measures, suggesting these parameters reflect unique facets of fetal growth. Growth in these three-dimensional measures may be altered by genetic, nutritional, metabolic or environmental influences and pregnancy complications, in ways not identifiable using corresponding two-dimensional measures. Further investigation into the relationships of these three-dimensional standards to abnormal fetal growth, adverse perinatal outcomes, and health status in postnatal life is warranted.

Inter-observer variation in two-dimensional and three-dimensional ultrasound measurement of papillary thyroid microcarcinoma

BackgroundsThe reliable ultrasound (US) measurements of papillary thyroid microcarcinoma (PTMC) are very important during active surveillance. This prospective study was design to investigate the inter-observer reliability and agreement of two- dimensional ultrasound(2DUS) and three-dimensional ultrasound(3DUS) in the measurement of maximum diameter and volume for PTMC.MethodsThis prospective study included 51 consecutive patients with solitary PTMC confirmed by biopsy. Two independent observers performed measurements of each tumor using a standardized measurement protocol. The maximum diameter was the largest one of the three diameters measured on the largest transverse and longitudinal 2DUS images. 2DUS volume was calculated using ellipsoid formula method. The virtual organ computer aided analysis(VOCAL) was used to determine 3DUS volume. The inter-observer reliability was assessed using intraclass correlation coefficient(ICC) with 95% confidence intervals(CIs). Bland-Altman analysis was used to evaluate agreement, and expressed as a bias with 95% limits of agreement(LOA).ResultsThe maximum diameter was 0.78 ± 0.14 cm. Volume measured by 3DUS was significantly smaller than that by 2DUS(0.163 ± 0.074 cm3 vs. 0.175 ± 0.078 cm3, P = 0.005). The ICCs of inter-observer reliability of maximum diameter, 2DUS volume and 3DUS volume was 0.922(0.864–0.955), 0.928(0.874–0.959), and 0.974(0.955–0.985), respectively. The ICCs of 2DUS and 3DUS volume was 0.955(0.909–0.976). The inter-observer agreement of maximum diameter, 2DUS volume and 3DUS volume was 1.096(0.7322 to 1.459), 1.008(0.5802–1.435), and 1.011(0.7576–1.265), respectively. The inter-observer agreement of 2DUS and 3DUS volume was 1.096(0.7322 to 1.459).ConclusionMaximum diameter had the lowest degree of observer variation among all the measurements. Volume measured by 3DUS had lower variability and higher repeatability than that by 2DUS, which might be helpful to provide more reliable estimates of tumor size for PTMC.

Validation of an automatic software in assessing fetal brain volume from three dimensional ultrasonographic volumes: Comparison with manual analysis.

This study was aimed to test the agreement between a manual and an automatic technique in measuring fetal brain volume (FBV) from three-dimensional (3D) fetal head datasets. FBV were acquired independently by two operators from low risk singleton pregnancies at a gestational age between 19 and 34 weeks. FBV measurements were obtained using an automatic software (Smart ICV™) and manually by Virtual Organ Computer-aided AnaLysis (VOCAL™). Intraclass correlation coefficient (ICC) were calculated to assess reliability, while bias and agreement were evaluate by examining Bland-Altman plots. The time spent in measuring volumes was calculated and values obtained compared. Sixty-three volumes were considered for the study. In all the included volumes successful volume analysis were obtained with both techniques. Smart ICV™ showed a high intra-observer (0.996; 95% CI 0.994-0.998) and inter-observer (ICC 0.995; 95% CI 0.991-0.997). An excellent degree of reliability was found when the two techniques were compared (ICC 0.995; 95% CI 0.987-0.998). The time required to perform FBV was significantly lower for Smart ICV™ than VOCAL™ (8.2 ± 4.5 vs. 121.3 ± 19.0 s; p < 0.0001). The measurement of FBV is feasible with both manual and automatic techniques. Smart ICV™ showed an excellent intra- and inter-observer reliability associated with a valuable agreement with volume measurements obtained manually with VOCAL™. Volumes may be measured significantly faster with smart ICV™ than manually and this automatic software has the potential to become the preferred methods for the assessment of FBV.

Concordance between US and MRI Two-Dimensional Measurement and Volumetric Segmentation in Fetal Ventriculomegaly.

