Virtual Organ Computer-aided Analysis Research Articles

Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update.

Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.

References Values of Fetal Heart Myocardial Volume by Three-Dimensional Ultrasound using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis Methods and Their Applicability in Pregestational Diabetic Women

To determine reference values for myocardial volume of the fetal heart using three-dimensional ultrasound with spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) and to assess their applicability in women with pregestational diabetes. This retrospective cross-sectional study included 177 normal pregnant women with fetuses between 200/7 and 336/7 weeks of age. Fetal cardiac volumes were collected using the STIC method, and myocardial volume was obtained by subtraction of the intracavitary volumes using the VOCAL 30-degree method. Intra- and interobserver reproducibility values were determined using the concordance correlation coefficient (CCC). Sixteen women with pregestational diabetes mellitus were evaluated for validation. There was a strong correlation between fetal myocardial volume and gestational age (R 2 = 0.82). Intra- and interobserver reproducibility values were excellent and moderate, respectively, with CCCs of 0.99 and 0.83, respectively. There was no significant difference in mean fetal myocardial volume between normal pregnant women and those with pregestational diabetes (p = 0.64). Reference values for myocardial volume of the fetal heart were determined in normal pregnant women and were not statistically different from those in women with pregestational diabetes mellitus.

Особливості гемодинаміки тіла матки залежно від її об’єму та ступеня васкуляризації вузлів, які досліджували за допомогою методу тривимірної допплерографії, у хворих з лейоміомою

with leiomyoma using doppler sonography there is information about the fact that the degree of uterus blood supply in this disease is associated with its proliferative capacities.Use of three-dimensional power doppler sonography allows to evade a subjective assessment of organs and tumors vascularization, present in two-dimensional doppler sonography, by quantitative evaluation of vascular blood flow intensity with calculation of volume indices of uterine body vascularization in female patients with leiomyoma.We decided to conduct this study to develop a standardized approach to the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma predictors. The objective: to study peculiarities of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography. Materials and methods. 238 women aged 18 to 39 years were examined (Me=28.5). The main group consisted of 127 (53.36%) fertile age women aged 27 to 39 years (Me=33.0) with uterine leiomyoma, found during ultrasonography.All of them were divided into further sub-groups: women with small and large leiomyomas, and they, in their turn, into women with uterine leiomyoma of moderate vascularization with single color loci peripherally in the mode of two-dimensional power flow mapping and women with uterine leiomyoma of profound vascularization with a great amount of color loci both peripherally and in the center in the mode of two-dimensional power flow mapping.The comparison group consisted of 111 (46.6%) of apparently healthy women aged 18 to 39 years (Ме=28.5), in which uterus examination allowed to develop new and improve the existent nomograms of uterine body blood flow values (VI, FI, VFI) and develop uterine cervix nomograms. In case of three-dimensional (3D) reconstruction of the uterus using power mapping and options of VOCAL (Virtual Organ Computer-aided Analysis), an objective assessment of hemodynamics of the uterine body was carried out by calculating the vascularization index (VI) that characterizes the percentage of color voxels in the volume of the uterine body, index of flow intensity (FI) that shows median brightness of the color voxels depending on the flow velocity in a predetermined three-dimensional volume, and vascularization flow index (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100. Results. In the fertile period the study three-dimensional blood flow indices values, reflecting hemodynamics of uterus, affected by leiomyoma, depended on uterine body volume (Kruskal–Wallis test, p<0.05), falling to the bottom boundary of reference values of the comparison group progressively as the uterine body volume increases by more than 370 cm3 (large uterine leiomyoma) subject to moderate vascularization of lumps, and approaching with some exceedence to median values of norm subject to significant vascularization (CC, Mann-Whitney U-test; p<0.05).Therefore uterine body volume of 370 cm3 we consider the differential criteria, which allows to get oriented in the dynamics of the indices under study. Characteristics of small (less than 370 cm3) uterine leiomyoma values under study depended on lumps vascularization degree: if vascularization was medium, practically no differences from norm were observed, and if vascularization was profound, the significant exceedence in comparison groups nomograms values was obvious (Mann–Whitney U-test; p<0.05). Conclusion. Obtained regularities in changes of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography, opens new prospects of the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma.Use of standardized diagnostic approach should considerably increase the sensibility and specificity of three-dimensional power doppler sonography method in diagnostics of leiomyoma and uterine sarcoma in future. Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine sarcoma, uterine body volume, lumps vascularization degree.

