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Khandelwal M, Shipp TD, Zelop CM, Abuhamad AZ, Afshar Y, Einerson BD, Fox KA, Huisman TAGM, Lyell DJ, Perni U, Platt LD, Shainker SA. Imaging the Uterus in Placenta Accreta Spectrum Disorder. Am J Perinatol 2023; 40:1013-1025. [PMID: 37336220 DOI: 10.1055/s-0043-1761914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present. KEY POINTS: · Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.. · Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.. · Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler)..
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Affiliation(s)
- Meena Khandelwal
- Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thomas D Shipp
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, Valley Medical Group, Paramus, New Jersey and Clinical Professor of Obstetrics and Gynecology, Ne NYU Grossman School of Medicine, New York
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Thierry A G M Huisman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houstan, Texas
| | - Deirdre J Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
| | - Uma Perni
- Subspecialty Care for Women's Health, Cleveland Clinic, Beachwood, Ohio
| | - Lawrence D Platt
- Center for Fetal Medicine & Women's Ultrasound and the David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Clark A, Flouri D, Mufti N, James J, Clements E, Aughwane R, Aertsen M, David A, Melbourne A. Developments in functional imaging of the placenta. Br J Radiol 2023; 96:20211010. [PMID: 35234516 PMCID: PMC10321248 DOI: 10.1259/bjr.20211010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
The placenta is both the literal and metaphorical black box of pregnancy. Measurement of the function of the placenta has the potential to enhance our understanding of this enigmatic organ and serve to support obstetric decision making. Advanced imaging techniques are key to support these measurements. This review summarises emerging imaging technology being used to measure the function of the placenta and new developments in the computational analysis of these data. We address three important examples where functional imaging is supporting our understanding of these conditions: fetal growth restriction, placenta accreta, and twin-twin transfusion syndrome.
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Affiliation(s)
- Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Joanna James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eleanor Clements
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Rosalind Aughwane
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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Rubin JM, Fowlkes JB, Pinter SZ, Treadwell MC, Kripfgans OD. Umbilical Vein Pulse Wave Spectral Analysis: A Possible Method for Placental Assessment Through Evaluation of Maternal and Fetal Flow Components. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2445-2457. [PMID: 34935157 PMCID: PMC10204125 DOI: 10.1002/jum.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Placental blood flow analysis is complicated by having both maternal and fetal flow components. Using the Fast Fourier Transform (FFT) of the umbilical venous pulse wave spectra (PW) envelope, we could simultaneously assess maternal/fetal blood flow in the placenta and investigate if normal and intrauterine growth restriction (IUGR)/pre-eclamptic pregnancies could be distinguished. METHODS This retrospective study included normal gestations (N = 11) and gestations with IUGR, pre-eclampsia, or both (N = 13). Umbilical vein PW were acquired and spectral envelopes were identified as a function of time and analyzed by FFT. Base-10 logarithms of the ratios of the maternal/fetal spectral peaks (LRSP) were compared in normal and IUGR/pre-eclamptic populations (two-tailed t-test). Body mass index (BMI), gestational age at scan time, placental position, and weight-normalized umbilical vein blood volume flow (two-tailed t-test, analysis of variance [ANOVA] analysis) were tested. P < .05 was considered significant. RESULTS The LRSP for normal and IUGR/pre-eclamptic pregnancies were 0.141 ± 0.180 and -0.072 ± 0.262 (mean ± standard deviation), respectively (P = .033). We detected differences between normal gestations and combinations of LRSP and weight-normalized umbilical venous blood flows. Placental effects based on LRSPs and blood flow may act synergistically in cases with both pre-eclampsia and IUGR (P = .014). No other significant associations were seen. CONCLUSIONS In this preliminary study, we showed that umbilical venous flow contains markers related to placental maternal/fetal blood flow, which can be used to assess IUGR and pre-eclampsia. When coupled with umbilical cord blood flow, this new marker may potentially identify the primary causes of the two conditions.
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Affiliation(s)
- Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Z Pinter
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Marjorie C Treadwell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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de Vos ES, Koning AHJ, Steegers-Theunissen RPM, Willemsen SP, van Rijn BB, Steegers EAP, Mulders AGMGJ. Assessment of first-trimester utero-placental vascular morphology by 3D power Doppler ultrasound image analysis using a skeletonization algorithm: the Rotterdam Periconception Cohort. Hum Reprod 2022; 37:2532-2545. [PMID: 36125007 PMCID: PMC9627684 DOI: 10.1093/humrep/deac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
STUDY QUESTION Can three-dimensional (3D) Power Doppler (PD) ultrasound and a skeletonization algorithm be used to assess first-trimester development of the utero-placental vascular morphology? SUMMARY ANSWER The application of 3D PD ultrasonography and a skeletonization algorithm facilitates morphologic assessment of utero-placental vascular development in the first trimester and reveals less advanced vascular morphologic development in pregnancies with placenta-related complications than in pregnancies without placenta-related complications. WHAT IS KNOWN ALREADY Suboptimal development of the utero-placental vasculature is one of the main contributors to the periconceptional origin of placenta-related complications. The nature and attribution of aberrant vascular structure and branching patterns remain unclear, as validated markers monitoring first-trimester utero-placental vascular morphologic development are lacking. STUDY DESIGN, SIZE, DURATION In this prospective observational cohort, 214 ongoing pregnancies were included before 10 weeks gestational age (GA) at a tertiary hospital between January 2017 and July 2018, as a subcohort of the ongoing Rotterdam Periconception Cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS By combining 3D PD ultrasonography and virtual reality, utero-placental vascular volume (uPVV) measurements were obtained at 7, 9 and 11 weeks GA. A skeletonization algorithm was applied to the uPVV measurements to generate the utero-placental vascular skeleton (uPVS), a network-like structure containing morphologic characteristics of the vasculature. Quantification of vascular morphology was performed by assigning a morphologic characteristic to each voxel in the uPVS (end-, vessel-, bifurcation- or crossing-point) and calculating total vascular network length. A Mann–Whitney U test was performed to investigate differences in morphologic development of the first-trimester utero-placental vasculature between pregnancies with and without placenta-related complications. Linear mixed models were used to estimate trajectories of the morphologic characteristics in the first trimester. MAIN RESULTS AND THE ROLE OF CHANCE All morphologic characteristics of the utero-placental vasculature increased significantly in the first trimester (P < 0.005). In pregnancies with placenta-related complications (n = 54), utero-placental vascular branching was significantly less advanced at 9 weeks GA (vessel points P = 0.040, bifurcation points P = 0.050, crossing points P = 0.020, total network length P = 0.023). Morphologic growth trajectories remained similar after adjustment for parity, conception mode, foetal sex and occurrence of placenta-related complications. LIMITATIONS, REASONS FOR CAUTION The tertiary setting of this prospective observational study provides high internal, but possibly limited external, validity. Extrapolation of the study’s findings should therefore be addressed with caution. WIDER IMPLICATIONS OF THE FINDINGS The uPVS enables assessment of morphologic development of the first-trimester utero-placental vasculature. Further investigation of this innovative methodology needs to determine its added value for the assessment of (patho-) physiological utero-placental vascular development. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Department of Obstetrics and Gynecology of the Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. There are no conflicts of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6854).
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Affiliation(s)
- Eline S de Vos
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Keizer A, Niewenhuis L, Hehenkamp W, Twisk J, Brölmann H, Huirne J. Fibroid vascularisation assessed with 3D Power Doppler as predictor for fibroid related symptoms and quality of life; a pilot study. Facts Views Vis Obgyn 2021; 13:387-394. [PMID: 35026100 PMCID: PMC9148716 DOI: 10.52054/fvvo.13.4.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Uterine fibroids present differently, from well vascularised up to calcified, with some causing heavy menstrual bleeding (HMB). Objectives To investigate the association between fibroid vascularisation and HMB, other fibroid related symptoms and quality of life (QOL). Materials and Methods A single centre pilot study was carried out in the Netherlands. Women with a maximum of two fibroids who chose expectant management were included. 3D sonography including power doppler was performed at baseline and at 3, 6 and 12 months follow up. Women were asked to complete the Pictorial Blood Assessment Chart (PBAC) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires at every visit. Main outcome measure The association between fibroid vascularisation and HMB. Results 53 women were included in the study. Baseline fibroid vascularisation, measured as vascular index (VI) is associated with PBAC score; a 1% higher VI at baseline leads to an 11 point increase in PBAC score over time (RC 10.99, p=0.05, 95% CI -0.15 – 22.12). After correction for the baseline variables ethnicity and fibroid type the association becomes stronger (P<0.05). Fibroid volume at baseline and HMB are also associated: a 1 cm3 larger fibroid leads to 0.6 points increase in PBAC score over time (RC 0.56, p=0.03, 95% CI 0.05 – 1.07). Conclusions This study highlights that both fibroid vascularisation and fibroid volume may be associated with an increase in menstrual blood loss, other fibroid related symptoms and QOL over time. What is new? We used 3D power doppler to predict symptomatic fibroids.
