Reproducibility of renal volume measurement in adults using 3-dimensional sonography.

OBJECTIVES: The purpose of this study was to determine the interobserver reproducibility of renal volume measurement performed by 3-dimensional (3D) sonography. METHODS: We conducted an exploratory, quantitative, observational, and descriptive cross-sectional study. We calculated ranges, means, and standard deviations of the renal volumes obtained with 3D sonography by 2 different examiners from a sample of 30 patients. The interobserver reproducibility was assessed by calculating intraclass correlation coefficients (ICCs) and by construction of Bland-Altman plots. RESULTS: The ICC between the right 3D renal volumes obtained by examiners 1 and 2 was 0.8552 (95% confidence interval, 0.7153-0.9292), showing excellent reproducibility (P < .0001). For the left 3D renal volumes obtained by examiners 1 and 2, the ICC was 0.6411 (95% confidence interval, 0.3652-0.8135), showing average to good reproducibility (P = .0001). The Bland-Altman plots showed mean differences ± SD of -4.8% ± 23.9% between the right renal volumes obtained by examiners 1 and 2 and -2.2% ± 38% between the left renal volumes. The 95% limits of agreement between the right renal volumes obtained by examiners 1 and 2 were -28.7% to 19%, whereas those between the left renal volumes were -40.2% to 35.7%. CONCLUSIONS: Three-dimensional sonography showed good interobserver reproducibility, which was better for the right kidney. It appears necessary to establish standardized techniques for acquisition of sonographic renal volumes.

Avaliação do comportamento fetal por meio da ultrassonografia de quarta dimensão: conhecimento atual e perspectivas futuras / Assessment of fetal behavior using four-dimensional ultrasonography: current knowledge and perspectives

Durante as últimas décadas, o desenvolvimento da ultrassonografia em tempo real tem possibilitado a visibilização direta do feto no útero, bem como a avaliação de sua atividade. Com o advento da ultrassonografia tridimensional (3D) no final dos anos 1980, iniciou-se uma nova era no diagnóstico por imagem em Obstetrícia, ampliando-se sobremaneira a possibilidade do estudo fetal. Recentemente, uma técnica que permitiu que a imagem 3D fosse transformada em um modo em tempo real foi introduzida e tem sido chamada de ultrassonografia em quarta dimensão (4D), a qual permite o monitoramento contínuo da face fetal e de outras áreas da superfície do feto, como, por exemplo, suas extremidades. Alguns estudos já se ocuparam em avaliar esta nova metodologia na observação do comportamento fetal durante diferentes estágios da gestação, na tentativa de melhor entender as relações entre a maturação do sistema nervoso central do feto e suas implicações em seu padrão de comportamento. No presente artigo, os autores realizam uma revisão sobre o uso atual da ultrassonografia 4D na avaliação do comportamento fetal, discorrendo sobre as perspectivas da técnica em espelhar, por meio da observação de padrões de movimentos e expressões faciais, o desenvolvimento neurológico do feto, destacando as potenciais aplicabilidades dessa tecnologia como nova área de pesquisa em medicina fetal.

In the last decades, the development of real-time ultrasonography has allowed the direct view of the fetus in the uterus, as well as assessing its activity. The advent of threedimensional ultrasonography (3D) at the end of the 80s initiated a new era in diagnostic imaging for Obstetrics, dramatically increasing the possibility of studying the fetus. Recently, a new technique allowing the 3D image to be transformed into real-time was introduced: the four-dimensional (4D) ultrasonography. It allows the continuous monitoring of fetal face and other surface areas, such as the extremities. Some studies have already assessed this new methodology for fetal behavior observation during different stages of pregnancy, trying to understand better the relationship between fetal central nervous system maturation and the implications for its behavior. In this article, the authors review the current use of 4D ultrasonography in the assessment of fetal behavior, and discuss the possibilities of the technique to show the neurological development of the fetus, by means of watching movement and facial expressions. They also highlight the potential applicability of this new method in this new research area of fetal medicine.