3D evaluation of fetal brain structures: reference values and growth curves

Background The development of the fetal central nervous system is one of the most important fields of research in perinatology. Since the early 1980s, 3 D ultrasound has become one of the major research tools in obstetrics and gynecology. Objective The aim of this study was to reconstruct thalamus, cerebellum and Cortex volumes of fetal brain and generate, for these volumes, growth curves related to gestational age. Methods We enrolled 344 pregnant women. Using “Tomographic Ultrasound Imaging” (TUI), in all cases we obtained a satisfying 3 D acquisition of fetal brain. We reconstructed offline thalamus, cerebellum and cortex volumes using “Virtual Organ Computer-Aided AnaLysis” (VOCAL) or 4 D View (GE Healthcare). Results Among the 344 fetuses examined, we obtained 314 thalamus volumes, 252 cerebellum volumes and 261 cortex volumes and we constructed the reference growth curves. Conclusion Our study confirms the reliability of cerebral volumes evaluation using 3 D technology and how these cerebral structures grow through gestation.

Treatment of rectovaginal endometriosis with the etonogestrel-releasing contraceptive implant

This study aimed to investigate the efficacy of the etonogestrel (ENG)-releasing implant in treating patients with rectovaginal endometriosis. The study was based on the retrospective analysis of a prospectively collected database, including symptomatic women who had ultrasonographic diagnosis of rectovaginal endometriosis. Patients were follow-up at 6, 12 and 24 months from the insertion of the ENG-releasing implant. The intensity of pain symptoms was evaluated using a visual analog scale. The volume of the nodules was estimated by virtual organ computer-aided analysis. The Endometriosis Health Profile (EHP-30) was used to evaluate quality of life. Overall, 43 women were included in the study. The 2-year continuation rate for the ENG-releasing implant was 93.0%. The treatment quickly improved the intensity of non-menstrual pelvic pain, deep dyspareunia, dysmenorrhea, and dyschezia. At 6-month follow-up, there were improvements in all domains of the EHP-30 compared with baseline. Further improvements in the EHP-30 results were observed only in pain sub score at 12-month follow-up and in emotional well-being sub score at 24-month follow-up. At 6-month follow-up the volume of the rectovaginal nodules was significantly lower compared with baseline; a further decrease was observed at 12- and 24-month follow-up. The treatment was well tolerated.

Порівняльна характеристика показників тривимірної енергетичної допплерографії тіла матки пацієнток з лейоміосаркомою, лейоміомою та здорових жінок у період менопаузи

Despite the data on the effectiveness of three-dimensional sonography in the improvement of the diagnostic capabilities for predicting the degree of proliferative activity of uterine tumorsalready obtained by other researchers in their previous studies, some aspects of the problem remain insufficiently studied, and the data obtained are contradictory. Thus, there are no quantitative characteristics of threshold values of blood flow indices (VI, FI, VFI) in simple uterine leiomyomas and sarcomas allowing predicting uterine sarcoma with sufficient accuracyat the stage of ultrasound. The objective: comparison of characteristics of uterine body three-dimensional power Doppler sonographyindices in female patients with leiomyosarcoma, leiomyoma, and in a group of healthy women for searching threshold differential diagnostic values of uterine body vascularization indices in patients with leiomyosarcoma. Materials and methods. 74 menopausal women aged 50 to 75 years were examined (Me=62.5). The main group consisted of 46 (62.16%) patients with myometrial tumors. Of these, the study included 10 (21.73%) women with uterine leiomyosarcoma and 36 (78.26%) with uterine leiomyoma. The comparison group consisted of 28 (37.84%) healthy menopausal women aged 50 to 75 years (Me=62.5). In case ofthree-dimensional (3D) reconstruction of the uterus using power mapping and options of VOCAL (Virtual Organ Computer–aided Analysis), an objective assessment of hemodynamics of the uterine body was carried out by calculating the vascularization index (VI) that characterizes the percentage of color voxels in the volume of the uterine body, index of flow intensity (FI) that shows median brightness of the color voxels depending on the flow velocity in a predetermined three-dimensional volume, and vascularization flowindex (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100. Results. At pair comparison of the groups among themselves, VI and FI indicesof the uterine body in groups of women with leiomyoma and leiomyosarcoma differ at a statistically significant level (Mann-Whitney U-test, p <0.05) from the comparison group, and when comparing groups with leiomyoma and leiomyosarcoma, differences between VI and VFI indices of the uterine body are statistically significant. According to the results of the study, in menopausal women, the differential diagnostic criteria of three-dimensional Doppler sonography for predicting the presence of uterine leiomyosarcoma are the following threshold critical values: 26.2% for VI index of the uterine body and 2.47 for VFI index of the uterine body. Conclusion. A method of three-dimensional power Doppler sonography increases the information content of the differential diagnosis of benign and malignant tumors of the myometrium. Prospects for further research involve the study of critical threshold values of three-dimensional indices of vascularization, allowing predicting the presence of uterine leiomyosarcoma in the group of women of reproductive age and the group of menopausal women in a larger sample. Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine leiomyosarcoma.