We provide a study comparison between two-dimensional measurement and volumetric (3D) segmentation of the lateral ventricles and brain structures in fetuses with isolated and non-isolated ventriculomegaly with 3D virtual organ computer-aided analysis (VOCAL) ultrasonography vs. magnetic resonance imaging (MRI) analyzed with 3D-Slicer software. In this cross-sectional study, 40 fetuses between 20 and 38 gestational weeks with various degrees of ventriculomegaly were included. A total of 71 ventricles were measured with ultrasound (US) and with MRI. A total of 64 sonographic ventricular volumes, 80 ventricular and 40 fetal brain MR volumes were segmented and analyzed using both imaging modalities by three observers. Sizes and volumes of the ventricles and brain parenchyma were independently analyzed by two radiologists, and interobserver correlation of the results with 3D fetal ultrasound data was performed. The semiautomated rotational multiplanar 3D VOCAL technique was performed for ultrasound volumetric measurements. Results were compared to manually extracted ventricular and total brain volumes in 3D-Slicer. Segmentation of fetal brain structures (cerebral and cerebellar hemispheres, brainstem, ventricles) performed independently by two radiologists showed high interobserver agreement. An excellent agreement between VOCAL and MRI volumetric and two-dimensional measurements was established, taking into account the intraclass correlation coefficients (ICC), and a Bland-Altman plot was established. US and MRI are valuable tools for performing fetal brain and ventricular volumetry for clinical prognosis and patient counseling. Our datasets could provide the backbone for further construction of quantitative normative trajectories of fetal intracranial structures and support earlier detection of abnormal brain development and ventriculomegaly, its timing and progression during gestation.

Ultrasound Control of Cervical Regeneration after Large Loop Excision of the Transformation Zone: Results of an Innovative Measurement Technique

The objective of this research is to evaluate cervical regeneration after large loop excision of the transformation zone (LLETZ) through the identification of a new sonographic reference point at the level of the uterine margins. In the period March 2021-January 2022, a total of 42 patients affected by CIN 2-3 were treated with LLETZ at the University Hospital of Bari (Italy). Before performing LLETZ, cervical length and volume were measured with trans-vaginal 3D ultrasound. From the multiplanar images, the cervical volume was obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL™) program with manual contour mode. The line that connects the points where the common trunk of the uterine arteries reaches the uterus splitting into the ascending major branch and the cervical branch was considered as the upper limit of the cervical canal. From the acquired 3D volume, the length and the volume of the cervix were measured between this line and the external uterine os. Immediately after LLETZ, the removed cone was measured using Vernier's caliper, and before fixation in formalin, the volume of the excised tissue was evaluated by the fluid displacement technique based on the Archimedes principle. The proportion of excised cervical volume was 25.50 ± 17.43%. The volume and the height of the excised cone were 1.61 ± 0.82 mL and 9.65 ± 2.49 mm corresponding to 14.74 ± 11.91% and 36.26 ± 15.49% of baseline values, respectively. The volume and length of the residual cervix were also assessed using 3D ultrasound up to the sixth month after excision. At 6 weeks, about 50% of cases reported an unchanged or lower cervical volume compared to the baseline pre-LLETZ values. The average percentage of volume regeneration in examined patients was equal to 9.77 ± 55.33%. In the same period, the cervical length regeneration rate was 69.41 ± 14.8%. Three months after LLETZ, a volume regeneration rate of 41.36 ± 28.31% was found. For the length, an average regeneration rate of 82.48 ± 15.25% was calculated. Finally, at 6 months, the percentage of regeneration of the excised volume was 90.99 ± 34.91%. The regrowth percentage of the cervical length was 91.07 ± 8.03%. The cervix measurement technique that we have proposed has the advantage of identifying an unequivocal reference point in 3D cervical measurement. Ultrasound 3D evaluation could be useful in the clinical practice to evaluate the cervical tissue deficit and express the "potential of cervical regeneration" as well as provide the surgeon useful information about the cervical length.

Which is more accurate measuring pulmonary artery resistance index or 4D lung volume for prediction of neonatal respiratory distress in preterm pregnancies?