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Periconceptional maternal and paternal homocysteine levels and early utero-placental (vascular) growth trajectories: The Rotterdam periconception cohort. Placenta 2021; 115:45-52. [PMID: 34560327 DOI: 10.1016/j.placenta.2021.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Maternal elevated plasma total homocysteine (tHcy) is involved in the origin of several placenta-related pregnancy complications. The first trimester is the most sensitive period for placentation influenced by maternal and paternal health. The aim is to study associations between periconceptional parental tHcy levels and utero-placental growth trajectories in the first trimester of pregnancy. METHODS Pregnant women and their partners were enrolled before 10 weeks of gestation in the Virtual Placenta study as subcohort of the Rotterdam periconception cohort (Predict study). A total of 190 women with a singleton pregnancy, of which 109 conceived naturally and 81 after IVF/ICSI treatment, were included. We measured serial utero-placental vascular volumes (uPVV) and placental volumes (PV) at 7, 9 and 11 weeks of gestation. First-trimester trajectories of PV were also measured in 662 pregnancies from the total Predict study. RESULTS Comparing all participants of the virtual placenta study, no association between maternal tHcy and uPVV was observed. However, in IVF/ICSI pregnancies sub-analyses showed significantly negative associations between maternal tHcy in the 3rd and 4th quartile and uPVV trajectories (beta: -0.38 (95%CI -0.74 to -0.02) and beta: -0.42 (95% CI -0.78 to -0.05), respectively) with the 1st quartile as reference. Analysis in the total Predict cohort showed similar negative associations for the total study population. DISCUSSION Periconceptional high maternal tHcy levels are associated with smaller placental growth trajectories depicted as PV and uPVV in the first trimester of pregnancy. The stronger negative associations with uPVV in IVF/ICSI pregnancies underline the need for further investigation.
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Reijnders IF, Mulders AGMGJ, Koster MPH, Kropman ATM, de Vos ES, Koning AHJ, Willemsen SP, Rousian M, Steegers EAP, Steegers-Theunissen RPM. First-trimester utero-placental (vascular) development and embryonic and fetal growth: The Rotterdam periconception cohort. Placenta 2021; 108:81-90. [PMID: 33823358 DOI: 10.1016/j.placenta.2021.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Impaired placental development is a major cause of fetal growth restriction (FGR) and early detection will therefore improve antenatal care and birth outcomes. Here we aim to investigate serial first-trimester ultrasound markers of utero-placental (vascular) development in association with embryonic and fetal growth. METHODS In a prospective cohort, we periconceptionally included 214 pregnant women. Three-dimensional power Doppler ultrasonography at 7, 9 and 11 weeks gestational age (GA) was used to measure placental volumes (PV) and basal plate surface area by Virtual Organ Computer-aided AnaLysis™, and utero-placental vascular volume (uPVV), crown-rump length (CRL) and embryonic volume (EV) by a V-scope volume rendering application. Estimated fetal weight (EFW) was measured by ultrasound at 22 and 32 weeks GA and birth weight percentile (BW) was recorded. Linear mixed models and regression analyses were applied and appropriately adjusted. All analyses were stratified for fetal sex. RESULTS PV trajectories were positively associated with CRL (βadj = 0.416, 95%CI:0.255; 0.576, p < 0.001), EV (βadj = 0.220, 95%CI:0.058; 0.381, p = 0.008) and EFW (βadj = 0.182, 95%CI:0.012; 0.352, p = 0.037). uPVV trajectories were positively associated with CRL (βadj = 0.203, 95%CI 0.021; 0.384, p = 0.029). In girls, PV trajectories were positively associated with CRL (p < 0.001), EV (p = 0.018), EFW (p = 0.026), and uPVV trajectories were positively associated with BW (p = 0.040). In boys, positive associations were shown between PV trajectories and CRL (p = 0.002), and between uPVV trajectories and CRL (p = 0.046). DISCUSSION First-trimester utero-placental (vascular) development is associated with embryonic and fetal growth, with fetal sex specific modifications. This underlines the opportunity to monitor first-trimester placental development and supports the associations with embryonic and fetal growth.
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Affiliation(s)
- I F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - M P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A T M Kropman
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - E S de Vos
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A H J Koning
- Department of Pathology, Clinical Bioinformatics Unit Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
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Knowledge-guided Pretext Learning for Utero-placental Interface Detection. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2020; 12261:582-593. [PMID: 33163992 DOI: 10.1007/978-3-030-59710-8_57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Modern machine learning systems, such as convolutional neural networks rely on a rich collection of training data to learn discriminative representations. In many medical imaging applications, unfortunately, collecting a large set of well-annotated data is prohibitively expensive. To overcome data shortage and facilitate representation learning, we develop Knowledge-guided Pretext Learning (KPL) that learns anatomy-related image representations in a pretext task under the guidance of knowledge from the downstream target task. In the context of utero-placental interface detection in placental ultrasound, we find that KPL substantially improves the quality of the learned representations without consuming data from external sources such as IMAGENET. It outperforms the widely adopted supervised pre-training and self-supervised learning approaches across model capacities and dataset scales. Our results suggest that pretext learning is a promising direction for representation learning in medical image analysis, especially in the small data regime.
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Yin Y, Looney P, Collins SL. Standardization of blood flow measurements by automated vascular analysis from power Doppler ultrasound scan. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11314. [PMID: 33132475 DOI: 10.1117/12.2549349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yi Yin
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Pádraig Looney
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Sally L Collins
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Fetal Medicine Unit, The Womens Centre, John Radcliffe Hospital, Oxford, UK
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Cheung W, Stevenson GN, de Melo Tavares Ferreira AEG, Alphonse J, Welsh AW. Feasibility of image registration and fusion for evaluation of structure and perfusion of the entire second trimester placenta by three-dimensional power Doppler ultrasound. Placenta 2020; 94:13-19. [PMID: 32217266 DOI: 10.1016/j.placenta.2020.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/24/2020] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Placental perfusion can be evaluated by 3D power Doppler ultrasound (3D PD-US), particularly using the validated tool 3D Fractional Moving Blood Volume (3D-FMBV); however regional variability and size limitations beyond the first trimester mean that multiple 3D PD-US volumes are required to evaluate the whole organ. PURPOSE We assessed the feasibility of manual offline stitching of second trimester 3D PD-US volumes of the placenta to assess whole organ perfusion using 3D-FMBV. MATERIALS AND METHODS This was a single-centre, prospective, observational cohort study of 36 normal second trimester singleton pregnancies with anterior placentas. 3D PD-US placental volumes were manually segmented offline and stitched together by rigid registration using manually selected, pair-wise coordinates. Data acquisition and offline volume segmentation and stitching were triplicated by a single observer with Dice similarity coefficient (DSC) and Hausdorff distance used to assess consistency. Intraclass correlation coefficient (ICC) was used to assess intra-observer repeatability of 3D-FMBV and placental volume. RESULTS Acquisition and stitching success were 94% and 88%, respectively. Median time for acquisition, segmentation and stitching were 13 min, 40 min and 95 min, respectively. Median intra-observer DSCs were 0.94 and 0.88, and Hausdorff distances were 11.85 mm and 36.6 mm, for segmentations and stitching, respectively. CONCLUSION 3D-ultrasound volume stitching of the placenta is technically feasible. Intra-observer repeatability was good to excellent for all measured parameters. This work demonstrates technical feasibility; further studies may provide the basis of an in-vivo assessment tool to measure the placenta in mid-to late pregnancy.
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Affiliation(s)
- Winnie Cheung
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Gordon N Stevenson
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | | | - Jennifer Alphonse
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Alec W Welsh
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia; Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia.