Study of hemodynamics of the uterine body by the method of three-dimensional energy dopplerography of patients with leiomyoma in different age periods

To date, there is not enough papers to establish the reproducibility of the calculation of three-dimensional indices of blood flow and their threshold values for the diagnosis of a particular pathology. In this regard, the technique of three-dimensional Doppler sonography requires further study.The aim of research is studying the hemodynamics of the uterine body of patients with leiomyoma by three-dimensional energy Doppler ultrasonography to determine the possible patterns of changes in the indicators of three-dimensional vascularization indices depending on the phases of the menstrual cycle of women of reproductive age, in perimenopause and at different periods of menopause.Materials and methods. 326 women between the ages of 18 and 75 were surveyed (Me = 46.5). The comparison group consisted of 157 (48.15 %) healthy women, the main group was 169 women (51.84 %) with uterine leiomyoma. All patients in both groups were divided into women of reproductive age, women in peri - and menopause.In 3D reconstruction of the uterus using the energy mapping function and the VOCAL (Virtual Organ Computer - aided Analysis) option, an objective assessment of the hemodynamics of the uterine body was performed by calculating the vascularization index (VI), which characterizes the percentage of colour voxels in uterus body volume, flow intensity index (FI), showing the median luminance of colour voxels, which depends on the blood flow velocity in a given three-dimensional volume and vascularization-flow index (VFI), which is a product of multiplying the vascularization index and the flow index, divided by 100.Result. As a result, the main group identified the patterns of dynamics of three-dimensional indices of blood flow, depending on the survey at different ages, similar to the comparison group. In the reproductive period in patients with uterine leiomyoma, regardless of the size and degree of vascularization, the minimum values of the indexes VI, FI and VFI of the body of the uterus were registered in the early proliferative phase, significantly increasing to the middle secretion phase, coinciding with the fertility period of corpus luteum, secretion (p <0.05, CCU). In peri - and menopause, patients with leiomyomas have a statistically significant dynamics, similar to the nomograms of the comparison group, in reducing the values of the three-dimensional index of perfusion of the VI of the uterus as the period of absence of menstruation increases (CCU, p = 0.0472), with the highest values being characteristic of the perimenopause period. In the analysis of the dynamics of the FI and VFI indices of the body of the uterus of women with perio- and menopausal leiomyomas, the distribution of the studied indices was not confirmed by statistical significance. However, their pattern quite accurately reproduces the dynamics of a gradual decrease in these three-dimensional indices of blood flow in women with uterine body leiomyoma as the duration of absence of menstruation increases: the highest values were characteristic of the perimenopause period and the lowest - for the menopause period of more than 10 years.Conclusions. Taking into account the revealed patterns of dynamics of indicators of three-dimensional indices of blood flow depending on the age periods of women with leiomyoma will in the future increase the sensitivity and specificity of the method of three-dimensional energy Doppler sonography in the differential diagnosis of proliferative activity of uterine leiomyoma

Antidiastole Value of Three-dimensional Ultrasonography and Power Doppler between Uterine Parenchyma Lumps and Endometrial Cancer: A Retrospective Study.