BackgroundNeonatal respiratory distress syndrome (RDS) is a leading cause of neonatal respiratory failure and neonatal mortality. It is frequent in preterm infants, because deficient surfactant needed to keep the airways (alveoli) open to assist infants breathe after birth. Nonetheless, it was also seen in full-term pregnancies. Noninvasive approaches for predicting the development of neonatal respiratory distress (RD) in preterm newborns include comparing the prenatal clinical outcome with the pulmonary artery resistance index (PA-RI) and fetal lung capacity as assessed by the virtual organ computer-aided analysis (VOCAL). Our study aimed to estimate optimal cutoff values and compare measurements of fetal pulmonary artery resistance index (PA-RI) and fetal lung volume (LV) assessed by VOCAL as noninvasive measures to predict neonatal RD development in preterm pregnancies to show which is more accurate.ResultsOut of the examined 147 women who delivered 147 living newborns, 59 of newborn (40.1%) developed neonatal RD. PA-RI has a higher value in 45 (76.27%), while fetal lung volume (FLV) was significantly lower in 43 (72.88%) of neonates who developed RD. Combining both measurements of PA-RI and FLV could predict all cases of RDS 59 (100%). Thirty of RDS neonates had mechanical ventilation and died (50.85%). Cutoff values of PA-RI ≥ 0.75 with 76.27% sensitivity, 82.95% specificity and 81.5% accuracy, whereas a cutoff of FLV ≤ 28 cm3 with sensitivity of 72.88%, specificity of 65.91% and accuracy of 74.8%, for prediction of RDS. Combining both cutoffs generated a more accurate detection 100%, specificity of 65.91% and 66.3% positive predictive value (PPV) and 100% negative predictive value (NPV) and 83% accuracy.ConclusionsBoth PA-RI and FLV are promising noninvasive tools which help in predicting RD fetuses with high sensitivity and specificity. PA-RI is more accurate than FLV cm3 in prediction of neonatal RDS. Combining these parameters increases the predictive value.

Two- and Three-Dimensional Ultrasonographic Evaluation of the Fetal Thymus in Women with Preterm PrematureRupture of Membranes: A Prospective Study

Objective: To evaluate the relationship between fetal thymus diameter and perinatal outcomes in preterm premature rupture of membranes (PPROM) cases and to compare three-dimensional (3D) fetal thymus volume in the same cases. Material and Methods: This was a prospective study from March 2019 through March 2020. Women diagnosed with PPROM between 24 and 33+6 weeks of gestation were included. Pregnancies were divided into 2 groups as small and normal according to the thymus size nomogram. The virtual organ computeraided analysis software calculated the volumes automatically. Results: In 41 patients, measurements could be successfully acquired with twodimensional and 3D sonography. Twenty eight (68.3%) patients were in the small thymus group and 13 patients (31.7%) were in the normal thymus group. The probability of clinical chorioamnionitis increased 7.7-fold-times in cases with small thymus (odds ratio 7.7, 95% confidence interval 1.1-67.4, p=0.038). The latency period was significantly higher in the normal thymus group. The correlation between transverse diameter and thymus volume was analyzed according to gestational age at ultrasound measurement and a significant correlation was observed between them. Conclusion: A small transverse diameter of the thymus in PPROM cases may be associated with clinical chorioamnionitis, and a normal thymus diameter may predict a longer latency period. In addition, although transverse thymus diameter was correlated with thymus volume, no significant volume difference was observed between the groups when percentile classification was made.

Ultrasound combined with Ki67 detection for analyzing contributing factors of failure to cure and recurrence of hyperthyroidism in patients with Graves disease after 131I treatment