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Welsh AW, Fowlkes JB, Pinter SZ, Ives KA, Owens GE, Rubin JM, Kripfgans OD, Looney P, Collins SL, Stevenson GN. Three-dimensional US Fractional Moving Blood Volume: Validation of Renal Perfusion Quantification. Radiology 2019; 293:460-468. [PMID: 31573404 PMCID: PMC6800606 DOI: 10.1148/radiol.2019190248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Three-dimensional (3D) fractional moving blood volume (FMBV) derived from 3D power Doppler US has been proposed for noninvasive approximation of perfusion. However, 3D FMBV has never been applied in animals against a ground truth. Purpose To determine the correlation between 3D FMBV and the reference standard of fluorescent microspheres (FMS) for measurement of renal perfusion in a porcine model. Materials and Methods From February 2017 to September 2017, adult pigs were administered FMS before and after measurement of renal 3D FMBV at baseline (100%) and approximately 75%, 50%, and 25% flow levels by using US machines from two different vendors. The 3D power Doppler US volumes were converted and segmented, and correlations between FMS and 3D FMBV were made with simple linear regression (r2). Similarity and reproducibility of manual segmentation were determined with the Dice similarity coefficient and 3D FMBV reproducibility (intraclass correlation coefficient [ICC]). Results Thirteen pigs were studied with 33 flow measurements. Kidney volume (mean Dice similarity coefficient ± standard deviation, 0.89 ± 0.01) and renal segmentation (coefficient of variation = 12.6%; ICC = 0.86) were consistent. The 3D FMBV calculations had high reproducibility (ICC = 0.97; 95% confidence interval: 0.96, 0.98). The 3D FMBV per-pig correlation showed excellent correlation for US machines from both vendors (mean r2 = 0.96 [range, 0.92-1.0] and 0.93 [range, 0.78-1.0], respectively). The correlation between 3D FMBV and perfusion measured with microspheres was high for both US machines (r2 = 0.80 [P < .001] and 0.70 [P < .001], respectively). Conclusion The strong correlation between three-dimensional (3D) fractional moving blood volume (FMBV) and fluorescent microspheres indicates that 3D FMBV shows excellent correlation to perfusion and good reproducibility. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Morrell et al in this issue.
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Affiliation(s)
- Alec W. Welsh
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - J. Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen Z. Pinter
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kimberly A Ives
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Gabe E Owens
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan M. Rubin
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pádraig Looney
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Sally L. Collins
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Fetal Medicine Unit, Women’s Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gordon N. Stevenson
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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Mathewlynn S, Collins SL. Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta. Placenta 2019; 84:32-36. [PMID: 31279487 DOI: 10.1016/j.placenta.2019.06.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022]
Abstract
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. Identifying which pregnancies are at risk of FGR facilitates enhanced surveillance and early delivery before fetal demise can ensue. However, existing risk stratification strategies yield an unacceptably low detection rate. A robust and reliable first trimester screening test for FGR would not only enable high-risk women to be appropriately monitored but would facilitate future trials for possible interventions to enhance fetal growth. Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia. The investigation of novel ultrasound markers for FGR are discussed along with the development of methods for fully automatic placental volume estimation which has the potential for use as part of a multi-variable population-based screening test.
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Affiliation(s)
- S Mathewlynn
- Department of Obstetrics and Gynaecology, Milton Keynes University Hospital, Milton Keynes, UK
| | - S L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK; Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK.
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13
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Schwartz N, Siegal J, Rourke A, Sehgal CM. Placental Pulsatility: Quantitative Assessment of Placental Bed Vasculature by 2-Dimensional Doppler Cine Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:471-479. [PMID: 30121962 PMCID: PMC6347511 DOI: 10.1002/jum.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Vascular resistance is known to be one of the determinants of pulsatile flow. This study aimed to investigate whether quantitative 2-dimensional Doppler ultrasound can capture and evaluate the pulsatility within the placental bed vasculature. METHODS The placental bed vasculature was imaged by directional power Doppler ultrasound. Ten-second cine clips were recorded by using standardized machine settings. A region of interest with a prominent Doppler signal in the uteroplacental interface was analyzed for the percentage of vascularity to generate a time-vascularity waveform. A vascular pulsatility index representing variation over the cardiac cycle was calculated by the ratio of the systolic-diastolic difference in vascularity to the mean vascularity. The acquisitions were repeated with 6 different pulse repetition frequencies (PRFs) and 3 wall motion filter (WMF) settings to evaluate their impact on the Doppler measurements. RESULTS Ten sets of cine clips were analyzed for this study. The pulsatile nature of the vascularity was readily apparent in each cine clip. The measured time-vascularity waveforms showed uniform cyclic variation in vascularity over the cardiac cycle, with systolic vascularity significantly higher than diastolic vascularity at each combination of PRF and WMF (P < .05). A gradual increase in the vascular pulsatility index was observed with an increasing PRF or WMF. Normalization of systolic-to-diastolic measurement provided a stable vascular assessment across the range of PRFs. CONCLUSIONS Doppler cine clips provide a dynamic representation of the placental bed vasculature and a novel analytic approach to quantitatively evaluating the pulsatility of this critical vascular network. Further work is warranted to explore the reproducibility and clinical potential of this approach.
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Affiliation(s)
- Nadav Schwartz
- Maternal Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Siegal
- Maternal Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Aaron Rourke
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chandra M. Sehgal
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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14
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Sun W, Yin S, Wei Q, Zhang Y, Yang Z, Cai A, Wang Y, Lei W. Three-dimensional power Doppler ultrasound evaluation of placental blood flow in normal monochorionic diamniotic twin pregnancies. BMC Pregnancy Childbirth 2018; 18:443. [PMID: 30428855 PMCID: PMC6237010 DOI: 10.1186/s12884-018-2080-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023] Open
Abstract
Background Monochorionic diamniotic (MCDA) twin pregnancies are at higher risk of adverse outcomes and complications, which are attributed to the influence of placental morphology in MCDA twins. Monitoring of placental function is an important index for clinical decisions. The aim of our study was to evaluate the placental blood flow estimated using three-dimensional power Doppler (3D-PD) ultrasound and the vascular indices distribution with gestational age (GA) in normal MCDA twin pregnancies. Methods One hundred four MCDA twin pregnancies and 106 singleton pregnancies (GA range, 14–32 weeks) were included in this prospective study. 3D-PD volume data of each fetus was obtained separately from the placenta at the site of umbilical cord insertion. We analyzed the volume data using sonobiopsy technique. The placental vascularization index (VI), flow index (FI) and vascularizationflow index (VFI), were auto-calculated. The means and standard deviation values of three vascular indices per fetus were calculated and regression analysis of the vascular indices as a function of GA was performed in twin pregnancies. The vascular indices of twin and singleton pregnancies were compared using independent t-test. Results There were no significant differences in VI, FI or VFI among the fetuses of twins (p > 0.05). These vascular indices increased over the course of pregnancy (p < 0.05). We obtained the regression equations for the indices as a function of GA in days: VI = exp. (4.369–28.533/GA) (R2 = 0.699, p < 0.05), FI = exp. (3.916–13.003/GA) (R2 = 0.511, p < 0.05), and VFI = exp. (3.577–37.468/GA) (R2 = 0.675, p < 0.05). There were no significant differences in three vascular indices between MCDA twin and singleton groups (p > 0.05). Conclusions 3D-PD placental data using sonobiopsy technique could reflect the placental blood flow of each twin, which could be applied to the study of placental perfusion in MCDA twin pregnancies. This study also presented the vascular indices distribution with GA in normal twin pregnancies, which might be useful for early detection of MCDA complications.
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Affiliation(s)
- Wei Sun
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaowei Yin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuju Wei
- Department of Obstetrics and Gynecology, the University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ying Zhang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zeyu Yang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ailu Cai
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yu Wang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjia Lei
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
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Qi H, Collins S, Noble JA. Automatic Lacunae Localization in Placental Ultrasound Images via Layer Aggregation. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2018; 11071:921-929. [PMID: 30854531 PMCID: PMC6402041 DOI: 10.1007/978-3-030-00934-2_102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Accurate localization of structural abnormalities is a precursor for image-based prenatal assessment of adverse conditions. For clinical screening and diagnosis of abnormally invasive placenta (AIP), a life-threatening obstetric condition, qualitative and quantitative analysis of ultrasonic patterns correlated to placental lesions such as placental lacunae (PL) is challenging and time-consuming to perform even for experienced sonographers. There is a need for automated placental lesion localization that does not rely on expensive human annotations such as detailed manual segmentation of anatomical structures. In this paper, we investigate PL localization in 2D placental ultrasound images. First, we demonstrate the effectiveness of generating confidence maps from weak dot annotations in localizing PL as an alternative to expensive manual segmentation. Then we propose a layer aggregation structure based on iterative deep aggregation (IDA) for PL localization. Models with this structure were evaluated with 10-fold cross-validations on an AIP database (containing 3,440 images with 9,618 labelled PL from 23 AIP and 11 non-AIP participants). Experimental results demonstrate that the model with the proposed structure yielded the highest mean average precision (mAP=35.7%), surpassing all other baseline models (32.6%, 32.2%, 29.7%). We argue that features from shallower stages can contribute to PL localization more effectively using the proposed structure. To our knowledge, this is the first successful application of machine learning to placental lesion analysis and has the potential to be adapted for other clinical scenarios in breast, liver, and prostate cancer imaging.