Sometimes endometrial polyps, submucosal myomas, and endometrial cancer show similar findings under ultrasonography. The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional (3D) power Doppler ultrasonography angiography (PDA) between endometrial cancer and uterine parenchyma lumps. The data of the blood flow indices in 3D-PDA including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps (endometrial polyps and submucosal myomas) were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis (VOCAL) software. The results showed that all the blood flow parameters (VI, FI, VFI) were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps (P<0.001). The area under the curve of ROC of VI, FI, and VFI was 0.98, 0.84, and 0.97, respectively. Thus, the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%. The optimal cutoff value of VI was 4.06%. Our data demonstrated that all of the blood flow signal parameters (including VI, FI, and VFI) in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.

P09.03: Measurement of fetal urine production using three‐dimensional ultrasonography rotational technique in normal pregnancy

The aim of this study was to measure bladder volume by 3D ultrasonography to establish a correlation between urine production rate (UPR) with amniotic fluid index (AFI) and peak sistolic velocity (PSV) of the renal artery. We collected 121 cases of normal singleton pregnancy without medical or obstetric complications. The gestational age was between 20 and 38 weeks. The method to obtain volume measurement from 3D volume datasets was VOCAL (virtual organ computer-aided analysis, GE Medical System, Zipf, Austria). To calculate the rate of fetal urine production, we measured bladder volume at intervals of 5 mins following this formula: urinary production rate (UPR) (mL/h) = (second bladder volume – first bladder volume) x (60/x) where x is the time interval in mins between bladder volume measurements. For each case we considered also 2D ultrasonography to evaluate fetal biometry, AFI, Doppler measurements (resistance index, PSV of renal artery). The mean of UPR rate was 3.53 ml/h in according with the data of literature. Considering the Doppler measurements taken for each patient of our study we demonstrated the correlation between UPR and both RI and PSV of renal artery (p < 0.05). We couldn't find out a significative relation between UPR and AFI (p = 0.750). Measurement of fetal urine production may therefore be an alternative to AFI or single deepest pocket, and might provide an alternative to amniotic fluid volume measurement as a means of evaluating fetal hypoxia. 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.

The Role of Blood Flow in Corpus Luteum Measured by Transvaginal Two-Dimensional and Three-Dimensional Ultrasound in the Prediction of Early Intrauterine Pregnancy Outcomes.

Objective: The purpose of this study was to explore the application of transvaginal two-dimensional and three-dimensional power Doppler ultrasound in pregnancy corpus luteum to predict the final outcome of early intrauterine pregnancy. Methods: This is a prospective observational cohort study. Six hundred early intrauterine pregnant women in Shanghai Changning Maternity and Infant Health Hospital were selected as the research objects from January 2015 to December 2015. According to the follow-up of 12 weeks, these pregnant women were divided into the normal pregnancy group (group A, n = 512) and the terminational pregnancy group (group B, n = 88). They all underwent both transvaginal two-dimensional ultrasound and three-dimensional power Doppler ultrasound to obtain relevant parameters of corpus luteum, namely, the average diameter of the corpus luteum (D), resistance index (RI), pulsatility index (PI), corpus luteum volume (V), vascularization index (VI), blood flow index (FI), and vascularized blood flow index (VFI). Among them, V, VI, FI, and VFI were calculated with the virtual organ computer-aided analysis method. Receiver operator characteristic (ROC) curves were drawn. The corresponding diagnostic cut-off, sensitivity, and specificity were calculated and compared. Results: Compared with group A, the D, V, VI, FI, and VFI of corpus luteum in group B were statistically significant lower while RI and PI were statistically significant higher (P < 0.05). The diagnostic cut-off values in the prediction of early intrauterine pregnancy outcomes were D: 14.48, RI: 0.56, PI: 0.81, V: 3.89, VI: 21.48, FI: 38.99, and VFI: 10.21 respectively, and the sensitivity and specificity were D (99.2%, 67.0%), RI (98.9%, 65.0%), PI (78.4%, 89.1%), V (95.1%, 78.4%), VI (74.%, 90.9%), FI (91.8%, 90.9%), and VFI (93.9%, 87.5%) respectively. The area under the ROC curve of the combined index (RI + FI) was 0.963, which was not significantly higher compared with any single index, and both the sensitivity and specificity were 94.3%. Conclusion: Both transvaginal two-dimensional and three-dimensional ultrasonography are of high diagnostic value in predicting the early intrauterine pregnancy outcomes.