Assessment of fetal behavior using four-dimensional ultrasonography: current knowledge and perspectives.

In the last decades, the development of real-time ultrasonography has allowed the direct view of the fetus in the uterus, as well as assessing its activity. The advent of three-dimensional ultrasonography (3D) at the end of the 80s initiated a new era in diagnostic imaging for Obstetrics, dramatically increasing the possibility of studying the fetus. Recently, a new technique allowing the 3D image to be transformed into real-time was introduced: the four-dimensional (4D) ultrasonography. It allows the continuous monitoring of fetal face and other surface areas, such as the extremities. Some studies have already assessed this new methodology for fetal behavior observation during different stages of pregnancy, trying to understand better the relationship between fetal central nervous system maturation and the implications for its behavior. In this article, the authors review the current use of 4D ultrasonography in the assessment of fetal behavior, and discuss the possibilities of the technique to show the neurological development of the fetus, by means of watching movement and facial expressions. They also highlight the potential applicability of this new method in this new research area of fetal medicine.

Radiological findings in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. Although cephalometric analysis is an important method in the diagnosis of craniofacial deformities, CT and magnetic resonance imaging have been highlighted as the major imaging methods to investigate the possible causes of OSA, which, in most cases, is multifactorial. Magnetic resonance and CT both allow an excellent evaluation of the various anatomical planes of the site of obstruction, which enables better clinical assessment and surgical approach. This pictorial essay aims to describe the aspects that must be evaluated in the diagnostic imaging of patients presenting with the major predisposing factors for OSA.

Short cervix syndrome: current knowledge from etiology to the control.

BACKGROUND: Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery. OBJECTIVE: To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies. METHODS: Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary. RESULTS: We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20-24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix. CONCLUSION: The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.

Achados radiológicos em pacientes portadores de apneia obstrutiva do sono / Radiological findings in patients with obstructive sleep apnea

A apneia obstrutiva do sono (AOS) é caracterizada por obstruções recorrentes das vias aéreas superiores durante o sono que ocorrem no nível da faringe. Apesar de a análise cefalométrica ser um importante método no diagnóstico das deformidades craniofaciais, a TC e a ressonância magnética vêm se destacando como os principais métodos de imagem para a investigação das eventuais causas da AOS que, na maioria das vezes, é multifatorial. Esses métodos permitem uma excelente avaliação nos diversos planos anatômicos do eventual sítio da obstrução, o que permite uma melhor avaliação clínica e abordagem cirúrgica. O presente ensaio pictórico tem como objetivo descrever os aspectos que devem ser avaliados no diagnóstico por imagem dos principais fatores predisponentes para a AOS.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. Although cephalometric analysis is an important method in the diagnosis of craniofacial deformities, CT and magnetic resonance imaging have been highlighted as the major imaging methods to investigate the possible causes of OSA, which, in most cases, is multifactorial. Magnetic resonance and CT both allow an excellent evaluation of the various anatomical planes of the site of obstruction, which enables better clinical assessment and surgical approach. This pictorial essay aims to describe the aspects that must be evaluated in the diagnostic imaging of patients presenting with the major predisposing factors for OSA.

Avaliação ultrassonográfica dos distúrbios intracapsulares temporomandibulares / Sonographic evaluation of temporomandibular joint internal disorders