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Affiliation(s)
- Huan Qi
- Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
| | - Sally Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - J Alison Noble
- Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
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16
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Gu B, Stevenson GN, Ferreira A, Pathirana S, Sanderson J, Henry A, Alphonse J, Welsh AW. Applying spatial-temporal image correlation to the fetal kidney: Repeatability of 3D segmentation and volumetric impedance indices. Australas J Ultrasound Med 2018; 21:169-178. [DOI: 10.1002/ajum.12094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bonita Gu
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
| | - Gordon N. Stevenson
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
| | - Ana Ferreira
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
| | - Sudeshni Pathirana
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
| | - Jennifer Sanderson
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Locked Bag 2000, Barker Street Randwick New South Wales 2031 Australia
| | - Amanda Henry
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Locked Bag 2000, Barker Street Randwick New South Wales 2031 Australia
- Women's and Children's Health; St George Hospital; Kogarah New South Wales Australia
| | - Jennifer Alphonse
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
| | - Alec W. Welsh
- School of Women's and Children's Health; University of New South Wales; Randwick New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Locked Bag 2000, Barker Street Randwick New South Wales 2031 Australia
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17
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Sun W, Liu J, Zhang Y, Cai A, Yang Z, Zhao Y, Wang Y, Cao Z, Wei Q. Quantitative assessment of placental perfusion by three-dimensional power Doppler ultrasound for twins with selective intrauterine growth restriction in one twin. Eur J Obstet Gynecol Reprod Biol 2018; 226:15-20. [DOI: 10.1016/j.ejogrb.2018.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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Leijnse JEW, de Heus R, de Jager W, Rodenburg W, Peeters LLH, Franx A, Eijkelkamp N. First trimester placental vascularization and angiogenetic factors are associated with adverse pregnancy outcome. Pregnancy Hypertens 2018; 13:87-94. [PMID: 30177079 DOI: 10.1016/j.preghy.2018.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/11/2018] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertensive disorders, fetal growth restriction and preterm birth are major obstetrical complications and are related to impaired placentation. Early identification of impaired placentation can advance clinical care by preventing or postpone adverse pregnancy outcome. OBJECTIVES Determine whether sonographic assessed placental vascular development and concomitant changes in inflammation- and/or angiogenesis-related serumproteins differ in the first trimester between uncomplicated pregnancies and pregnancies with adverse outcome. STUDY DESIGN This prospective longitudinal study defines adverse pregnancy outcome as conditions associated with impaired placentation; fetal growth restriction, hypertensive disorder, preterm birth and placental abruption. The vascularization index, flow index, vascularization flow index and placental volume were determined at 8, 10 and 12 weeks pregnancy from 64 women using 3D power Doppler. Serum levels were analyzed for Angiopoetin-1 and -2, Leptin, VEGF-R, VEGF, and EGF. RESULTS The vascularization index and vascular flow index increased in uneventful pregnancies with almost 50% between 8 and 12 weeks, resulting in a ∼50% higher vascularization index at 12 weeks compared to women with an adverse pregnancy outcome. Women with an adverse pregnancy outcome (n = 13) had significantly lower indices and placental volumes at all time points measured and these indices did not increase between 8 and 12 weeks. Reduced vascular development was associated with increased Angiopoietin-1 levels at 8 and 12 weeks and increased Leptin levels at 8 weeks. CONCLUSIONS Pregnancies with an adverse outcome caused by conditions associated with impaired placentation differ from uneventful pregnancies in having reduced placental vascularization accompanied by elevated circulating levels of Angiopoietin-1 and Leptin already in the first trimester.
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Affiliation(s)
- Johanna E W Leijnse
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands.
| | - Roel de Heus
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Wilco de Jager
- Department of Pediatric Immunology, Laboratory of Translational Immunology and Multiplex Core Facility, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Wendy Rodenburg
- National Institute for Public Health and Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Louis L H Peeters
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Niels Eijkelkamp
- Laboratory of Neuroimmunology and Developmental Origins of Disease (NIDOD), Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3584 EA Utrecht, The Netherlands
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Stevenson GN, Noble JA, Welsh AW, Impey L, Collins SL. Automated Visualization and Quantification of Spiral Artery Blood Flow Entering the First-Trimester Placenta, Using 3-D Power Doppler Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:522-531. [PMID: 29305123 PMCID: PMC6479225 DOI: 10.1016/j.ultrasmedbio.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/29/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
The goal of our research was to quantify the placental vascularity in 3-D at 11-13 + 6 wk of pregnancy at precise distances from the utero-placental interface (UPI) using 3-D power Doppler ultrasound. With this automated image analysis technique, differences in vascularity between normal and pathologic pregnancies may be observed. The algorithm was validated using a computer-generated image phantom and applied retrospectively in 143 patients. The following features from the PD data were recorded: The number of spiral artery jets into the inter-villous space, total geometric and PD area. These were automatically measured at discrete millimeter distances from the UPI. Differences in features were compared with pregnancy outcomes: Pre-eclamptic versus normal, all small-for-gestational age (SGA) to appropriate-for-gestational age (AGA) patients and AGA versus SGA in normotensives (Mann-Whitney). The Benjamini-Hochberg procedure was used (false discovery rate 10%) for multiple comparison testing. Features decreased with increasing distance from the UPI (Kruskal-Wallis test; p <0.001). At 2- 3 mm from the UPI, all features were smaller in pre-eclamptic compared with normal patients and for some in SGA compared with AGA patients (p <0.05). For AGA versus SGA in normotensive patients, no significant differences were found. Number of jets measured at 2-5 mm from the UPI did not vary because of the position of the placenta in the uterus (ANOVA; p > 0.05). This method provides a new in-vivo imaging tool for examining spiral artery development through pregnancy. Size and number of entrances of blood flow into the UPI could potentially be used to identify high-risk pregnancies and may provide a new imaging biomarker for placental insufficiency.
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Affiliation(s)
- Gordon N Stevenson
- School of Womens' & Childrens' Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - J Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Alec W Welsh
- School of Womens' & Childrens' Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - Lawrence Impey
- The Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sally L Collins
- The Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
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20
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Stevenson GN, Keshavarzi R, de Melo Tavares Ferreira AG, Barber T, Welsh AW. Spatio-temporal Image Correlation (STIC): Estimation of Heart Rate Using STIC Compared with 2-D Pulsed Wave Doppler in a Flow Phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2507-2508. [PMID: 28743376 DOI: 10.1016/j.ultrasmedbio.2017.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Gordon N Stevenson
- School of Women's & Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Reza Keshavarzi
- School of Mechanical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Tracie Barber
- School of Mechanical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Alec W Welsh
- School of Women's & Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia.
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21
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Nieuwenhuis LL, Hehenkamp WJK, Brölmann HAM, Huirne JAF. 3D power Doppler in uterine fibroids; influence of gain, cardiac cycle and off-line measurement techniques. J OBSTET GYNAECOL 2017; 38:103-109. [PMID: 28780884 DOI: 10.1080/01443615.2017.1330323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study answers the question of whether ultrasound machine settings and the cardiac cycle can influence 3D power Doppler (3D PD) indices in the evaluation of uterine fibroid vascularisation. These parameters were reported to affect the vascular indices and cause undesired variation. 3D PD ultrasound was performed using three different gain settings: a fixed predetermined gain (50 dB), a higher gain (65 dB) and an individualised subjectively most optimal gain. Two consecutive 3D PD sweeps were taken to evaluate the effect of the cardiac cycle. A predetermined most optimal fixed gain setting was not different from the individually most optimal chosen gain in vascular assessment of fibroids. A higher gain corresponded with a significantly higher vascular index (VI). Potential variation during the cardiac cycle does not disturb the VI in fibroids.