To analyze factors associated with failure to cure or recurrence of hyperthyroidism in patients with Graves disease (GD) after 131I treatment using ultrasound combined with Ki67 detection. Eighty-nine patients with GD receiving 131I treatment in the Department of Nuclear Medicine at our hospital from January, 2020 to November, 2021 were enrolled. Before treatment, thyroid volume, shear wave elastic value and Ki67 expression in the follicular epithelial cells were measured using three-dimensional ultrasonic virtual organ computer-aided analysis, shear-wave elastic imaging and ultrasound-guided fine needle aspiration. The data including age, gender, antithyroid drug (ATD) history, dose of 131I, and TRAb were collected from all the cases. The patients were followed up for up to 1 year, starting at 1 month after 131I treatment, and the follow-up results of the patients were divided into failure to cure or recurrence of hyperthyroidism, premature hypothyroidism and euthyroidism or loss to follow-up. The proportional hazards model and fine-Gray test were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) for patients with failure to cure or recurrence of hyperthyroidism. Among the 89 patients, 27 patients were found to have failure to cure or recurrence of hyperthyroidism, 50 had premature hypothyroidism, 1 patient had euthyroidism, and 11 patients were lost to follow-up at the end of the 1-year follow-up. Analysis of the competitive risk model showed that status of Ki67 expression, 131I dose and thyroid volume were independently correlated with failure to cure or recurrence of hyperthyroidism after the treatment with HR (95% CI) of 0.36 (0.15, 0.86), 0.81 (0.68, 0.96) and 1.11 (1.07, 1.15), respectively. In patients with GD, the expression of Ki67 in thyroid follicular epithelial cells, 131I dose and thyroid volume are independently correlated with failure to cure or recurrence of hyperthyroidism after 131I treatment. New ultrasound techniques can play an important role in evaluating the therapeutic outcome of 131I treatment in GD patients.

Three-dimensional ultrasound VOCAL combined with contrast-enhanced ultrasound: an alternative to contrast-enhanced magnetic resonance imaging for evaluating ablation of benign uterine lesions

Objective This study explores the feasibility and value of three-dimensional ultrasound virtual organ computer-aided analysis (3D-VOCAL) combined with contrast-enhanced ultrasound (CEUS) for measuring the non-perfused volume (NPV) after microwave ablation (MWA) of benign uterine lesions. Methods Fifty-six patients with uterine myoma (UM) and adenomyosis (AM) treated with MWA were enrolled. NPV measurements were obtained postoperatively using two-dimensional CEUS (2D-CEUS), 3D-VOCAL combined with CEUS and three-dimensional contrast-enhanced magnetic resonance imaging (3D-CEMRI). Bland–Altman analysis and intraclass correlation coefficient (ICC) values were used to analyze the agreement of NPV measurements obtained via 2D-CEUS and the combined method with 3D-CEMRI. The inter- and intra-observer agreements of the NPV values obtained with all three methods were also analyzed. Results Considering 3D-CEMRI as the standard, 3D-VOCAL showed greater agreement than 2D-CEUS and higher ICCs (ICC, 0.999 vs. 0.891) than 2D-CEUS for different lesion types and sizes of non-perfusion areas (p < 0.001 for all comparisons). NPV measurements obtained via 2 D-CEUS and 3 D-CEMRI differed significantly for AM and non-perfusion areas with maximum diameter ≥5 cm (p < 0.05) and showed no significant differences (p > 0.05) for UM and non-perfusion areas with maximum diameter <5 cm. The NPV measurements obtained via 3D-VOCAL and 3D-CEMRI did not differ significantly (p > 0.05). The intra- and inter-observer agreements of 3D-VOCAL measurements were better than those of 2D-CEUS and slightly lower than those of 3D-CEMRI. Conclusions 3D-VOCAL combined with CEUS provides accurate estimates of NPV after MWA of benign uterine lesions, and offers a reliable, simple and efficient alternative to CEMRI.

Subchorionic Hematoma Volume Measured by Virtual Organ Computer-Aided Analysis in the Prediction of First-Trimester Pregnancy Outcome.