OBJETIVO: Avaliar a sensibilidade e a especificidade do exame ultrassonográfico de alta resolução para a avaliação dos distúrbios intracapsulares temporomandibulares. MATERIAIS E MÉTODOS: Estudamos 38 pacientes (76 articulações) com queixas de distúrbios temporomandibulares. Todos os pacientes realizaram exames de ultrassonografia e ressonância magnética (padrão ouro para a avaliação) e os resultados obtidos foram comparados. RESULTADOS: De 24 articulações evidenciando deslocamento discal com o paciente em repouso na ressonância magnética, 7 foram confirmados pela ultrassonografia, em 13 não foram visualizados os discos e 4 estavam tópicos na ultrassonografia. Em 48 articulações, o disco articular não foi visualizado na ultrassonografia com o paciente em repouso. Destes, 41 apresentavam posicionamento normal na ressonância magnética e 7 apresentavam deslocamento anterior. Alterações morfológicas do côndilo mandibular foram visualizadas pela ressonância magnética em 13 articulações, identificadas pela ultrassonografia em 2 delas. CONCLUSÃO: Podemos concluir, no estudo, que o exame de ultrassonografia apresenta alta sensibilidade e especificidade para o diagnóstico da localização do disco articular com o paciente em repouso, tanto para a análise de seu posicionamento anatômico como nos casos de deslocamentos, não apresentando resultados significativos para a análise dos discos com o paciente com a boca aberta e para a análise de alterações morfológicas discais e condilares.

OBJECTIVE: To evaluate the sensitivity and specificity of high-resolution ultrasonography in the assessment of intracapsular temporomandibular disorders. MATERIALS AND METHODS: The authors have studied 38 patients (76 joints) with complaint of temporomandibular disorder. All the patients underwent ultrasonography and magnetic resonance imaging (gold standard for the evaluation) and the results were compared. RESULTS: Among 24 joints demonstrating disc displacement at magnetic resonance imaging of patients at rest, 7 were confirmed at ultrasonography; in 13, the discs could not be visualized; and in 4, no sonographic abnormality was observed. In 48 joints, the articular discs could not be visualized at ultrasonography of patients at rest. Among them, 41 exhibited normal positioning at magnetic resonance imaging, and 7 exhibited anterior disc displacement. Morphological changes of the mandibular condyle were visualized in 13 joints at magnetic resonance imaging, and in 2 at ultrasonography. CONCLUSION: With the present study, the authors can conclude that ultrasonography offers high sensitivity and specificity in the diagnosis of the articular disc location with the patient at rest, either to analyze anatomical position or to analyze disc displacement. On the other hand, it does not offer significant results to analyze articular discs in patients with open mouth as well as to analyze disc/condyle morphological changes.

Reproducibility of three-dimensional power Doppler placental vascular indices in pregnancies between 26 and 35 weeks.

PURPOSE: Assess intra and interobserver reproducibility of three-dimensional power Doppler (3DPD) placental vascular indices in normal pregnancies between 26 and 35 weeks. METHODS: Thirty 3D volumes were captured by one observer and stored for analysis. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated from the spherical placental tissue samples obtained through the automatic Virtual Organ Computer-aided AnaLysis (VOCAL). Two observers analyzed the stored volumes and calculated the indices and their findings were compared. Intraclass correlation coefficients (ICCs) were used to analyze intra and interobserver correlations. Data were analyzed using confidence intervals, reliability coefficients and Bland-Altman graphs with concordance limits. RESULTS: All three indices had good intra and interobserver reproducibility. Intraobserver ICCs for the three indices were > 0.90. The FI had the highest ICC (0.99), the highest interobserver ICC (0.98) and the best concordance on the Bland-Altman graphs. CONCLUSION: 3DPD placental vascular indices obtained using the automatic sphere mode had a good intra and interobserver reproducibility for pregnancies between 26 and 35 weeks. The FI obtained the highest reproducibility scores.

Reprodutibilidade interobservador dos índices vasculares do Doppler de amplitude tridimensional do embrião entre 7 e 10 semanas e 6 dias de gestação / Interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler ultrasonography of embryos at 7 to 10 weeks and 6 days of gestation