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Affiliation(s)
- L L Nieuwenhuis
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - W J K Hehenkamp
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - H A M Brölmann
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
| | - J A F Huirne
- a Department of Obstetrics and Gynaecology , VU University Medical Centre , Amsterdam , The Netherlands
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Wu L, Ferreira A, Stevenson GN, Sanderson J, Mahajan A, Meriki N, Welsh AW. Novel spatial-temporal image correlation derived indices of tissue vascular impedance: A variability study. Australas J Ultrasound Med 2017; 20:115-122. [DOI: 10.1002/ajum.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Linda Wu
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Ana Ferreira
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Gordon N Stevenson
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
| | - Jennifer Sanderson
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
| | - Aditi Mahajan
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
| | - Neama Meriki
- Department of Obstetrics & Gynecology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Department of Maternal Fetal Medicine; King Khalid University Hospital; Riyadh Saudi Arabia
| | - Alec W Welsh
- School of Women's & Children's Health; UNSW Sydney; Sydney New South Wales Australia
- Department of Maternal-Fetal Medicine; Royal Hospital for Women; Sydney New South Wales Australia
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Qi H, Collins S, Noble A. Weakly Supervised Learning of Placental Ultrasound Images with Residual Networks. MEDICAL IMAGE UNDERSTANDING AND ANALYSIS : 21ST ANNUAL CONFERENCE, MIUA 2017, EDINBURGH, UK, JULY 11-13, 2017, PROCEEDINGS. MEDICAL IMAGE UNDERSTANDING AND ANALYSIS (CONFERENCE) (21ST : 2017 : EDINBURGH, SCOTLAND) 2017; 723:98-108. [PMID: 31660542 PMCID: PMC6816799 DOI: 10.1007/978-3-319-60964-5_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Accurate classification and localization of anatomical structures in images is a precursor for fully automatic image-based diagnosis of placental abnormalities. For placental ultrasound images, typically acquired in clinical screening and risk assessment clinics, these structures can have quite indistinct boundaries and low contrast, and image-level interpretation is a challenging and time-consuming task even for experienced clinicians. In this paper, we propose an automatic classification model for anatomy recognition in placental ultrasound images. We employ deep residual networks to effectively learn discriminative features in an end-to-end fashion. Experimental results on a large placental ultra-sound image database (10,808 distinct 2D image patches from 60 placental ultrasound volumes) demonstrate that the proposed network architecture design achieves a very high recognition accuracy (0.086 top-1 error rate) and provides good localization for complex anatomical structures around the placenta in a weakly supervised fashion. To our knowledge this is the first successful demonstration of multi-structure detection in placental ultrasound images.
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Affiliation(s)
- Huan Qi
- Institute of Biomedical Engineering (IBME), University of Oxford
| | - Sally Collins
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford
| | - Alison Noble
- Institute of Biomedical Engineering (IBME), University of Oxford
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Collins SL, Welsh AW, Impey L, Noble JA, Stevenson GN. 3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby. PLoS One 2017; 12:e0178675. [PMID: 28570600 PMCID: PMC5453560 DOI: 10.1371/journal.pone.0178675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To undertake an observational study to see whether first trimester placental vascularity, measured with a standardized power Doppler index: 3D-FMBV, is different in pregnancies which either develop pre-eclampsia or lead to term, normotensive small for gestational age (SGA) babies. METHODS Women were scanned between 11 and 13+6 weeks. The placental volume (sPlaV) was estimated using our previously validated semi-automated tool. Estimates of 3D-FMBV were generated from the raw power Doppler signal for the whole utero-placental interface, UPI (FMBV-UPI) and 5mm into the placenta (FMBV-IVS). Differences in the placental volume and FMBV for pregnancies developing pre-eclampsia and resulting in term, normotensive SGA babies were compared with term, normotensive, appropriate for gestational age (AGA), controls. RESULTS Results were available for 143 women. The placental volume (sPlaV) was reduced in both pre-eclampsia (p = 0.007) and term, normotensive SGA (p = 0.001) when compared with term normotensive AGA controls. 3D-FMBV estimates were significantly lower for pregnancies developing pre-eclampsia (FMBV-UPI, p = 0.03, FMBV-IVS, p = 0.01) but not for the normotensive SGA pregnancies (FMBV-UPI, p = 0.16, FMBV-IVS, p = 0.27). CONCLUSION Pregnancies destined to develop pre-eclampsia are more likely to have small placentas with significantly reduced vascularity at 11-13 weeks. Those pregnancies which were normotensive throughout but resulted in an SGA baby delivered at term, had significantly smaller placentas but with similar vascularity to normotensive AGA pregnancies.
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Affiliation(s)
- Sally L. Collins
- The Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail:
| | - Alec W. Welsh
- School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Lawrence Impey
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - J. Alison Noble
- The Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Gordon N. Stevenson
- School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
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Nieuwenhuis LL, Keizer AL, Stoelinga B, Twisk J, Hehenkamp W, Brölmann H, Huirne J. Fibroid vascularisation assessed with three-dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study. BJOG 2017; 125:577-584. [PMID: 28211610 DOI: 10.1111/1471-0528.14608] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse fibroid vascularisation measured with three-dimensional (3D) power Doppler in relation to absolute fibroid volume change during 12 months of follow up and in relation to fibroid growth rate per year. DESIGN A prospective cohort study was performed between March 2012 and March 2014. SETTING Outpatient clinic of the VU medical centre, Amsterdam. POPULATION OR SAMPLE All premenopausal women diagnosed with a maximum of two fibroids with expectant management were consecutively included. METHODS Three-dimensional ultrasound including power Doppler was performed at baseline, 3, 6 and 12 months. Volume and vascular parameters were calculated using VOCAL software. MAIN OUTCOME MEASURES The relationship between vascular index (VI) at baseline and fibroid volume over time was analysed using linear mixed model analyses for repeated measurements. Second, the relationship between VI at baseline and fibroid growth rate per year was calculated using linear regression analyses. Analyses were adjusted for possible confounders. RESULTS In all, 66 women (mean age 42 years) completed 12 months of follow up without treatment. Baseline fibroid vascularisation (VI) measured with 3D power Doppler is correlated with fibroid volume at 12 months (P = 0.02 ). An increase of 1% in VI at baseline was associated with a 7.00-cm3 larger fibroid volume at 12 months. Furthermore, vascularisation was also associated with fibroid growth rate per year (P = 0.04). CONCLUSION In women with uterine fibroids without therapy, baseline vascularisation (VI) measured with 3D power Doppler is correlated with absolute fibroid volume change at 12 months and with fibroid growth rate per year. TWEETABLE ABSTRACT Fibroid vascularisation correlates with absolute fibroid volume change and fibroid growth rate per year.
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Affiliation(s)
- L L Nieuwenhuis
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - A L Keizer
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - B Stoelinga
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jwr Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Wjk Hehenkamp
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ham Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jaf Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
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Schindler T, Gilbert Y, Jayatilake S, Stevenson G, Oei JL, Welsh A. Basal ganglia perfusion in the preterm infant during transition. Pediatr Res 2016; 80:573-6. [PMID: 27304098 DOI: 10.1038/pr.2016.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The preterm brain is susceptible to changes in blood flow. Using power Doppler images, digital imaging techniques have been developed to measure the total amount of blood flow in a defined area, giving the index: fractional moving blood volume (FMBV). The aim of this study was to investigate temporal changes in basal ganglia perfusion during the transitional period after birth. METHODS Twenty-four preterm infants were examined with serial cranial ultrasounds at four time points during the first 48 h of life. FMBV was calculated using power Doppler images at each time point. RESULTS All infants had analyzable data and FMBV was successfully calculated at all time points. Twenty-three of the 24 infants had an increasing trend in FMBV over time. The median FMBV increased from 17% at 6 h to 25% at 48 h. One-way repeated measures ANOVA showed a significant increase in values at P < 0.001 at each of the four time points. CONCLUSION We have demonstrated changes in basal ganglia blood flow as the cerebral circulation adapts to extrauterine life. With further investigation, this technique may be useful in the assessment of preterm circulatory adaptation, either alone or in conjunction with other modes of evaluating cerebral blood flow.
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Affiliation(s)
- Tim Schindler
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
| | - Yasmin Gilbert
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Sonali Jayatilake
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gordon Stevenson
- Department of Engineering Science, University of Oxford, Oxford, England
| | - Ju Lee Oei
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
| | - Alec Welsh
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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Duan J, Chabot-Lecoanet AC, Perdriolle-Galet E, Christov C, Hossu G, Cherifi A, Morel O. Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study. BMJ Open 2016; 6:e009909. [PMID: 27033959 PMCID: PMC4823389 DOI: 10.1136/bmjopen-2015-009909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental vascularisation and three vascular indices have been calculated: the vascularisation index (VI), flow index (FI) and vascularisation-FI (VFI). However, several technical endpoints hinder the clinical use of 3DPD as physical characteristics and machine settings may affect 3DPD indices, and so its clinical significance is not yet clear. OBJECTIVES The primary objective is to better understand the clinical significance of 3DPD indices by evaluating the relationship between these indices and placental morphometry. Secondary objectives are (i) to determine the impact of machine settings and physical characteristics on 3DPD indices, and (ii) to evaluate physio-pathological placental vascularisation patterns. METHODS AND ANALYSIS This is a prospective controlled study. We expect to include 112 women: 84 with normal pregnancies and 28 with PE and/or IUGR (based on our former cohort study on 3DPD indices for PE and/or IUGR prediction (unpublished data)). Within 72 h before planned or semi-urgent caesarean section, utero-placental 3DPD images with five different machine settings will be acquired. Placentas will be collected and examined after surgery and stereological indices (volume density, surface density, length density) calculated. The 3DPD indices (VI, FI and VFI) of the placenta and adjacent myometrium will be calculated. Correlation between Doppler and morphological indices will be evaluated by Pearson or Spearman tests. Agreement between 3DPD indices and morphological indices will be assessed by Bland and Altman plots. The impact of Doppler settings and maternal characteristics on 3DPD indices will be evaluated with a multivariate linear regression model. ETHICS The study and related consent forms have been approved by the French Ethics Committee (CPP, Comité de Protection des Personnes) Est III on 4 March 2014.