This study aimed to assess the association of subchorionic hematoma (SCH) size measured by virtual organ computer-aided analysis (VOCAL) with the first-trimester pregnancy outcome. A total of 139 first-trimester pregnancies from 6 to 12 weeks of gestational age with SCH were included. The circumference, area, and volume of the SCH (Cs, As, and 3DVs) and gestational sac (Cg, Ag, and 3DVg) were automatically calculated by VOCAL. Interobserver agreement was assessed with the intraclass correlation coefficient and Bland-Altman plot. Odds ratios for the clinical and ultrasound characteristics of adverse pregnancy outcomes were estimated by univariate or multivariable logistic regression. There was high interobserver agreement in VOCAL measurements of the SCH and gestational sac (intraclass correlation coefficients, >0.900). By univariate regression analysis, women with adverse pregnancy outcomes were more likely to have vaginal bleeding, a larger As and 3DVs, and higher Cs/Cg, As/Ag, and 3DVs/3DVg ratios (all P < 0.05). In the multivariable regression analysis, a higher 3DVs/3DVg ratio of SCH (odds ratio, 1.034; 95% confidence interval [CI], 1.015-1.053; P = 0.000) and vaginal heavy bleeding had a significant positive relationship with the risk of adverse pregnancy outcomes (odds ratio, 7.846; 95% CI, 1.104-55.737; P = 0.039) remained associated with an increased risk of adverse pregnancy outcomes. With 11.87% as the cutoff, the receiver operating characteristic curve yielded a good predictive performance (area under the curve, 0.713) and high sensitivity (91.18%). The measurements of SCH by VOCAL provide high reliability for estimating the total hematoma burden in first-trimester pregnant patients. A greater volume proportion (3DVs/3DVg) of SCH worsens the pregnancy outcome, and a greater risk of adverse pregnancy outcome also associated with the severity of vaginal bleeding.

The Correlation Between Three-Dimensional Ultrasound Measurement of Fetal Adrenal Gland and Maternal Serum Fructosamine Level in Gestational Diabetes Mellitus: Prospective Cohort Study.

ObjectiveGestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in the GDM population. This study used 2D and 3D ultrasound scanning to determine the correlation of fetal adrenal gland size and volume with fructosamine levels, HbA1c levels, estimated fetal weight (EFW), and neonatal birth weight in GDM patients.MethodsThis study included eighty singleton pregnant women diagnosed with GDM between 24–28 weeks of gestation. During weeks 32–34 of gestation, the length, width, and depth of the fetal zone and total adrenal gland were measured using transabdominal 2D ultrasound. Virtual organ computer-aided analysis (VOCAL) software was used to evaluate fetal zone and total adrenal gland volume in 3D ultrasound. All the participants were followed until delivery. Pearson’s correlation analysis was conducted to examine the correlation between fetal adrenal gland ultrasound measurements and the factors of interest.ResultsThe study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and fourteen (17.5%) pregnant women with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the diet-controlled (GDMA1) and the insulin-managed (GDMA2) groups. All the participants had achieved optimal glucose levels at the time of ultrasound acquisition. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, only the fetal zone volume was significantly correlated with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9, p = 0.01) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3, p = 0.01).ConclusionThe fetal zone volume is correlated with EFW, fructosamine levels, and HbA1c levels. This non-invasive technique may be beneficial as an indirect marker for glycemic monitoring in GDM.

Assessment of left ventricular function by spatio-temporal image correlation in fetuses with fetal growth restriction.

To compare the evaluation of left ventricular function by spatio-temporal image correlation (STIC) between fetal growth restriction (FGR) fetuses and normal fetuses. Forty-two FGR fetuses and 50 normal fetuses with gestational age ranging from 28 to 35weeks, were chosen for the study group and control group, respectively. The fetal heart was acquired using the STIC modality, beginning with a four-chamber view. A 7.5-12.5 s acquisition time and 20-35°angle of the acquisition were used for the acquisition. The resulting STIC dataset was saved for offline analysis. Ventricular volumes were measured using the Virtual Organ Computer-aided Analysis (VOCAL) mode, where the observer defines the contours of the ventricle and traces the endocardia. Stroke volume (SV)=end diastolic volume (EDV)-end systolic volume (ESV) and ejection fraction (EF)=SV/EDV × 100%. The data of the two groups were analyzed. (1) SV increased with fetal growth in both groups and was positively correlated with gestational age (p <.01), whereas EF remained constant throughout gestation and had no correlation with gestational age (p >.05). (2) There was no difference found in EF between the two groups, (p >.05), SV was significantly lower in FGR group than those in the normal group (p <.01). The STIC is a precise method for calculating fetal ventricular volume changes and functions. Reduced SV occurred at the initial stage of fetal deterioration before the discovery of abnormal EF in FGR fetuses, indicating cardiac dysfunction. SV could be a sensitive indicator of cardiac dysfunction. The use of EF to assess fetal cardiac function is not perfect.

