Three-dimensional volume sonographic study of fetal anatomy: intraobserver reproducibility and effect of examiner experience.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) sonography in assessing fetal anatomy and to determine the intraobserver reproducibility and the effect of examiner experience. METHODS: Three-dimensional volumes of the head, face, thorax, and abdomen were obtained for 40 fetuses. The volume data sets obtained were explored offline with multiplanar navigation and tomographic ultrasound imaging on a personal computer. Each case was examined twice by the same observer at least 3 months apart. The percentage for identification of fetal anatomic structures, 2-dimensional (2D) and 3D measurements, and the time spent on 2D and 3D examinations were calculated and compared. RESULTS: Ninety-two percent of fetal anatomic structures were identified with multiplanar navigation and tomographic ultrasound imaging. The genitals, the entry of the vena cava, and the ears were visualized in less than 70% of cases. Tomographic ultrasound imaging allowed viewing of 14 structures not seen in the multiplanar study. Intraobserver agreement for anatomic examinations was good (kappa = 0.78). Intraobserver agreement for fetal measurements showed differences between both examinations that approached 0 and intraclass correlation indices close to 0.9. The mean 2D scanning time +/- SD was 10.11 +/- 2.5 minutes, and the acquisition time for the 3D volumes was 1.54 +/- 0.35 minutes. The total time for the second 3D study was 7.23 +/- 1.17 minutes, significantly shorter than the 9.96 +/- 1.53 minutes spent on the first study (P < .001). CONCLUSIONS: Three-dimensional volumes are highly effective for complete fetal anatomic surveys. They show excellent intraobserver reproducibility and take less time to study as the examiner's experience increases.

¿Puede la ecografía tridimensional cambiar la exploración ecográfica ginecológica en nuestro medio? / Can 3-dimensional ultrasonography change gynecological ultrasonographic examination in Spain?

Objetivo: Comprobar si la ecografía en 3D vaginal es tan fiable como la convencional y si aporta alguna ventaja al diagnóstico ecográfico ginecológico. Material y métodos: Estudio prospectivo en 46 mujeres a las que se realizó consecutivamente una ecografía vaginal en 2D y en 3D. Se obtuvieron tres volúmenes en 3D (útero y cada uno de los ovarios) y se estudiaron 4 meses más tarde en un ordenador personal. Se compararon ambas técnicas con respecto el diagnóstico y la biometría ecográfica y el tiempo empleado. Resultados: Se comprobó un acuerdo total entre los diagnósticos ecográficos realizados en modo 2D y 3D (31 exploraciones normales, 16 quistes anexiales y 7 miomas uterinos), excepto para la visualización y medida del cuello uterino. El tiempo medio ± desviación estándar por exploración fue de 3,29 ± 1,32 min para el modo 2D y de 2,96 ± 0,58 min para el modo 3D (p = 0,076). La adquisición de los volúmenes en 3D necesita sólo 1 h, lo que permite destinar el ecógrafo a otras exploraciones durante 1 h 32 min (AU)

Objective: To verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis. Material and methods: We performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent. Results: There was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29 ± 1.32 minutes and was 2.96 ± 0.58 minutes for 3D examination (P=.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans. Conclusions: Transvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis (AU)

Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome?

OBJECTIVE: To evaluate whether endometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D US-PDA) can predict in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome. DESIGN: Prospective clinical study. SETTING: Assisted reproduction unit in a referral hospital. PATIENT(S): Eighty women who underwent IVF cycles. INTERVENTION(S): Endometrial 3D US-PDA evaluated by VOCAL software (plane C and 9 degrees of rotational steps). MAIN OUTCOME MEASURE(S): Endometrial pattern, endometrial thickness (ET), endometrial volume (EV), and PDA indexes of vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured on the day of human chorionic gonadotropin (hCG) administration. These measurements were related to IVF/ICSI and embryo transfer outcome. RESULT(S): In the pregnant group, EV, VI, FI, and FVI but not triple-line pattern and ET were statistically significantly higher. The area under receiver operating characteristic (ROC) curve was statistically significant for EV (0.746), VI (0.724), FI (0.828), and VFI (0.800) when no grade 1 embryos or only one were transferred (43 cycles, 14 pregnancies) but not when two or three grade 1 embryos were transferred. Moreover, these parameters were statistically significant in predicting a normal pregnancy outcome (no early pregnancy loss) but were not related to multiple pregnancies. CONCLUSION(S): In IVF/ICSI cycles, 3D US-PDA is useful for evaluating endometrial receptivity. Endometrial volume and 3D power Doppler indexes are statistically significant in predicting the cycle outcome when one grade 1 or no grade 1 embryos are transferred, which could be helpful data in a single-embryo transfer policy.

Clinical usefulness of 3-dimensional sonography and power Doppler angiography for diagnosis of endometrial carcinoma.