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Affiliation(s)
- Jie Duan
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Anne-Claire Chabot-Lecoanet
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Estelle Perdriolle-Galet
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Christophe Christov
- Service Commun de Microscopie, Faculté de Médecine, University of Lorraine, Vandoeuvre-Lès-Nancy, France
- Laboratory of Fetal and Placental Pathology, CHRU Nancy, Nancy, France
| | | | | | - Olivier Morel
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
- PremUp Foundation, Paris, France
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Schindler T, Gilbert Y, Wu L, Oei JL, Welsh A. Spatiotemporal Image Correlation and Volumetric Impedance Indices in the Neonatal Brain: Proof of Concept and Preliminary Reproducibility. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:505-510. [PMID: 26860484 DOI: 10.7863/ultra.15.05022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Changes in tissue perfusion can be critically important in the vulnerable neonate, but they are very difficult to assess at the bedside. Spatiotemporal image correlation (STIC) sonography is an exciting concept that allows assessment of blood flow by rearranging and merging multiple 2-dimensional color images to create serial 3-dimensional images showing regional blood flow throughout the cardiac cycle. Variations in tissue blood flow may reflect tissue impedance and perfusion. The aim of this study was to demonstrate that it is possible to use STIC images to evaluate tissue impedance in the neonatal brain. METHODS Spatiotemporal image correlation data sets were acquired by cranial sonography in 19 neonates. Offline data analysis was performed by using virtual organ computer-aided analysis. With the use of STIC images from different phases of the cardiac cycle, impedance indices were calculated, based on maximum (systolic), minimum (diastolic), and mean virtual organ computer-aided analysis values, in the same way that resistive indices are calculated in 2-dimensional sonography. RESULTS Volumetric indices for tissue impedance were obtained for all neonates. Intraclass correlation coefficients (95% confidence intervals) for volumetric impedance indices were as follows: systolic/diastolic ratio, 0.793 (0.615-0.906); pulsatility index, 0.790 (0.609-0.905); and resistive index, 0.783 (0.598-0.901). Interclass correlation coefficients for image processing and analysis were as follows: systolic/diastolic ratio, 0.868 (0.692-0.947); pulsatility index, 0.904 (0.772-0.962); and resistive index, 0.914 (0.794-0.966). CONCLUSIONS This study shows that STIC data sets can be used to calculate volumetric impedance indices in the neonatal brain. Preliminary assessment shows that this technique appears reliable and allows evaluation of regional tissue impedance in the neonate.
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Affiliation(s)
- Tim Schindler
- Departments of Newborn Care (T.S., J.L.O.) and Maternal-Fetal Medicine (A.W.), Royal Hospital for Women, Randwick, New South Wales, Australia; and Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia (T.S., Y.G., L.W., J.L.O., A.W.)
| | - Yasmin Gilbert
- Departments of Newborn Care (T.S., J.L.O.) and Maternal-Fetal Medicine (A.W.), Royal Hospital for Women, Randwick, New South Wales, Australia; and Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia (T.S., Y.G., L.W., J.L.O., A.W.)
| | - Linda Wu
- Departments of Newborn Care (T.S., J.L.O.) and Maternal-Fetal Medicine (A.W.), Royal Hospital for Women, Randwick, New South Wales, Australia; and Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia (T.S., Y.G., L.W., J.L.O., A.W.)
| | - Ju Lee Oei
- Departments of Newborn Care (T.S., J.L.O.) and Maternal-Fetal Medicine (A.W.), Royal Hospital for Women, Randwick, New South Wales, Australia; and Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia (T.S., Y.G., L.W., J.L.O., A.W.)
| | - Alec Welsh
- Departments of Newborn Care (T.S., J.L.O.) and Maternal-Fetal Medicine (A.W.), Royal Hospital for Women, Randwick, New South Wales, Australia; and Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia (T.S., Y.G., L.W., J.L.O., A.W.)
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Collins SL, Ashcroft A, Braun T, Calda P, Langhoff-Roos J, Morel O, Stefanovic V, Tutschek B, Chantraine F. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:271-275. [PMID: 26205041 DOI: 10.1002/uog.14952] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/30/2015] [Accepted: 07/12/2015] [Indexed: 05/26/2023]
Affiliation(s)
- S L Collins
- The Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - A Ashcroft
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - T Braun
- Department of Obstetrics and Division of Experimental Obstetrics, Study Group Perinatal Programming, Charité Campus Virchow, Berlin, Germany
| | - P Calda
- Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O Morel
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - V Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - F Chantraine
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- University of Liège, CHR de la Citadelle, Liège, Belgium
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30
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Miyague AH, Pavan TZ, Soares CA, De Catte L, Nastri CO, Welsh AW, Martins WP. Importance of Pulse Repetition Frequency Adjustment for 3- and 4-Dimensional Power Doppler Quantification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2245-2251. [PMID: 26543167 DOI: 10.7863/ultra.15.01021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the influence of the pulse repetition frequency (PRF) and wall motion filter on the 3-dimensional (3D) power Doppler vascularization-flow index (VFI) and volumetric pulsatility index (PI) obtained from spatiotemporal image correlation (STIC) data sets acquired from a common carotid artery of a healthy participant. METHODS We acquired 11 STIC data sets, 1 for each PRF value ranging from 0.6 to 9.0 kHz. Vascularization-flow index and volumetric PI values were determined from the 440 static 3D data sets contained in these STIC data sets. Additionally, 3 sets of radio-frequency data were acquired for offline processing of different wall motion filter values for PRF values of 0.6, 3.3, and 10 kHz. RESULTS We constructed VFI curves and observed 2 patterns: a flattened pattern with a low PRF and a triphasic pattern with a high PRF, correlating with the known pulsed wave Doppler profile of this vessel. Volumetric PI values were around 0 for low PRF settings and increased with increasing PRF. Analysis of the radiofrequency data showed that increasing wall motion filter values gradually filtered out the low-velocity power Doppler signals while retaining the higher-velocity ones, allowing the distinction of integrated power Doppler signal velocity throughout the cardiac cycle. CONCLUSIONS We conclude that the PRF and wall motion filter dramatically influence 3D power Doppler indices and the volumetric PI, and the use of PRF values in which minimum VFI values are measured during the diastolic phase in the spectral Doppler wave may validate the use of the volumetric PI.
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Affiliation(s)
- Andre H Miyague
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Theo Z Pavan
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Carlos A Soares
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Luc De Catte
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Carolina O Nastri
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Alec W Welsh
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.)
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto (A.H.M., C.A.S., C.O.N., W.P.M.), and Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto (T.Z.P.), University of São Paulo, Ribeirao Preto, Brazil; Department of Obstetrics and Gynecology, University Hospital Evangelico, Curitiba, Brazil (A.H.M.); Woman and Fetal Medicine Institute, Curitiba, Brazil (A.H.M.); Ultrasonography and Retraining Medical School of Ribeirão Preto, Ribeirão Preto, Brazil (C.A.S., C.O.N., W.P.M.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (L.D.C.); School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia (A.W.W.); and Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia (A.W.W.).