P-691 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day seven of menstrual cycle to predict the number of eggs collected in antagonist cycle

Abstract Study question Could ovarian vascularity indices on day 2 and 7 of stimulation, measured by 3-dimensional (3D) vaginal power Doppler, predict after controlled ovarian stimulation? Summary answer Ovarian vascularity index (VI) on day 7 may be an indicator of poor (&amp;lt;three mature eggs collected) ovarian responses to gonadotropins. What is known already Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS. Study design, size, duration A prospective study was conducted on 296 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and dec 2021. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (36.1%), high responders group (16 or more MII eggs collected) group ( 6.7%), and normal responders group (more than 3 and less than 16 MII eggs collected) (57,2%). Participants/materials, setting, methods On the second and seventh day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On day 2 , the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol. Main results and the role of chance Mean age was 35,88+/- 6 year , day2 VI and day2 VFI correlates with the number of egg collected (p = 0.014 and 0.045 respectively). 9 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, day2 VI, day2 FI , day2 VFI , day7 VI, day7 FI and day7 VFI) in a Receiver operator characteristics (ROC) curve model . Ovarian day7 FI significantly predicted poor ovarian response to gonadotropins (p = 0.038) with an area under the curve of 0.679. AFC predicted also poor ovarian response to gonadotropins (p = 0.006) . In parallel, AFC significantly predicted high ovarian response to gonadotropins (p = 0.002) and AUC (0.778) while all other 3D doppler parameters couldn’t predict high responders. Limitations, reasons for caution It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes. Wider implications of the findings Assessing ovarian vascularity during ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology. Trial registration number Not Applicable

Reference ranges of fetal cisterna magna volume measurements by three-dimensional ultrasonography in the late second trimester considering sonographic experience.

Volume measurements of fetal cisterna magna (CM) by three-dimensional (3D) ultrasonography may have a role in the diagnosis of various posterior fossa abnormalities. To evaluate reference intervals and reliability of fetal CM volume values by virtual organ computer-aided analysis (VOCAL) in structurally normal fetuses, considering experience of evaluators. Three operators with different 3D sonography experience levels measured CM volumes of 100 structurally normal fetuses at 18-27 weeks of gestation. Reference intervals for CM volumes were generated. Intraclass correlation coefficients (ICC) were calculated. Mean fetal CM volume measurements by the three operators did not significantly (P = 0.49, P = 0.22, and P = 0.17, respectively) change through 20-23 weeks of gestation. Moderate degrees of inter-observer reliability were found with an ICC of 0.69 between novice and intermediate-level, ICC of 0.74 between experienced and intermediate-level, and ICC of 0.78 between experienced and novice observer, respectively. The novice sonographer generally overestimated CM measurements. Intra-observer reliability was good (ICC=0.85). A reference chart for fetal CM volume by VOCAL was formed, revealing uniform mean values of 20-23 weeks of gestation. The inter-observer reliability is moderate, and biases seem relatively common for all experience categories.

Variability of bovine conceptus-related volumes in early pregnancy measured with transrectal 3-dimensional ultrasonography

Up until now, bovine fetometry has been entirely based on 2-dimensional ultrasonography. Fetal size is estimated by several linear measurements such as crown-rump length (CRL). However, the advent of 3-dimensional ultrasonography (3D-US) provides in vivo access to the volumes of the fetus and its amniotic sac. The objective of this preliminary observational study was to determine the variability of conceptus-related volumes using transrectal 3D-US in dairy cows and to identify factors affecting them. Furthermore, relationships between the gained measurements and calf birth weight were investigated. In total, 315 Simmental and Holstein-Friesian dairy cows were transrectally examined at d 42 after breeding using a portable ultrasound device (Voluson I, GE Healthcare). Gestational volumes including fetal volume (FV) and amniotic sac volume (ASV) were determined with the software tool VOCAL (Virtual Organ Computer-Aided Analysis, GE Healthcare), whereas amniotic fluid volume (AFV) values were derived from the subtraction of FV from ASV. The CRL was determined by means of 3-dimensional data. The mean values and standard deviations for FV, ASV, AFV, and CRL were 1.47 ± 0.25 cm3, 5.86 ± 1.22 cm3, 4.38 ± 1.02 cm3, and 2.38 ± 0.18 cm, respectively. All gestational volumes and CRL values were affected by breed. In Simmental cattle, larger concepti were observed compared with pregnancies derived from Holstein-Friesian animals. Parity affected only ASV and AFV, with heifers showing greater values than lactating cows. The CRL was positively associated with milk protein content. It was not possible to predict calf weight at birth by using FV, ASV, or AFV; however, tendencies were found for ASV and AFV. The present study was the first to adopt 3D-US volumetry to assess early pregnancy development in dairy cattle. Our results showed that this method could be used successfully to identify minor variations in conceptus growth.