OBJETIVO: Avaliar a reprodutibilidade interobservador dos índices de vascularização do Doppler de amplitude tridimensional (Doppler de amplitude 3D) no primeiro trimestre de gestação. MATERIAIS E MÉTODOS: Realizou-se estudo de reprodutibilidade com 32 gestantes normais entre 7 e 10 semanas e 6 dias. Para o cálculo do volume tridimensional dos embriões utilizou-se o método VOCAL (Virtual Organ Computer-aided AnaLysis) com ângulo de rotação de 12°. Em seguida obtiveram-se, automaticamente, os três índices vasculares do Doppler de amplitude 3D: índice de vascularização (VI), índice de fluxo (FI) e índice de vascularização e fluxo (VFI). Para o cálculo da variabilidade interobservador, um examinador realizou uma segunda medida dos 32 embriões e um segundo examinador realizou uma terceira medida dos mesmos volumes, ambos desconhecendo os resultados do outro. Utilizaram-se, para análise estatística, o coeficiente de correlação intraclasse (CCI) e gráficos de Bland-Altman. RESULTADOS: Observou-se boa reprodutibilidade interobservador dos três índices vasculares. O VI apresentou CCI = 0,9 e média da diferença = -1,1; o FI apresentou CCI = 0,9 e média da diferença = -0,5; e o VFI apresentou CCI = 0,9 e média da diferença = -1,1. CONCLUSÃO: Os índices vasculares do Doppler de amplitude 3D do embrião no primeiro trimestre de gestação foram altamente reprodutíveis, em especial o FI.

OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = -1.1. For the FI, the ICC was 0.9 and mean difference = -0.5. The VFI presented ICC = 0.9 and mean difference = -1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Doppler ultrasonography at the first trimester of gestation demonstrated a high reproducibility.

Avaliação do volume da placenta no primeiro trimestre de gestação por meio da ultrassonografia tridimensional utilizando o método XI VOCAL / Estimation of placental volume by three-dimensional ultrasonography with the XI VOCAL method in the first gestational trimester

OBJETIVO: Determinar valores de referência para o volume da placenta entre 7 e 10 semanas e 6 dias de gestação por meio da ultrassonografia tridimensional utilizando o método XI VOCAL (eXtended Imaging Virtual Organ Computer-aided Analysis). MATERIAIS E MÉTODOS: Realizou-se estudo de corte transversal com 70 gestantes normais entre 7 e 10 semanas e 6 dias. Para o cálculo de volume, utilizou-se o método XI VOCAL com delimitação de dez planos adjacentes. Foram determinadas médias, medianas, desvios-padrão, valores máximo e mínimo para o volume da placenta. Para avaliar a correlação do volume da placenta com a idade gestacional, foi criado gráfico de dispersão, sendo o ajuste realizado pelo coeficiente de determinação (R²). RESULTADOS: A média do volume da placenta variou de 4,6 cm³ (2,6-8,6 cm³) a 28,9 cm³ (11,4-66,9 cm³). O volume da placenta (VP) se mostrou altamente correlacionado com a idade gestacional (IG), sendo o melhor ajuste com a regressão exponencial [VP = exp(0,582 × IG + 0,063); R² = 0,82]. CONCLUSÃO: Valores de referência para o volume da placenta no primeiro trimestre de gestação utilizando o método XI VOCAL foram determinados.

OBJECTIVE: To determine reference values for placental volume at 7 to 10 + 6 weeks of gestation by means of three-dimensional ultrasonography with the XI VOCAL (eXtended Imaging Virtual Organ Computer-aided Analysis) method. MATERIALS AND METHODS: A cross-sectional study was developed with 70 pregnant women at 7 to 10 + 6 weeks of gestation. The XI VOCAL method with ten sequential adjacent planes was utilized in the volume calculations. Means, medians, standard deviation, minimum and maximum values for placental volume were calculated. A scatter plot adjusted by the determination coefficient (R²) was constructed to correlate placental volume and gestational age. RESULTS: Mean placental volume ranged from 4.6 cm³ (2.6-8.6 cm³) to 28.9 cm³ (11.4-66.9 cm³). The placental volume (PV) has shown to be highly correlated with the gestational age (GA) and the best fit equation was [PV = exp(0.582 × GA + 0.063); R² = 0.82]. CONCLUSION: Reference values for placental volume in the first gestational trimester were determined with the XI VOCAL method.