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Stevenson GN, Collins SL, Ding J, Impey L, Noble JA. 3-D Ultrasound Segmentation of the Placenta Using the Random Walker Algorithm: Reliability and Agreement. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3182-3193. [PMID: 26341043 DOI: 10.1016/j.ultrasmedbio.2015.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 07/07/2015] [Accepted: 07/16/2015] [Indexed: 06/05/2023]
Abstract
Volumetric segmentation of the placenta using 3-D ultrasound is currently performed clinically to investigate correlation between organ volume and fetal outcome or pathology. Previously, interpolative or semi-automatic contour-based methodologies were used to provide volumetric results. We describe the validation of an original random walker (RW)-based algorithm against manual segmentation and an existing semi-automated method, virtual organ computer-aided analysis (VOCAL), using initialization time, inter- and intra-observer variability of volumetric measurements and quantification accuracy (with respect to manual segmentation) as metrics of success. Both semi-automatic methods require initialization. Therefore, the first experiment compared initialization times. Initialization was timed by one observer using 20 subjects. This revealed significant differences (p < 0.001) in time taken to initialize the VOCAL method compared with the RW method. In the second experiment, 10 subjects were used to analyze intra-/inter-observer variability between two observers. Bland-Altman plots were used to analyze variability combined with intra- and inter-observer variability measured by intra-class correlation coefficients, which were reported for all three methods. Intra-class correlation coefficient values for intra-observer variability were higher for the RW method than for VOCAL, and both were similar to manual segmentation. Inter-observer variability was 0.94 (0.88, 0.97), 0.91 (0.81, 0.95) and 0.80 (0.61, 0.90) for manual, RW and VOCAL, respectively. Finally, a third observer with no prior ultrasound experience was introduced and volumetric differences from manual segmentation were reported. Dice similarity coefficients for observers 1, 2 and 3 were respectively 0.84 ± 0.12, 0.94 ± 0.08 and 0.84 ± 0.11, and the mean was 0.87 ± 0.13. The RW algorithm was found to provide results concordant with those for manual segmentation and to outperform VOCAL in aspects of observer reliability. The training of an additional untrained observer was investigated, and results revealed that with the appropriate initialization protocol, results for observers with varying levels of experience were concordant. We found that with appropriate training, the RW method can be used for fast, repeatable 3-D measurement of placental volume.
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Affiliation(s)
- Gordon N Stevenson
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK; Evelyn Perinatal Imaging Centre, Rosie Hospital, Cambridge, UK.
| | - Sally L Collins
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK; Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Jane Ding
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Lawrence Impey
- Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - J Alison Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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32
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Three-Dimensional Power Doppler Ultrasonography for Diagnosing Abnormally Invasive Placenta and Quantifying the Risk. Obstet Gynecol 2015. [PMID: 26214694 DOI: 10.1097/aog.0000000000000962] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test an objective ultrasound marker for diagnosing the presence and severity of abnormally invasive placenta. METHODS Women at risk of abnormally invasive placenta underwent a three-dimensional power Doppler ultrasound scan. The volumes were examined offline by a blinded observer. The largest area of confluent three-dimensional power Doppler signal (Area of Confluence [Acon], cm) at the uteroplacental interface was measured and compared in women subsequently diagnosed with abnormally invasive placenta and women in a control group who did not have abnormally invasive placenta. Receiver operating characteristic curves were plotted for prediction of abnormally invasive placenta and abnormally invasive placenta requiring cesarean hysterectomy. RESULTS Ninety-three women were recruited. Results were available for 89. Abnormally invasive placenta was clinically diagnosed in 42 women; 36 required hysterectomy and had abnormally invasive placenta confirmed histopathologically. Median and interquartile range for Acon was greater for abnormally invasive placenta (44.2 [31.4-61.7] cm) compared with women in the control group (4.5 cm [2.9-6.6], P<.001) and even greater in the 36 requiring hysterectomy (46.6 cm [37.2-72.6], P<.001). Acon rose with histopathologic diagnosis: focal accreta (32.2 cm [17.2-57.3]), accreta (59.6 cm [40.1-89.9]), and percreta (46.6 cm [37.5-71.5]; P<.001 analysis of variance for linear trend). Receiver operating characteristic analysis for prediction of abnormally invasive placenta revealed that with an Acon of 12.4 cm or greater, 100% sensitivity (95% confidence interval [CI] 91.6-100) could be obtained with 92% specificity (95% CI 79.6-97.6); area under the curve is 0.99 (95% CI 0.94-1.0). For prediction of abnormally invasive placenta requiring hysterectomy, 100% sensitivity (95% CI 90.3-100) can be obtained with an Acon of 17.4 cm or greater with 87% specificity (95% CI 74.7-94.5; area under the curve 0.98 [0.93-1.0]). CONCLUSION The marker Acon provides a quantitative means for diagnosing abnormally invasive placenta and assessing severity. If further validated, subjectivity could be eliminated from the diagnosis of abnormally invasive placenta. LEVEL OF EVIDENCE II.
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[Placental 3D Doppler angiography: current and upcoming applications]. ACTA ACUST UNITED AC 2014; 44:107-18. [PMID: 25307617 DOI: 10.1016/j.jgyn.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
The placental dysfunction, which seems to be caused by a defect of trophoblastic invasion and impaired uterine vascular remodeling since the first trimester, is responsible in a non-exclusive way for the chronic placental hypoxia, resulting secondarily in the intra-uterine growth restriction (IUGR) and/or pre-eclampsia (PE). The quality of utero-placental vasculature is essential for a proper fetal development and a successful progress of pregnancy. However, the in vivo assessment of placental vascularization with non-invasive methods is complicated by the small size of placental terminal vessel and its complex architecture. Moreover, imaging with contrast agent is not recommended to pregnant women. Until recently, the fetal and maternal vascularization could only be evaluated through pulse Doppler of uterine arteries during pregnancy, which has little clinical value for utero-placental vascularization defects assessment. Recently, a non-invasive study, without use of contrast agent for vasculature evaluation of an organ of interest has become possible by the development of 3D Doppler angiography technique. The objective of this review was to make an inventory of its current and future applications for utero-placental vasculature quantification. The main findings of the literature on the assessment of utero-placental vascularization in physiological situation and major placental vascular dysfunction pathologies such as PE and IUGR were widely discussed.
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Stevenson GN, Collins SL, Welsh AW, Impey LW, Noble JA. A technique for the estimation of fractional moving blood volume by using three-dimensional power Doppler US. Radiology 2014; 274:230-7. [PMID: 25117590 DOI: 10.1148/radiol.14132363] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To (a) demonstrate an image-processing method that can automatically measure the power Doppler signal in a three-dimensional ( 3D three-dimensional ) ultrasonographic (US) volume by using the location of organs within the image and (b) compare 3D three-dimensional fractional moving blood volume ( FMBV fractional moving blood volume ) results with commonly used, unstandardized measures of 3D three-dimensional power Doppler by using the human placenta as the organ of interest. MATERIALS AND METHODS This is a retrospective study of scans obtained as part of a prospective study of imaging placental biomarkers with US, performed with ethical approval and written informed consent. One hundred forty-three consecutive female patients were examined by using an image-processing technique. Three-dimensional FMBV fractional moving blood volume was measured on the vasculature from the uteroplacental interface to a depth 5 mm into the placenta by using a normalization volume 10 mm outside the uteroplacental interface and compared against the Virtual Organ Computer-aided AnaLysis ( VOCAL Virtual Organ Computer-aided AnaLysis ; GE Healthcare, Milwaukee, Wis) vascularization flow index ( VFI vascularization flow index ). Intra- and interobserver variability was assessed in a subset of 18 volumes. Wilcoxon signed rank test and intraclass correlation coefficients were used to assess measurement repeatability. RESULTS The mean 3D three-dimensional FMBV fractional moving blood volume value ± standard deviation was 11.78% ± 9.30 (range, 0.012%-44.16%). Mean VFI vascularization flow index was 2.26 ± 0.96 (range, 0.15-6.06). Linear regression of VFI vascularization flow index versus FMBV fractional moving blood volume produced an R(2) value of 0.211 and was significantly different in distribution (P < .001). Intraclass correlation coefficient analysis showed higher FMBV fractional moving blood volume values than VFI vascularization flow index for intra- and interobserver variability; intraobserver values were 0.95 for FMBV fractional moving blood volume (95% confidence interval [ CI confidence interval ]: 0.90, 0.98) versus 0.899 for VFI vascularization flow index (95% CI confidence interval : 0.78, 0.96), and interobserver values were 0.93 for FMBV fractional moving blood volume (95% CI confidence interval : 0.82, 0.97) versus 0.67 for VFI vascularization flow index (95% CI confidence interval : 0.32, 0.86). CONCLUSION The extension of an existing two-dimensional standardized power Doppler measurement into 3D three-dimensional by using an image-processing technique was shown in an in utero placental study. Three-dimensional FMBV fractional moving blood volume and VFI vascularization flow index produced significantly different results. FMBV fractional moving blood volume performed better than VFI vascularization flow index in repeatability studies. Further studies are needed to assess accuracy against a reference standard.
