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4D Doppler Ultrasound in High Grade Serous Ovarian Cancer Vascularity Evaluation-Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11040582. [PMID: 33805053 PMCID: PMC8064103 DOI: 10.3390/diagnostics11040582] [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: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to evaluate the usefulness of 4D Power Doppler tissue evaluation to discriminate between normal ovaries and ovarian cancer tumors. This was a prospective observational study. Twenty-three cases of surgically confirmed ovarian High Grade Serous Carcinoma (HGSC) were analyzed. The control group consisted of 23 healthy patients, each matching their study-group counterpart age wise (±3 years) and according to their menopausal status. Transvaginal Doppler 4D ultrasound scans were done on every patient and analyzed with 3D/4D software. Two 4D indices-volumetric Systolic/Diastolic Index (vS/D) and volumetric Pulsatility Index (vPI)-were calculated. To keep results standardized and due to technical limitations, virtual 1cc spherical tissue samples taken from the part with highest vascularization as detected by bi-directional Power Doppler were analyzed for both groups of ovaries. Values of volumetric S/D indices and volumetric PI indices were statistically lower in ovarian malignant tumors compared to normal ovaries: 1.096 vs. 1.794 and 0.092 vs. 0.558, respectively (p < 0.001). The 4D bi-directional Power Doppler vascular indices were statistically different between malignant tumors and normal ovaries. These findings could support the rationale for future studies for assessing this technology to discriminate between malignant and benign tumors.
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Cansu A, Ayan E, Kul S, Eyüboğlu İ, Oğuz Ş, Mungan S. Diagnostic value of 3D power Doppler ultrasound in the characterization of thyroid nodules. Turk J Med Sci 2019; 49:723-729. [PMID: 31203590 PMCID: PMC7018289 DOI: 10.3906/sag-1803-92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules. Materials and methods Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis. Results Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively. Conclusion 3D PDUS can be useful in the characterization of thyroid nodules.
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Affiliation(s)
- Ayşegül Cansu
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Emine Ayan
- Department of Radiology, Faculty of Medicine, Acıbadem University, Kayseri Hospital, Kayseri, Turkey
| | - Sibel Kul
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - İlker Eyüboğlu
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şükrü Oğuz
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sevdegül Mungan
- Department of Pathology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Martins MR, Martins WP, Soares CAM, Miyague AH, Kudla MJ, Pavan TZ. Understanding the Influence of Flow Velocity, Wall Motion Filter, Pulse Repetition Frequency, and Aliasing on Power Doppler Image Quantification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:255-261. [PMID: 28736982 DOI: 10.1002/jum.14338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/06/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although power Doppler imaging has been used to quantify tissue and organ vascularity, many studies showed that limitations in defining adequate ultrasound machine settings and attenuation make such measurements complex to be achieved. However, most of these studies were conducted by using the output of proprietary software, such as Virtual Organ computer-aided analysis (GE Healthcare, Kretz, Zipf, Austria); therefore, many conclusions may not be generalizable because of unknown settings and parameters used by the software. To overcome this limitation, our goal was to evaluate the impact of the flow velocity, pulse repetition frequency (PRF), and wall motion filter (WMF) on power Doppler image quantification using beam-formed ultrasonic radiofrequency data. METHODS The setup consisted of a blood-mimicking fluid flowing through a phantom. Radiofrequency signals were collected using PRFs ranging from 0.6 to 10 kHz for 6 different flow velocities (5-40 cm/s). Wall motion filter cutoff frequencies were varied between 50 and 250 Hz. RESULTS The power Doppler magnitude was deeply influenced by the WMF cutoff frequency. The effect of using different WMF values varied with the PRF; therefore, the power Doppler signal intensity was dependent on the PRF. Finally, we verified that power Doppler quantification can be affected by the aliasing effect, especially when using a PRF lower than 1.3 kHz. CONCLUSIONS The WMF and PRF greatly influenced power Doppler quantification, mainly when flow velocities lower than 20 cm/s were used. Although the experiments were conducted in a nonclinical environment, the evaluated parameters are equivalent to those used in clinical practice, which makes them valuable for aiding the interpretation of related data in future research.