Placental blood flow measured by three-dimensional power Doppler ultrasound at 26 to 35 weeks gestation in normal pregnancies.

OBJECTIVE: To evaluate placental vascular indices, in pregnancies between 26 and 35 weeks, using three-dimensional power Doppler (3DPD) ultrasound and the effect of placental location on these indices. METHODS: This was a cross-sectional study involving 283 patients. The placental vascularization index (VI), flow index (FI) and vascularization and flow index (VFI) was obtained using the VOCAL program. Pearson's linear correlation coefficient was used to assess the relationship between gestational age and these indices. Student's parametric t-test and Levene's test were used to analyse the results between VI, FI and VFI and placental location. RESULTS: There was no linear correlation between gestational age (GA) and VI (p = 0.390) and VFI (p = 0.053). Only the FI presented a significant linear correlation (p = 0.004), with a slow increase according to GA. It was possible to construct a reliable nomogram only for this index. There were no significant differences in the VI, FI and VFI according to placental location (p = 0.323, 0.172 and 0.120, respectively). CONCLUSION: Placental FI assessed by 3DPD increases progressively and significantly between 26 and 35 weeks. Placental location has no influence on the three vascular indices studied. The FI reference values obtained in this study can be used as a parameter for future investigations on placental vascularization using 3DPD.

Utilização do índice de resistência vascular na diferenciação entre nódulos mamários benignos e malignos / Utilization of vascular resistance index in the differentiation between benign and malignant breast nodules

OBJETIVO: O objetivo deste estudo foi avaliar o significado do Doppler espectral por meio da obtenção do índice de resistência vascular na diferenciação entre lesões mamárias benignas e malignas. MATERIAIS E MÉTODOS: Dezenove lesões malignas e 18 benignas, diagnosticadas por estudo histológico, foram submetidas previamente a análise de sua vascularização por meio do Doppler espectral para se obter o índice de resistência vascular. RESULTADOS: Observou-se diferença estatisticamente significante (p < 0,001) entre os valores médios do índice de resistência para os resultados benigno e maligno (0,62x 0,80, respectivamente), em nódulos maiores que 1 cm. Um índice de resistência 0,69 foi altamente associado a lesões malignas, com sensibilidade de 84,2 por cento, especificidade de 88,9 por cento, taxa de falso-positivo de 11,1 por cento e taxa de falso-negativo de 15,8 por cento. CONCLUSÃO: A análise do índice de resistência vascular pode fornecer grande auxílio na avaliação das lesões nodulares da mama maiores que 1 cm, em conjunto com as informações obtidas por meio da escala de cinzas, com elevada sensibilidade e especificidade.

OBJECTIVE: The present study was aimed at evaluating the role played by spectral Doppler as a method to measure the vascular resistance index in the differentiation between benign and malignant breast lesions. MATERIALS AND METHODS: Nineteen malignant and 18 benign lesions histologically diagnosed had their vascularization previously analyzed through the resistance index. RESULTS: A statistically significant difference (p < 0.001) was observed between the mean values of resistance index for benign and malignant lesions (respectively 0.62x 0.80) in nodular breast lesions greater than 1 cm. A resistance index 0.69 was highly associated with malignant lesions, with 84.2 percent sensitivity, 88.9 percent specificity, false-positive rate of 11.1 percent, and false-negative rate of 15.8 percent. CONCLUSION: The analysis of vascular resistance index combined with findings on grayscale sonographic images can be of great assistance in the assessment of nodular breast lesions greater than 1 cm, with high sensitivity and specificity.

Diagnóstico pré-natal de rabdomioma cardíaco fetal pela ultrassonografia: relato de caso / Prenatal sonographic diagnosis of fetal cardiac rhabdomyoma: a case report

Os tumores cardíacos constituem condição rara, com incidência entre 0,17 e 28/10.000 na população geral. Os rabdomiomas são os tumores mais frequentes no período pré-natal. Este trabalho tem como objetivo relatar o caso de um feto com 31 semanas de gestação que apresentava tumoração intracardíaca de grandes dimensões, com graves repercussões clínicas.