First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus

Introduction Trophoblastic invasion and placental growth are critical for pregnancy outcome. The placental volume can be assessed by 3 D ultrasound using Virtual Organ Computer-aided Analysis (VOCAL). Epidemiological and clinical data suggest that there are two different clinical phenotypes of hypertensive disorders of pregnancy (HDP) that coexist at any gestational age: HDP associated to fetal growth impairment and HDP associated to appropriate for gestational age fetal growth. The aim of this study was to determine whether placental volume in the first trimester of pregnancy differs between women with HDP associated or not to fetal growth impairment and uncomplicated pregnancies. Methods This is a retrospective cross-sectional study of prospectively recruited data in which maternal characteristics, Doppler velocimetry of uterine arteries, and three-dimensional (3 D) volume of the placenta were collected at 11 + 1 − 13 + 6 gestational weeks. The placental quotient (PQ) was calculated as placental volume/crown rump length. Results In a 2-year period, we prospectively collected first trimester data of 1322 women. For the purposes of this cross-sectional study, 57 women that delivered a SGA fetus, 34 that developed HDP-AGA, and six that developed HDP-SGA, respectively, were included in the study as cases. The control group was made of 117 uncomplicated pregnancies. The PQ was higher in women with uncomplicated pregnancies (PQ median 16.36 cm3/cm) than in all other study groups (PQ in SGA: 13.02 cm3/cm, p < .001; PQ in HDP-AGA: 12.65 cm3/cm, p = .002; and PQ in women with HDP-SGA: 8.33 cm3/cm [IQR 6.50–10.13], p < .001). The lowest PQ was observed in women with HDP-SGA and was significantly lower than PQ in either women with SGA or those with HDP-AGA (p = .02 and p = .04, respectively). The mean uterine artery pulsatility index was the highest in women with HDP-SGA (median 2.30) compared to all other groups (uncomplicated pregnancies 1.48, p < .0001; women with SGA 1.59, p = .001; and women with HDP-AGA 1.75, p = .009). Discussion Our findings suggest that HDP associated with SGA is characterized by impaired placental growth and perfusion as soon as in the first trimester of pregnancy. The role of PQ, isolated or in association with other biophysical parameters, to predict HDP with fetal growth impairment remains to be evaluated.

The Role of Endometrial Volume and Endometrial and Subendometrial Vascularization Parameters in a Frozen Embryo Transfer Cycle.

The role of three-dimensional power Doppler ultrasonography of the endometrium in assisted reproduction is still far from clear. In this retrospective cohort study, transvaginal three-dimensional power Doppler examinations were performed 30 min before frozen-thawed embryo transfer. After pregnancy tests, two cohorts were established: P (pregnant, n = 31) and NP (nonpregnant, n = 31). The study only included nullipara with no uterine abnormalities who were undergoing infertility treatment at the Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria. The main outcome measures were the vascularization flow index (VFI), flow index (FI), and vascularization index (VI) in the endometrium/subendometrium, assessed using Virtual Organ Computer-aided AnaLysis (VOCAL™), and the endometrial volume. A total of 62 patients were enrolled in the study, forming two cohorts (pregnant, P; nonpregnant, NP). There were no significant differences between the two cohorts with regard to demographic data, numbers of embryos transferred, or embryo grading, but there was a significant difference in endometrial volume (cohort P, 3.17 ± 0.84 mL; cohort NP, 2.36 ± 0.9 mL; P = 0.001) and the pregnancy rate rises with larger volume. No differences were observed in the vascularization parameters FI, VFI, and VI in the endometrium and subendometrium. In the cohort of pregnant patients, there were 26 (41.9%) live births, with 21 term deliveries (80.8%). The endometrial volume was larger in the cohort of pregnant patients. Measurements were performed 30 min before embryo transfer, and no differences were observed in vascularization parameters in the subendometrium and endometrium.