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Affiliation(s)
- Maricy R Martins
- Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos A M Soares
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Andre H Miyague
- Department of Obstetrics and Gynecology, University Hospital Evangelico de Curitiba, Curitiba, Brazil
- Woman and Fetal Medicine Institute, Curitiba, Brazil
| | - Marek J Kudla
- Clinical Department of Oncological Gynecology, Medical University of Silesia, Katowice, Poland
| | - Theo Z Pavan
- Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto, Ribeirão Preto, Brazil
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Abbas AM, Sheha AM, Salem MN, Altraigey A. Three-dimensional power Doppler ultrasonography in evaluation of adnexal masses. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rizzello F, Capezzuoli T, D'Amato Scherbatoff I, Cozzolino M, Gandini L, Coccia ME. Three-Dimensional Power Doppler Vascularization in Women With Ovarian Endometriomas and Relationship With Associated Painful Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2271-2278. [PMID: 28556312 DOI: 10.1002/jum.14258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of the study was to evaluate the correlation between endometrioma-associated pain and lesion vascularization as measured with 3-dimensional power Doppler transvaginal sonography. METHODS Endometriomas were examined, and 4 indices were obtained: mean grayness, flow index, vascularization index, and vascularization-flow index. Dysmenorrhea, chronic pelvic pain, and dyspareunia were analyzed in terms of severity, presence/absence, and duration. RESULTS Twenty-nine women were selected. The univariable association of painful symptoms in terms of presence/absence and duration was low with the exception of mean grayness with the presence of chronic pelvic pain (β = -0.106; P = .047; 95% confidence interval, 0.810 to 0.998). The R2 value increased to 0.226 for dysmenorrhea (β = -0.475; P = .029) when analyzing the association between the vascularization index and the severity of painful symptoms. The visual analog scale scores for chronic pelvic pain and dyspareunia were higher (R2 = 0.300; β = -0.547 and -0.548, respectively; P = .028 and .053). CONCLUSIONS We observed an inverse association between the severity of pain and endometrioma vascularization. Further larger studies are required to confirm our findings.
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Affiliation(s)
- Francesca Rizzello
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Capezzuoli
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Mauro Cozzolino
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Loredana Gandini
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
- Department of Experimental Medicine, Section of Medical Physiopathology, University of Rome La Sapienza, Rome, Italy
| | - Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
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Niemi RJ, Saarelainen SK, Luukkaala TH, Mäenpää JU. Reliability of preoperative evaluation of postmenopausal ovarian tumors. J Ovarian Res 2017; 10:15. [PMID: 28288666 PMCID: PMC5348789 DOI: 10.1186/s13048-017-0309-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 12/26/2022] Open
Abstract
Background Preoperative evaluation of ovarian tumors is challenging. This study was undertaken to evaluate the performance of conventional two-dimensional (2D) ultrasound and CA125 in predicting malignant or benign nature of pelvic masses, and to investigate if three-dimensional power Doppler (3DPD) ultrasound provides any added value. Ninety-six postmenopausal and four perimenopausal women with supposed ovarian tumors were examined by standardized 2D and 3DPD ultrasounds preoperatively. The tumors were evaluated using the risk of malignancy index (RMI), International Ovarian Tumors Analysis (IOTA) group simple rules, expert opinion, IOTA logistic regression model 2 (LR2) and 3D vascular indices, and were postoperatively compared to histopathological results. Results Ninety-eight tumors turned out to be ovarian in origin. Of these, 66 were benign and 32 malignant. RMI (cut-off value 200), simple rules, expert opinion and LR2 (cut-off value 25) were used to predict malignant nature of the tumors and had sensitivities of 71.9, 90.6, 87.5 and 90.6%, and specificities of 80.3, 84.6, 92.4 and 77.3%, respectively. When the 3D vascularization flow index (VFI) was added to RMI and LR2, the accuracy of the test improved from 77.6 to 81.4% and from 81.6 to 86.5%, respectively, at the expense of sensitivity, while VFI gave no added benefit for simple rules and expert opinion. Agreement between two examiners using expert opinion was good (Cohen’s kappa = 0.89). Conclusions The subjective opinion of an expert seems to be the most reliable method in assessing ovarian tumors, and the 3DPD indices seem to provide no significant added value.