441. Placental volume in gestational week 27 measured by three dimensional (3d) ultrasound and magnetic resonance imaging (mri)

Introduction and aims of the study: Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume. Methods: We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27 weeks of gestation (25+4 - 28+4 weeks). The 3D ultrasound acquisitions were analysed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique.

Performance Characteristics of 3-D Power Doppler Ultrasound (3-D-PD) with the Virtual Organ Computer-Aided Analysis (VOCAL) Technique in the Detection of Prostate Cancer.

The purpose of this study was to test the diagnostic performance of 3-D power Doppler ultrasound (3-D-PD) with the virtual organ computer-aided analysis (VOCAL) technique in the detection of prostate cancers (PCa). A total of 99 male patients referred for needle prostate biopsy owing to elevated serum prostate-specific antigen or abnormal direct rectal examination were prospectively included. The transrectal 3-D-PD-VOCAL quantitative vascularity parameters of vascularization index (VI), flow index and vascularization/flow index (VFI) were obtained before biopsy and compared with histopathologic results. We evaluated the predictive values for the detection of clinically significant PCa in the foci from different zones and the discrimination among various cancer grades. 3-D-PD-VOCAL discriminated malignant from benign foci, with cutoff values of 27.4% for VI, 38.2 for flow index and 8.6 for VFI. All parameters had higher areas under the curve in detecting lesions in the peripheral zone than in the transition zone (p < 0.05). VI and VFI had better diagnostic performance in detecting clinically significant PCa than flow index (p < 0.05). The area under the curve, sensitivity, specificity and accuracy in detecting clinically significant PCa were, for the VI and VFI respectively, 95% and 95%, 86% and 94%, 87% and 76%, and 87% and 85%. 3-D-PD-VOCAL initially demonstrated favorable performance in detecting PCa. Further, larger-sample studies based on prostatectomy specimens are needed to evaluate the exact usefulness of the technique.

Fetal Interventricular Septum Volume Evaluated by Three-Dimensional Ultrasound Using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis in Fetuses From Pre-Gestational Diabetes Mellitus Pregnant Women.

BACKGROUNDTo assess the interventricular septum (IVS) volume of fetuses from pre-gestational diabetes mellitus (DM) pregnant women by 3-dimensional ultrasound using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods.METHODSThis was a prospective cross-sectional study of 45 fetuses from pre-gestational DM and 45 fetuses from healthy pregnant women (controls). Only singleton pregnancies between 20 and 34 + 6 weeks of gestation were included. The fetal IVS volumes were obtained off-line using STIC and VOCAL methods. To analyze differences among variables, the Student’s t-test and Mann-Whitney U test were used. The correlation among continuous variables was determine using Spearman’s correlation test (r).RESULTSThe median of fetal IVS volume was significantly higher in pre-gestational DM than in healthy pregnant women (0.3 cm3 vs. 0.2 cm3, p = 0.032). A strong positive correlation was observed between fetal IVS volume and gestational age at the time of ultrasound examination (r = 0.75, R2 = 0.48, p < 0.0001) and between fetal IVS volume and estimated fetal weight (r = 0.63, R2 = 0.37, p < 0.0001). No significant correlation was noted between fetal IVS volume and glycated hemoglobin levels (r = −0.16, R2 = 0.01, p = 0.540) in the pre-gestational DM pregnant women.CONCLUSIONSSignificant differences were observed in fetal IVS volumes between pre-gestational and healthy mothers, with higher values in the fetuses of pre-gestational DM pregnant women.