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Affiliation(s)
- Gordon N Stevenson
- From the Institute of Biomedical Engineering, Department of Engineering Science (G.N.S., J.A.N.), and Nuffield Department of Obstetrics and Gynaecology (S.L.C.), University of Oxford, Oxford, England; School of Women's & Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, NSW, Australia (A.W.W.); and Fetal Medicine Unit, John Radcliffe Hospital, Oxford, England (S.L.C., L.W.I.)
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Sanderson J, Wu L, Mahajan A, Meriki N, Henry A, Welsh AW. Selection of the sub-noise gain level for acquisition of VOCAL data sets: a reliability study. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:562-567. [PMID: 24361225 DOI: 10.1016/j.ultrasmedbio.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/29/2013] [Accepted: 09/01/2013] [Indexed: 06/03/2023]
Abstract
This study was aimed at assessing the intra-observer and inter-observer repeatability of selecting the sub-noise gain (SNG) level when acquiring placental volumes with 3-D power Doppler for analysis using virtual organ computer-aided analysis (VOCAL). Sixty women with uncomplicated singleton pregnancies between 20 and 38 wk of gestation were recruited. Two women were excluded for flash artifact noted during image analysis. Two blinded observers independently adjusted gain to their perceived SNG level before acquiring a static 3-D volume of the placenta at the cord insertion; observers alternated after each acquisition until each had acquired two volumes. A single observer operated the probe at all times. During offline analysis, SNG levels were recorded and VOCAL indices were calculated. SNG exhibited excellent intra-observer and inter-observer reliability. Intra-observer intra-class correlation coefficients (95% confidence intervals) were 0.98 (0.97-0.99) and 0.98 (0.98-0.99) for observers 1 and 2, respectively. The inter-observer intra-class correlation coefficient was 0.96 (0.93-0.98). Despite its perceived inherent subjectivity, the excellent intra-class correlation coefficients obtained in this study support SNG as a promising tool for future research using 3-D power Doppler.
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Affiliation(s)
- Jennifer Sanderson
- Department of Maternal-Fetal Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Wu
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Aditi Mahajan
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Neama Meriki
- Department of Maternal-Fetal Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Obstetrics & Gynaecology, King Saud University, Riyadh, Saudi Arabia
| | - Amanda Henry
- Department of Maternal-Fetal Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alec W Welsh
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Australian Centre for Perinatal Science, University of New South Wales, Sydney, New South Wales, Australia.
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Welsh A. Re: assessing repeatability of 3D Doppler indices obtained by static 3D and STIC power Doppler: a combined in-vivo/in-vitro flow phantom study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:608. [PMID: 24166884 DOI: 10.1002/uog.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A Welsh
- Royal Hospital for Women, Department of Maternal-Fetal Medicine, Randwick, Sydney, NSW, Australia
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Miyague AH, Raine-Fenning NJ, Pavan TZ, Polanski LT, Baumgarten MN, Nastri CO, Martins WP. Influence of gain adjustment on 3-dimensional power Doppler indices and on spatiotemporal image correlation volumetric pulsatility indices using a flow phantom. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1831-1836. [PMID: 24065264 DOI: 10.7863/ultra.32.10.1831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Spatiotemporal image correlation can be used to acquire 3-dimensional power Doppler information across a single cardiac cycle. Assessment and comparison of the systolic and diastolic components of the data sets allow measurement of the recently introduced "volumetric pulsatility index" (vPI) through algorithms comparable with those used in 2-dimensional Doppler waveform analysis. The vPI could potentially overcome the dependency on certain machine settings, such as power, color gain, pulse repetition frequency, and attenuation, since these factors would affect the power Doppler signal equally throughout the cardiac cycle. The objective of this study was to compare the effect of color gain on the vascularization index (VI), vascularization-flow index (VFI), and vPI using an in vitro flow phantom model. We separated gains into 3 bands: -8 to -1 (no noise), -1 to +5 (low noise), and +5 to +8 (obvious noise). The vPI was determined from the 3-dimensional VI or VFI using the formula vPI = (maximum - minimum)/mean. Using no-noise gains, we observed that although the VI and VFI increased linearly with gain, the vPI was substantially less dependent on this adjustment. The VI and VFI continued to increase linearly with gain, whereas the vPI decreased slightly using low-noise gains. When gain was increased above the lower limit of obvious noise (+5), the VI and VFI increased noticeably, and there were marked reductions in both vPI values. We conclude that the vPI is less affected by changes in color gain than the VI and VFI at no-noise gains.
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Affiliation(s)
- Andre H Miyague
- Department of Obstetrics and Gynecology, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes 3900, 8° Andar, Ribeirão Preto, 14049-900 São Paulo-SP, Brazil.,
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Welsh AW, Collins SL, Stevenson GN, Noble JA, Impey L. Inapplicability of fractional moving blood volume technique to standardize Virtual Organ Computer-aided AnaLysis indices for quantified three-dimensional power Doppler. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:688-692. [PMID: 22344971 DOI: 10.1002/uog.11139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine whether the technique of fractional moving blood volume (FMBV) is applicable to Virtual Organ Computer-aided AnaLysis II (VOCAL II™)-based indices to quantify three-dimensional power Doppler ultrasound (3D-PDU) by investigating the effect of gain level on the indices measured at a possible reference point for standardization. METHODS Ten women with singleton pregnancy between 33+3 and 37+5 weeks' gestation were recruited. The optimal position for 3D acquisition of cord insertion into the placenta was identified and static 3D-PDU volumes were acquired using consistent machine configurations. Without moving the probe or the participant changing position, successive 3D volumes were stored at -3, -5, -7 and -9 dB and at the individualized sub-noise gain (SNG) level. Volumes were excluded if flash artifact was present, in which case all five volumes were reacquired. Using 4D View software, the cord insertion was magnified and the smallest sphere possible was used to measure vascularization index (VI), flow index (FI) and vascularization flow index (VFI). The associations between VOCAL indices and gain level were assessed using Pearson's correlation coefficient. RESULTS VOCAL indices for cord insertion correlated poorly with gain level, whether fundamental or relative to SNG level (R(2) = 0.07 and 0.04, respectively). VI was consistently 100% and mean FI and VFI were 99.5 (SD, 0.57), with all values > 97 irrespective of gain level. CONCLUSIONS Whilst previous work has shown that gain correlates well with placental tissue VOCAL indices, the correlation between gain level and VOCAL indices in an area of 100% vascularity at the cord insertion is poor. Regions of 100% vascularity appear to be artificially assigned a value approaching 100% for all VOCAL indices irrespective of gain level. This precludes using the technique of VOCAL indices from large vessels to standardize power Doppler measurements and the FMBV index is therefore not applicable to image analysis using VOCAL.
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Affiliation(s)
- A W Welsh
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
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Welsh AW, Hou M, Meriki N, Martins WP. Spatiotemporal image correlation-derived volumetric Doppler impedance indices from spherical samples of the placenta: intraobserver reliability and correlation with conventional umbilical artery Doppler indices. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:431-436. [PMID: 22302650 DOI: 10.1002/uog.11113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Volumetric impedance indices derived from spatiotemporal image correlation (STIC) power Doppler ultrasound (PDU) might overcome the influence of machine settings and attenuation. We examined the feasibility of obtaining these indices from spherical samples of anterior placentas in healthy pregnancies, and assessed intraobserver reliability and correlation with conventional umbilical artery (UA) impedance indices. METHODS Uncomplicated singleton pregnancies with anterior placenta were included in the study. A single observer evaluated UA pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) and acquired three STIC-PDU datasets from the placenta just above the placental cord insertion. Another observer analyzed the STIC-PDU datasets using Virtual Organ Computer-aided AnaLysis (VOCAL) spherical samples from every frame to determine the vascularization index (VI) and vascularization flow index (VFI); maximum, minimum and average values were used to determine the three volumetric impedance indices (vPI, vRI, vS/D). Intraobserver reliability was examined by intraclass correlation coefficients (ICC) and association between volumetric indices from placenta, and UA Doppler indices were assessed by Pearson's correlation coefficient. RESULTS A total of 25 pregnant women were evaluated but five were excluded because of artifacts observed during analysis. The reliability of measurement of volumetric indices of both VI and VFI from three STIC-PDU datasets was similar, with all ICCs ≥ 0.78. Pearson's r values showed a weak and non-significant correlation between UA pulsed-wave Doppler indices and their respective volumetric indices from spherical samples of placenta (all r ≥ 0.23). VOCAL indices from specific phases of the cardiac cycle showed good repeatability (ICC ≥ 0.92). CONCLUSION Volumetric impedance indices determined from spherical samples of placenta are sufficiently reliable but do not correlate with UA Doppler indices in healthy pregnancies.
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Affiliation(s)
- A W Welsh
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
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