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Affiliation(s)
- Riikka Johanna Niemi
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
| | - Sami Kristian Saarelainen
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Tiina Hannele Luukkaala
- Research and Innovation Center, Tampere University Hospital and Faculty of Social Sciences, University of Tampere, FI-33014, Tampere, Finland
| | - Johanna Unelma Mäenpää
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, FI-33014, Tampere, Finland
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Soares CAM, Pavan TZ, Miyague AH, Kudla M, Martins WP. Influence of Pulse Repetition Frequency on 3-D Power Doppler Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2887-2892. [PMID: 27680571 DOI: 10.1016/j.ultrasmedbio.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 06/06/2023]
Abstract
Three-dimensional power Doppler quantification has limited application because of its high dependency on attenuation. The purpose of the study described here was to assess if different degrees of attenuation, depending on pulse repetition frequency (PRF) adjustment, alter 3-D power Doppler quantification in a region of 100% moving blood when using vascularization index, flow index and vascularization flow index (VFI). A cubic-shaped gelatin phantom with a 1.8-mm-internal-diameter silicon tube was used. The tube, placed at 45° to the phantom's surface, was filled with blood-mimicking fluid with as constant maximum velocity of 30 cm/s. Two different attenuation blocks (low and high attenuation) were alternatively placed between the phantom and the transvaginal transducer. One single observer acquired 10 data sets for each PRF level from 0.3 to 7.5 kHz, using the high- and low-attenuation blocks, for a total of 200 3-D power Doppler data sets. We assessed VFI from 1.5-mm-diameter spherical samples, virtually placed inside the tube, always at the same position. No difference was noted between high- and low-attenuation VFI values when using a PRF of 0.3 kHz. As PRF increased, it was observed that VFI quantification progressively differed between low and high attenuation. Also, a slope on VFI values for both high- and low-attenuation models could be observed when increasing PRF, particularly above 4.0 kHz. We concluded that PRF adjustment is very relevant when using VFI to quantify 3-D power Doppler signal.
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Affiliation(s)
- Carlos A M Soares
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - Theo Z Pavan
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirao Preto, University of Sao Paulo (FFCLRP-USP), Ribeirao Preto, Brazil
| | - Andre H Miyague
- Department of Obstetrics and Gynecology, University Hospital Evangelico de Curitiba (HUEC), Curitiba, Brazil; Woman and Fetal Medicine Institute (IMMEF), Curitiba, Brazil
| | - Marek Kudla
- Clinical Department of Oncological Gynecology, Chair of Woman's Health, Medical University of Silesia, Katowice, Poland
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil.
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Guerriero S, Saba L, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Sedda F, Peddes C, Fabbri P, Pilla F, Zajicek M, Giuseppina P, Melis GB. Past, present and future ultrasonographic techniques for analyzing ovarian masses. ACTA ACUST UNITED AC 2016; 11:369-83. [PMID: 26102474 DOI: 10.2217/whe.15.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography is today the method of choice for distinguishing between benign and malignant adnexal pathologies. Using pattern recognition several types of tumors can be recognized according to their characteristic appearance on gray-scale imaging. Color Doppler imaging should be used only to perform a semiquantitative color score or evaluate the flow location. International Ovarian Tumor Analysis group had standardized definitions characterizing adnexal masses and suggested the use of 'simple rules' in premenopausal women. Recently, the use of 3D vascular indices has been proposed but its potential use in clinical practice is debated. Also computerized aided diagnosis algorithms showed encouraging results to be confirmed in the future.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics & Gynecology, University of Navarra, Pamplona, Spain
| | | | - Silvia Ajossa
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Maura Perniciano
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Cristina Peddes
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Paola Fabbri
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Pilla
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Michal Zajicek
- Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Parodo Giuseppina
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