OC04.04: The prediction of placental volume and vascular indices measured by three‐dimensional Doppler for the first trimester fetal growth restriction

To investigate the 3D power Doppler placental volume and vascular indices for fetal growth restriction (FGR) prediction in the first trimester. Ultrasonic indicators for prediction of first trimester FGR: a prospective cohort study. Ultrasonic indicators, including the 3D power Doppler vascular index (VI), flow index (FI), vascular flow index (VFI), placental volume (PV) and placental quotient (PQ) were measured by 3D ultrasound and virtual organ computer-aided analysis (VOCALTM) in the first trimester pregnancy. Receiver operating characteristic (ROC) curve analysis evaluated the ability of each variable to predict FGR. With 457 pregnancies enrolled, 35 delivered FGR (7.6%). The ultrasonic indicators of PV, PQ, VI, FI and VFI were markedly lower in the FGR pregnancies versus unaffected pregnancy. And the areas under the ROC curves (AUCs) of PV, PQ, VI, FI and VFI for FGR prediction were 0.751, 0.772, 0.870, 0.652 and 0.873, respectively. The result suggests that VI, FI, VFI, PV and PQ in the first trimester pregnancies are predictors factors of FGR. And further findings revealed that the optimum parameter for prediction of FGR pregnancies are vascular index (VI) and vascular flow index (VFI) in the first trimester. 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.

O-031 Importance of blood flow to human implantation

Abstract text The success of embryo implantation depends on a plethora of factors, with embryo quality and endometrial receptivity belonging to the most important ones. The receptive phenotype of endometrium develops in reaction to appropriate estrogen stimulation in the proliferative phase and embryo-synchronized maturation warranted by the action of progesterone. Uterine blood supply, myometrial contractions and the activity of local immune cells also belong to important factors affecting the outcome of both natural and assisted reproduction. Endometrial perfusion was shown to be an independent receptivity parameter, showing a direct association with pregnancy outcomes. Historically, the use of Doppler parameters of uterine vessels was studied as a reflection of blood flow to the endometrium. Although some authors showed a correlation between blood flow in uterine arteries and success rates in IVF cycles, it might not reflect the actual endometrial flow as most of the blood volume goes through myometrium, not endometrium. Currently, using available ultrasound tools – 2D/3D Power Doppler with VOCAL (Virtual Organ Computer-Aided Analysis) software enables clinicians to evaluate parameters of endometrial perfusion in a matter of minutes. In this method, ultrasound system can calculate indices reflecting endometrial blood flow - vascularity index (VI), endometrial flow index (FI), and endometrial vascularity flow index (VFI) which are based on the total and relative amounts of Power Doppler signal (corresponding to the blood flow) within the volume of interest. Endometrial blood flow parameters can be altered in implantation limiting conditions such as endometriosis or chronic intrauterine inflammation. It was also shown to be influenced by implantation-related hormones such as oxytocin. Oxytocin receptor antagonists were shown to decrease uterine contractions in non-pregnant uteri of women being prepared for embryo transfer procedure. This class of medications has been extensively studied as potential candidates for medications promoting embryo implantation in IVF-ET treatments. In several studies, it was shown that mixed oxytocin/vasopressin V1A receptor antagonist atosiban, which is currently registered in Europe for the tocolysis in preterm labour, had the potential of improving implantation rates. Interestingly, this effect was confirmed also in women without pronounced contractions. Additionally, it has been demonstrated that oxytocin antagonism enhances endometrial decidualization and influences other parameters necessary for the acquisition of the endometrial receptivity phenotype. Considering that atosiban and other oxytocin antagonists relax uterine blood vessels and increase endometrial blood flow, it was hypothesized that improvement in endometrial perfusion could be an additional mechanism for observed support of embryo implantation. A similar finding was confirmed in our study on nolasiban – a non-peptide, orally active, oxytocin receptor-specific antagonist. In the 1st phase study on volunteers undergoing estrogen/progesterone endometrial preparation reflecting the synchronization for embryo transfer, it was confirmed that application of nolasiban decreased uterine contractions and improved FI and VFI parameters of endometrial perfusion. Such an effect lasted for more than 24 hours after dosing. The study results suggested that oxytocin antagonism could have an effect on endometrial perfusion, and its potential clinical significance requires further investigation. In a longer perspective, once confirmed it would mean that, apart from the possibility of observation of endometrial blood flow, we could have a tool for improving it, which would hopefully lead to improved outcomes of assisted reproduction treatments.