OBJECTIVE: The purpose of this study was to assess whether endometrial volume (EV) and 3-dimensional (3D) power Doppler indices can discriminate between hyperplasia and endometrial carcinoma and can predict extension of the endometrial carcinoma. METHODS: Eighty-four women with uterine bleeding and a histopathologic diagnosis of endometrial hyperplasia (n = 29) or carcinoma (n = 55) were preoperatively examined by transvaginal 3D sonography and power Doppler angiography. Endometrial thickness (ET), EV, the vascularization index (VI), the flow index (FI), the vascularization-flow index (VFI), and the intratumoral resistive index (RI) were measured. A histopathologic diagnosis was made after endometrial biopsy was performed by hysteroscopy or curettage. RESULTS: The EV and 3D power Doppler indices (VI, FI, and VFI) were significantly higher in endometrial carcinoma than endometrial hyperplasia, whereas the intratumoral RI was significantly lower (P < .05). A VFI of 2.07 was the best cutoff for predicting endometrial carcinoma, with sensitivity of 76.5% and specificity of 80.8%. No significant differences were noticed for ET. The endometrial VI was significantly higher when the tumor stage was greater than I. All the 3D power Doppler indices were significantly higher when the carcinoma infiltrated more than 50% of the myometrium. The intratumoral RI was significantly lower in cases with a high histologic grade, myometrial infiltration of more than 50%, and lymph node metastases. CONCLUSIONS: The VI, 3D power Doppler indices, and the intratumoral RI are more useful than ET for differentiating between hyperplasia and endometrial carcinoma. Intratumoral blood flow evaluated by pulsed Doppler sonography and 3D power Doppler angiography can predict the spread of endometrial carcinoma.

Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography.

OBJECTIVE: The objective was to evaluate whether three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements can predict ovarian response and/or are associated with IVF/ICSI outcome. STUDY DESIGN: A prospective clinical study in 65 women undergoing IVF cycles. Ovarian volume (OV), number of antral follicles > or =2mm (NAF) and PDA indices: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) were evaluated by 3D-US and PDA on the day of pituitary suppression control. These measurements, age and BMI were correlated with the number of follicles>10mm on the hCG day and the number of oocytes retrieved. RESULTS: Ovarian volume, NAF, VI, FI and FVI correlate significantly (P<0.01) with the number of follicles and oocytes recovered. Ovarian volume and the number of antral follicles predicted significantly the number of follicles (R=0.67; adjusted R(2)=0.43) and oocytes retrieved (R=0.63; adjusted R(2)=0.37). The oestradiol peak and the number of follicles, oocytes and Grade 1 embryos transferred were higher in the pregnant group. CONCLUSIONS: Three-dimensional ultrasound and PDA make it easier to evaluate all the sonographic parameters implied in ovarian response. Ovarian volume and the number of antral follicles are the only independent predictors of the number of follicles developed and oocytes retrieved.

Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles.

OBJECTIVE: The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. METHODS: Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. RESULTS: The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. CONCLUSION: 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.

Endometrial volume and vascularity measurements by transvaginal three-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: intraobserver reproducibility.

OBJECTIVES: To assess intraobserver reproducibility of the endometrial volume (EV) and 3D power Doppler indices (vascularization index, VI; flow index, FI; and vascularization flow index, VFI) of the endometrium and subendometrial area using three-dimensional power Doppler angiography (3D-PDA). METHODS: Twenty-five women on the hCG day after controlled ovarian stimulation and 15 patients presenting with uterine bleeding and suspicious endometrial thickening (10 endometrial cancers and 5 endometrial hyperplasias) were scanned. Eighty volume data sets were analyzed using the VOCAL imaging program. EV and VI, FI and VFI of the endometrium and subendometrium (5 mm shell) were manually calculated in the longitudinal and coronal planes with 15 degrees and 9 degrees rotation steps. Intraclass correlation coefficient (ICC) and 95% confidence intervals were used to assess reliability. RESULTS.: EV measurements were highly reproducible (ICC > or = 0.97) without significant differences between planes and rotation steps. Endometrial and subendometrial VI, FI, and VFI presented ICCs above 0.90 with the exception of the subendometrial FI (ICC > or = 0.80). There were no significant differences according to measurement plane and rotation step except for subendometrial VFI. Nevertheless, 3D power Doppler indices calculated in the coronal plane and 9 degrees rotation step obtained the highest ICC. ICCs for 3D-PDA indices from the tumoral endometria were significantly higher than those calculated from the stimulated endometria. CONCLUSIONS: Endometrial volume and endometrial and subendometrial 3D power Doppler indices have an acceptable reproducibility, significantly higher in tumoral endometria. The reliability of measurements does not seem to be significantly influenced by the rotation plane and degrees of rotation. These results support that 3D-PDA and VOCAL are reliable methods to evaluate the physiological and pathological changes of the endometrium.

Assessment of placental vascularization by three-dimensional power Doppler "vascular biopsy" in normal pregnancies.