Four-Dimensional Ultrasound for Evaluating Newborn Cardiac Output: A Pilot Study of Healthy Infants

Background: There is currently no reliable non-invasive method of measuring cardiac output in neonatal intensive care. Spatiotemporal image correlation (STIC) is a novel four-dimensional (4D) ultrasound technique that was developed to assess the foetal heart, and it may be a useful way to assess neonatal haemodynamics. Objective: This study aimed to evaluate the feasibility and reproducibility of determining neonatal cardiac output using STIC ultrasound in newborn infants. Design: Infants were recruited opportunistically from a neonatal intensive care unit and then examined by 2 independent observers. STIC was used to obtain images of the heart. End-diastolic and end-systolic ventricular volumes were measured using virtual organ computer-aided analysis (VOCAL) and used to calculate cardiac output. Reproducibility was assessed with intraclass correlation coefficients (ICC) and agreement with Bland-Altman analysis. Results: Twenty-four clinically stable infants of 34–43 weeks corrected gestational age were assessed. Both observers successfully acquired 4D STIC volumes in all infants. Left ventricular output showed good reproducibility, with an intra-observer ICC of 0.86 (0.69–0.94) and inter-observer ICC of 0.87 (0.70–0.95). Right ventricular output also showed good reproducibility, with an intra-observer ICC of 0.88 (0.70–95) and inter-observer ICC of 0.84 (0.63–0.93). Conclusions: Determining cardiac output using 4D STIC ultrasound is feasible and reproducible in well newborn infants. With further evaluation, this technique may provide valuable information about haemodynamic status in newborn infants requiring intensive care.

The Diagnostic Value of 3D Power Doppler Ultrasound Combined With VOCAL in the Vascular Distribution of Breast Masses

This study uses a three-dimensional energy Doppler technique combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in order to determine the diagnostic threshold of blood flow index in breast tumors to provide a reference for evaluation and treatment options. We collected 322 solid lesions which had been operated. Each lesion met the definite pathological diagnosis; collected lesions included 262 cases of benign lesions and 60 cases of malignant lesions. All examinations were performed by using GE LOGIQ E9 with VOCAL software. Volume and four distinct vascular indices of gray mean (MG), power mean, ratio (R), and vascular flow index (VFI) were calculated by using the VOCAL software. Sampling and calculation were repeated three times and the mean value was calculated. The average age and power of the malignant group were greater than those of the benign group, ie p < .01 which had significant differences. The gray mean of the malignant group was lower than that of the benign group, ie p > .05 which had no significant differences between benign and malignant groups. The ratio, vascular flow index and volume had significant differences, i.e. p < .01. The area under the receiver operating characteristic curve (AUC) were 0.864, 0.830, 0.800, 0.758, and 0.764 for age, power, ratio, vascular flow index, and volume, respectively. The research indicators were higher than 50% of the curve showing their diagnostic value. The cut-off points of age, power, ratio, vascular flow index, and volume were 37.5, 26.56, 0.031, 0.846, and 1.75, respectively. Their corresponding sensitivity were 93.3%, 75%, 81.7%, 68.3%, 63.3%, and the specificity were 68.7%, 81%, 70.2%, 75.6%, and 81.7%, respectively. Comparison of vascular indices combined with the Breast imaging reporting and data System (BI-RADS) score and simple BI-RADS method, the AUC of power + BI-RADS, ratio + BI-RADS, VFI + BI-RADS, and BI-RADS alone are 0.928, 0.903, 0.895, and 0.796, respectively, which were higher than 50% of the curve. Sensitivity was 81.7%, 80%, 88.3%, 86.7%, and specificity was 88.5%, 85.5%, 77.1%, 69.5%, respectively. The power + BI-RADS method has the highest AUC among these three methods. Quantitative measurement of blood flow and blood vessel distribution in breast tumors by three-dimensional power Doppler ultrasound combined with the VOCAL method is more accurate and sensitive than the traditional two-dimensional ultrasound. And this method has potential promising applications in many current active research areas, such as the studies of random distribution of intratumoral blood vessels or the normalization of tumor blood vessels. Three-dimensional power Doppler ultrasound combined with the VOCAL method provides a new approach to achieving accurate judgments and the method evaluates the curative effect in breast cancer patients.

Clinical Monitoring of Sacrococcygeal Teratoma

Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9–11.6] vs. 4.4 [3.4–5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.

Diagnostic value of 3D power Doppler ultrasound in the characterization of thyroid nodules

Background/aim This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules.Materials and methods Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis.Results Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively. Conclusion 3D PDUS can be useful in the characterization of thyroid nodules.