Cardiac tumors constitute a rare condition, affecting 0.17-28/10,000 of the general population. Rhabdomyomas represent the most frequently found type of tumor in the prenatal period. The present report describes the case of a 31-week fetus presenting with a large intracardiac tumor with severe clinical repercussions.

Embryo vascularization by three-dimensional power Doppler ultrasonography at 7-10 weeks of pregnancy.

AIM: Assess vascular indices of 7-10 week embryos using three-dimensional power Doppler (3DPD) and correlate them with the crown-rump length (CRL). METHODS: This cross-sectional study included 65 healthy pregnancies between 7 and 10 weeks. The three-dimensional volume of the embryo was obtained using an endocavitary volumetric transducer and the VOCAL (Virtual Organ Computer-aided Analysis) method, with a 12 degree rotation angle and 15 sequential planes. The vascularization (VI), flow (FI) and the vascular and flow (VFI) indices were obtained using 3DPD and the mean, median, standard deviation, maximum and minimum values were calculated for each gestational age. Pearson's correlation coefficient (r) was used to evaluate the correlation between vascular indices and CRL. RESULTS: The VI ranged from 0.77 to 41.67, mean 14.68 (+/-8.60), the FI went from 25.71 to 139.50, mean 90.61 (+/-21.51) and the VFI from 0.20 to 81.57, mean 15.69 (+/-12.42). The correlation between CRL and all 3D power Doppler vascular indices was low (VI - r=-0.073, P=0.566; FI - r=0.173, P=0.168 and VFI - r=-0.004, P=0.974). CONCLUSION: 3D power Doppler vascular indices in 7-10 week embryos do not correlate with CRL.

Nomogram of fetal middle cerebral artery peak systolic velocity at 23-35 weeks of gestation in a Brazilian population: pilot study.

OBJECTIVE: To establish normative data for the peak systolic velocity of the middle cerebral artery (MCA-PSV) of fetuses in the second half of pregnancy using multiples of the median and percentile reference range. METHODS: A cross-sectional study was performed in 90 healthy fetuses at between 23 and 35 weeks of gestation. A bi-dimensional axial scan of the brain, including the thalami and cavitas septi pellucidi was obtained. The circle of Willis was visualized using color flow mapping. Pulsed-wave Doppler velocimetry of the MCA was performed close to the artery's origin, with a beam-vessel angle below 20 degrees . A table with the multiples of the median (MoM) of the MCA-PSV for each gestational age was generated and Pearson's correlation coefficient (r) was calculated. Regression modeling across gestational age was performed to obtain the reference values. RESULTS: There was a strong correlation between the MCA-PVS and gestational age (r = 0.70; p < 0.001). Values for the MCA-PSV for the following MoM were calculated: 1.0, 1.29, 1.50, and 1.55. The MCA-PSV 2.5(th) and 97.5(th) centiles ranged from 24.33 cm(2)/s to 78.36 cm(2)/s, respectively, between weeks 23 and 35. CONCLUSIONS: A nomogram for the fetal MCA-PSV during the second half of pregnancy was generated.

Aplicação de um novo software em ultra-sonografia 3D para o diagnóstico pré-natal de malformações fetais / Application of a new software in the 3D-sonography for prenatal diagnosis of fetal malformations