AIM: To describe the evolution of placental vascularization during a normal course of gestation and the blood flow 3D power Doppler indices obtained by "placental vascular biopsy." METHODS: A prospective study was carried out on 99 normal singleton pregnancies from 14 to 40 weeks. Placental vascularization was evaluated by 3D power Doppler ("placental biopsy"). The spherical volume acquired was analyzed using the VOCAL imaging program (Virtual Organ Computer-aided AnaLysis). Three vascular indices, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), were calculated. Equations and regression coefficients for placental volume and vascular indices (VI, FI, VFI) of the placental biopsy were calculated according to gestational age. Relationships between 3D placental flow indices and fetal growth parameters: biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal body weight, maximum systolic velocity (US), and resistance index in the umbilical artery (URI) were evaluated by calculating their correlation coefficients. RESULTS: All 3D Doppler indices had a significant relationship with gestational age. The most significant relationship was observed for FI, and the least significant for VI (r=0.58, r=0.29, respectively; P<0.01 for both). The FI increased linearly with gestation, whereas the VI showed a dispersion of values with a plateau from the 30th week onwards and a decrease from 37th week to the end of pregnancy. The VFI behaved as a combination of both VI and FI indices from which it was derived. All 3D Doppler indices were significantly related to fetal biometric parameters, except VI and fetal weight. A significant correlation was observed between 3D Doppler indices and maximum systolic velocity and URI. CONCLUSIONS: 3D power Doppler technique of placental vascular "biopsy" is an appropriate tool for routine evaluation of the human placental vascular tree during gestation. 3D Doppler indices change as pregnancy progresses and are significantly related with fetal biometry and umbilical artery Doppler velocimetry.

Intraobserver and interobserver reproducibility of ovarian volume, antral follicle count, and vascularity indices obtained with transvaginal 3-dimensional ultrasonography, power Doppler angiography, and the virtual organ computer-aided analysis imaging program.

OBJECTIVES: The purpose of this study was to assess intraobserver and interobserver reproducibility of the parameters of ovarian response and oocyte ability, studied by 3-dimensional ultrasonography and power Doppler angiography (PDA), and the possible influence of the ovarian functional stage. METHODS: Twenty-nine women were included in an in vitro fertilization program. Fourteen women were evaluated after pituitary suppression (basal group), and 15 were scanned on the human chorionic gonadotropin administration day, after gonadotropin ovarian stimulation (stimulated group). A first observer acquired 2 volumes for each ovary. Another observer performed a second analysis of the volumes acquired by the first observer. We analyzed ovarian volume, follicle number in the basal group, vascularization index, flow index, and vascularization-flow index. The volumes were processed by the Virtual Organ Computer-Aided Analysis imaging program using plane A and 15 degrees rotational steps. RESULTS: Ovarian volume showed excellent intraobserver and interobserver agreement, with an intraclass correlation coefficient (Intra-CC) and an interclass correlation coefficient (Inter-CC) close to the unit. The Intra-CC and Inter-CC about the number of follicles were 0.964 and 0.978, respectively. Vascularity indices showed an Intra-CC greater than 0.90. The vascularization index and the vascularization-flow index showed higher interobserver than intraobserver reproducibility (Inter-CC > 0.96 for both). The flow index Inter-CC was 0.898. The reproducibility differences between the basal and stimulated ovary measurements were not significant. CONCLUSIONS: There is an excellent intraobserver and interobserver reproducibility of the ovarian volume, follicle counts, and 3-dimensional PDA indices. The ovarian functional stage has no influence on the reliability. Three-dimensional ultrasonography and PDA improve the study of ovarian parameters, and their reliability impels a change in the current clinical routine of performing and interpreting ultrasonography.

Endometrial volume and vascularity measurements by transvaginal 3-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: an interobserver reproducibility study.

OBJECTIVE: The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements. METHODS: Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9 degrees rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability. RESULTS: Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88). CONCLUSIONS: Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.

Reproducibility of the study of placental vascularization by three-dimensional power Doppler.

AIMS: To assess the reproducibility of 3D power Doppler study of placental vascularization in order to establish its methodological bases for its further application in normal and pathological pregnancies. METHODS: A prospective study was carried on 30 normal singleton pregnancies from 14 to 40 weeks. To evaluate placental vascularization 3D power Doppler was applied to obtain a "placental biopsy". The spherical volume acquired was analyzed using the VOCAL imaging program. Two consecutive measurements were taken from each patient by a single observer, obtaining a total of 60 datasets. Placental volume (PV), Mean Gray (MG), Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI) were calculated. Intra-class correlation coefficient (ICC) and intra-observer agreement was evaluated. RESULTS: PV and MG presented an ICC of 0.98 and 0.94 respectively, with differences approaching zero. All 3D power Doppler vascular indices (VI, FI and VFI) showed a correlation greater than 0.85, with a better intra-observer agreement for the flow indices (FI and VFI). CONCLUSIONS: Placental vascular biopsy through 3D power Doppler is a new and simple tool to routinely study placental vascularization in human pregnancy. Our results provide the validation of the technique demonstrating a good reproducibility of the 3D power Doppler parameters when applied to the study of the placental vascular tree in normal pregnancies.