A novel ultrasound technique called saline-infusion sonoPODography to visualize and understand the pouch of Douglas and posterior compartment contents: A feasibility study

Objective To study the concept and understand the feasibility and steps involved in performing a novel ultrasound technique called saline-infusion sonoPODography (SPG). This would be completed in patients already undergoing routine hysterosalpingo-contrast-sonography (HyCoSy)/saline-infusion sonohysterography (SIS) for intracavitary pathology or fertility purposes. The objective is to further characterize the aspects of the posterior compartment, such as the uterosacral ligaments (USLs), rectovaginal septum (RVS), bowel and pouch of Douglas (POD). Methods This was a prospective observational study from January to September 2018. All women had SPG attempted at the time of a planned HyCoSy to assess tubal patency for fertility purposes and/or SIS to assess for intracavitary pathology. Following introduction of fluid into the POD, an assessment of the posterior compartment, including the POD, rectovaginal septum (RVS), and uterosacral ligaments (USLs) was performed and visualization of these structures recorded. The infused POD fluid created an acoustic window allowing a ‘stand-off’ view of these structures. Three-dimensional (3D) volumetric acquisitions of the POD with fluid collection were recorded and volumes were calculated using Virtual Organ Computer-aided AnaLysis (VOCALTM). Results Fifty-six patients underwent SPG attempt in a systematic manner. Thirty-nine (73.2%) patients had fluid collection in the POD with a mean fluid volume of 7.11cm3. There was no difference in the POD fluid collection status stratified by various patient characteristics (e.g. uterus orientation, indication for procedure, endometriosis presence). The rate of POD fluid collection amongst women with evidence of endometriosis was 77.3% vs. without 50.0% (p = 0.08). Amongst patients with POD fluid collection, the fluid volume did not significantly differ between those with evidence of endometriosis and those without. For visualizing structures in the posterior compartment, POD fluid collection provided more clear sonographic views of difficult to visualize anatomical structures including the RVS, USLs, torus uterinus, and the bowel. More importantly, we propose that when SPG-introduced fluid collection was present in the POD, normal USLs and the true POD could be visualized. We also propose that POD fluid potentially allows for the identification of an abnormal POD peritoneum, which may contain superficial endometriosis. Conclusions The majority of patients had iatrogenic fluid collect in the POD during SPG. SPG allows for identification of the RVS, USLs, and POD in most patients. Creation of an iatrogenic acoustic window in the POD could be a useful technique added to routinely performed pelvic ultrasound assessments in patients presenting with infertility and/or pelvic pain.

Nomograms of vascularization indices of uterine health women, studyed with the use of three-dimensional energy dopplerography

Differential diagnosis of benign and malignant tumors using the Doppler method is based on the fact that the blood supply of these tumors has its own peculiarities.The aim of the research is to study the nomograms of volumetric blood flow rates of the body and cervix of healthy women of different ages by means of three - dimensional angioplasty in search of differential diagnostic criteria for simple, proliferating leiomyoma and sarcoma of the uterus in the long term.Materials and methods. 157 practically healthy women were examined. The patients were divided into women of reproductive age, women in perimenopausal women and climacteric women. With the help of 3D uterine reconstruction using the energy mapping function and VOCAL (Virtual Organ Computer Aided Analysis), an objective assessment of the hemodynamics of the body and the cervix was performed by calculating the vascularization index (VI), which characterizes the percentage ratio of blood vessels to a certain extent tissues, blood flow index (FI), which characterizes the intensity of blood flow, which shows the volume of blood cells that move in the vessels at the time of the study and vascularization – flow index (VFI), which is an indicator of perfusion of the organ.Results. As a result, the nomograms of the volumetric blood flow (VI, FI, VFI) parameters of the uterus body were improved, and the nomograms of the volumetric blood flow (VI, FI, VFI) parameters of the cervix of healthy women were designed and the patterns of their changes depending on age were determined.The authors have established that the technique of three-dimensional echography-3D - reconstruction of the uterus in angiography with the use of the VOCAL option with the determination of volumetric blood flow parameters allows to objectively evaluate the degree of vascularization of the body and cervix of healthy women of all ages, preventing a subjective approach to assessing hemodynamics, which is present in the two-dimensional energy Doppler mapping mode.Conclusions. Based on the obtained results, the development of differential diagnostic criteria for benign, borderline and malignant tumors of myometrium with the determination of quantitative parameters of 3D – energy dopplerography will be based on the prospect, which will significantly increase the level of ultrasound diagnostics in gynecologic oncology and will allow to develop a rational tactic for treating patients

Assessment of the Placental Cord Insertion Using 3-Dimensional Ultrasound at the Time of the Structural Fetal Survey.