O surgimento da ultra-sonografia tridimensional no início da década de 90 representou significativo avanço na área de diagnóstico por imagem em Obstetrícia. A partir do modo multiplanar, podem-se obter múltiplos planos em diversas direções, o que não é possível ao modo bidimensional. O modo de superfície permite avaliar em detalhes a superfície fetal e permite mais fácil entendimento da doença pelos pais. Entretanto, a maior limitação da ultra-sonografia tridimensional em relação à ressonância magnética é a incapacidade de determinar múltiplos planos seqüenciais, de forma a se determinar o nível exato da malformação. Nos últimos dois anos, um novo software chamado 3D XItm tem sido proposto como uma forma de se eliminar essa limitação. Este se constitui de três programas chamados multi-slice view, volume CT view e oblique view. O multi-slice view possibilita a obtenção de múltiplos planos seqüenciais adjacentes, o volume CT view permite obter o nível exato da lesão e o oblique view viabiliza a obtenção de planos não padronizados de estruturas com contornos irregulares. Neste artigo, são apresentados: a descrição técnica, as potenciais aplicabilidades em diagnóstico pré-natal, as possíveis limitações técnicas e uma revisão do que há de mais atual na literatura sobre o software 3D XItm.

The appearance of the three-dimensional ultrasonography in the beginning of the 90s represented a great advance in diagnostic imaging in obstetrics. Through the multiplanar mode it is now possible to obtain multiple plans in several directions, something impossible with two-dimensional mode. The Surface mode allows the detailed assessment of fetal surface and allows the pathology easier understanding by the parents. Yet, three-dimensional ultrasonography is limited when comparing to magnetic resonance due to the impossibility in determining sequential multiple plans, which help to establish the exact place of the investigated malformation. For the last couple of years a new software called 3D XItm has been proposed as a way to avoid that limitation. The software includes three programs called multi-slice view, volume CT view and the oblique view. Multi-slice view makes possible to obtain the exact location of the lesion, while the oblique view allows the obtainment of non-patterned plans of structures with irregular shapes. In this article we present the technical description, potential applicabilities in prenatal diagnosis, possible technical limitations and a review of what is more recent in medical literature about the 3D XItm software.

Medida do comprimento do osso nasal entre 11 e 15 semanas de gestação em uma população brasileira: estudo preliminar / Measurement of fetal nasal bone length in the period between 11 and 15 gestational weeks in a Brazilian population: a preliminary study

OBJETIVO: Determinar valores de referência para o comprimento do osso nasal entre 11 e 15 semanas de gestação em uma população brasileira. MATERIAIS E MÉTODOS: Realizou-se estudo de corte transversal com 171 gestantes normais entre 11 e 15 semanas completas. O osso nasal foi medido por via transabdominal em todos os casos. Foram calculados os percentis 5 a 95 para o comprimento do osso nasal pela fórmula: média ± 1,645 desvio-padrão. Para avaliar a correlação do comprimento do osso nasal com parâmetros antropométricos fetais utilizou-se o coeficiente de correlação de Spearman, com intervalo de confiança de 95 por cento. RESULTADOS: O osso nasal foi mensurado em todos os casos, sendo que o comprimento médio variou de 1,69 mm a 2,94 mm. O comprimento do osso nasal mostrou-se fortemente correlacionado com todos os parâmetros antropométricos fetais (p < 0,001) e com a idade gestacional (R² = 0,59). CONCLUSÃO: Apesar de ser um estudo preliminar, a curva de referência do comprimento do osso nasal foi estabelecida.

OBJECTIVE: To establish reference values for fetal nasal bone length measurements between 11 and 15 gestational weeks in a Brazilian population. MATERIALS AND METHODS: A cross-sectional study was developed with 171 normal pregnant women between their 11th and 15th gestational weeks. The fetal nasal bone was measured by means of transabdominal ultrasound in all of the cases. The 5th and 95th percentiles for the nasal bone length were calculated by the formula: mean ± 1.645 standard deviation. The Spearman correlation coefficient with 95 percent confidence interval was utilized to correlate the nasal bone length with fetal anthropometric parameters. RESULTS: The nasal bone could be measured in all of the cases with the mean length ranging between 1.69 mm and 2.94 mm. Nasal bone length demonstrated to be strongly correlated with all of the fetal anthropometric parameters (p < 0.001) and with the gestational age (R² = 0.59). CONCLUSION: Despite the preliminary character of the present study, a reference range of fetal nasal bone length was established.