The influence of placental morphologic characteristics on pregnancy outcomes is poorly understood. Our objective was to evaluate the relationship of the distance of the placental cord insertion from the placental edge (PCI-D) with associated placental characteristics as well as birth outcomes. We performed a retrospective cohort study of nulliparous women with singleton gestations undergoing obstetric ultrasound examinations between 14 and 23 weeks' gestation with a cervical length of greater than 3.0 cm who delivered between 24 and 42 weeks. A 3-dimensional volume of the placenta was evaluated. The PCI-D was obtained with Virtual Organ computer-aided analysis software (GE Healthcare, Milwaukee, WI). Generalized linear regression and generalized additive models were fitted to explore the associations between the PCI-D in relation to demographic and clinical characteristics. A total of 216 pregnancies were included in the analysis. The PCI-D did not correlate with maternal age, gestational age at delivery, mode of delivery, or 5-minute Apgar score. Although not statistically significant, the birth weight z score (P = .09) was associated with a longer PCI-D, and gravidity was associated with a shorter PCI-D (P = .10). A low-lying placenta or placenta previa was associated with a longer PCI-D (P = .03). The PCI-D is associated with a low placental position in the second trimester. These data are helpful for understanding placental development. The PCI-D may be associated with pregnancy-related factors such as birth weight and multigravidity. More research is required to evaluate the effects of pregnancy-related factors on the PCI-D and the effect of the PCI-D on pregnancy outcomes.

Transrectal three-dimensional fetal volumetry and crown-rump length measurement during early gestation in mares: Intra- and inter-observer reliability and agreement

The aim of this study was to investigate if transrectal three-dimensional (3D) ultrasound is a reliable technique to measure equine fetal volume (FV) during early gestation in mares. In total 149 warmblood mares were examined once transrectally on days 45 ± 1 of pregnancy with a portable 3D ultrasound device (Voluson® i, GE Healthcare, Zipf, Austria). The following measurements were performed: Two-dimensional (2D) and 3D crown-rump length (CRL), FV using Virtual Organ Computer-aided AnaLysis (VOCAL™) software with rotational angles of 6° and 30°. To analyze intra- and inter-observer reliability (intraclass correlation coefficient (ICC)) and agreement (Bland-Altman's limits of agreement (LoA)) of FV measurements, images from 60 horse fetuses were selected and repeatedly analyzed by the same examiner (A) and by a second examiner (B). The time for each ultrasound examination (2D and 3D) and for the FV measurements was recorded. The 3D measured CRL was larger (P < 0.001) than the 2D CRL. Repeated measurements of 3D CRL showed a higher reliability (ICC = 0.91 (0.88–0.94), P < 0.001) and agreement (mean = 0.13%, 95% LoA: 7.45 to +7.19) compared to reliability (ICC = 0.50 (0.36–0.61), P < 0.001) and agreement (mean = −1.54%, 95% LoA: 23.29 to +20.21) of the CRL measurement in 2D mode. For intra-observer examinations, reliability was highest when using a rotational angle of 30° (ICC = 0.98 (0.97–0.99), P < 0.001). The inter-observer reliability of 3D measurements was good (ICC = 0.85 (0.67–0.92), P < 0.001). The extra time needed to perform the 3D scan ranged from 1 to 9 min and FV measurements lasted 03:30 ± 00:46 and 08:10 ± 01:05, for rotational angles of 30° and 6°, respectively. In conclusion, this study showed a high level of intra- and inter-observer reliability and agreement for FV measurements using VOCAL™. Furthermore, the 6° and 30° rotational angles can be used interchangeably, but test duration, reliability and agreement were better with the 30° rotational step method. The CRL measurements obtained with 3D mode probably reflects the true CRL, compared to the 2D measured CRL.