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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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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Utrilla-Layna J, Alcázar JL, Aubá M, Laparte C, Olartecoechea B, Errasti T, Juez L, Mínguez JÁ, Guerriero S, Jurado M. Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:613-617. [PMID: 25270368 DOI: 10.1002/uog.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the contribution of three-dimensional (3D) power Doppler angiography (3D-PDA) to the differential diagnosis of adnexal masses. METHODS This was a prospective study in women diagnosed with a persistent adnexal mass and subsequently scheduled for surgery in a tertiary university hospital. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol, with transabdominal ultrasound being performed in some cases. First, morphological evaluation of the mass was performed using gray-scale 'pattern recognition' (first step). Lesions diagnosed as having a benign pattern were considered as being at low risk of malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as being at high risk of malignancy. In both cases no further test was performed and a decision regarding clinical management, either for follow-up or surgery, was taken. Tumors with solid components but without signs of ascites or carcinomatosis were considered as being at intermediate risk of malignancy. These lesions were assessed by two-dimensional (2D) PDA to evaluate tumor vascularity (color score) (second step). Solid tumors with a color score of 1 or 2 were considered as benign and no further test was performed, while tumors with a color score of 2, 3 or 4 within solid components or a color score of 3 or 4 in the case of a solid tumor were considered as malignant. The latter group underwent 3D-PDA assessment (third step). Vascularization index (VI) was calculated in a 1-mL sphere of the most vascularized area of the tumor. When a VI ≥ 24.015% was found, the tumor was considered as malignant. All masses were removed surgically and definitive histological diagnosis was used as the gold standard. Sensitivity and specificity for each strategy were calculated and compared. In the case of bilateral tumors, only the more suspicious one was used for analysis. RESULTS A total of 367 adnexal masses diagnosed in 367 women (mean age, 46.5 (range, 18-80) years) were evaluated during the study period. Of these, 86 masses were malignant and 281 were benign. The sensitivity and specificity for each assessment strategy were as follows: one-step, 97.7% and 78.6%; two-step, 94.2% and 97.9% (P < 0.001 for specificity when compared with that of one-step); three-step, 90.7% and 98.9% (not statistically significant when compared with that of two-step). CONCLUSIONS The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.
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Affiliation(s)
- J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain
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Turkgeldi E, Urman B, Ata B. Role of Three-Dimensional Ultrasound in Gynecology. J Obstet Gynaecol India 2014; 65:146-54. [PMID: 26085733 DOI: 10.1007/s13224-014-0635-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.
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Affiliation(s)
- Engin Turkgeldi
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
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Hu R, Xiang H, Mu Y, Feng Y, Gu L, Liu H. Combination of 2- and 3-dimensional contrast-enhanced transvaginal sonography for diagnosis of small adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1889-1899. [PMID: 25336475 DOI: 10.7863/ultra.33.11.1889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the efficacy of the combination of 2-dimensional (2D) and 3-dimensional (3D) contrast-enhanced sonography in discriminating between benign and malignant small adnexal masses. METHODS Selected patients were evaluated with both 2D and 3D contrast-enhanced sonography after conventional sonography before undergoing any surgery. Time-intensity curves for 2D contrast-enhanced sonography were constructed by using contrast-enhanced sonographic software. A vascular perfusion characteristic analysis was achieved by 2D and 3D contrast-enhanced sonography. Results were finally verified by surgery. RESULTS Forty-seven cases of benign and 10 cases of malignant small adnexal masses were discovered. Significant differences in perfusion patterns, time-intensity curve shapes for 2D contrast-enhanced sonography, grayscale contrast-enhanced sonography, and blood flow imaging on 3D contrast-enhanced sonography were observed between benign and malignant masses (P< .05). Two-dimensional contrast-enhanced sonography, 3D contrast-enhanced sonography, parallel combination of 2D and 3D contrast-enhanced sonography, and serial combination of 2D and 3D contrast-enhanced sonography all reached diagnostic sensitivity of 100% for discriminating benign from malignant masses, whereas specificity values were 61.7%, 63.8%, 68.1%, and 57.4%, respectively. Areas under the receiver operating characteristic curves were 0.809, 0.819, 0.840, and 0.787. CONCLUSIONS Two-dimensional contrast-enhanced sonography is of high value in distinguishing malignant from benign small adnexal masses; 3D contrast-enhanced sonography provides richer and more useful information for evaluation of these masses. Diagnostic sensitivity of 100% can be achieved when using a serial combination of 2D and 3D contrast-enhanced sonography, although specificity needs further improvement.
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Affiliation(s)
- Rong Hu
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hong Xiang
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuming Mu
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yuling Feng
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Linaer Gu
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hui Liu
- Departments of Ultrasonography (R.H., H.X., Y.F., L.G., H.L.) and Echocardiography (Y.M.), First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Guerriero S, Alcazar JL, Pilloni M, Ajossa S, Olartecoechea B, Sedda F, Piras A, Melis GB, Saba L. Reproducibility of two different methods for performing mean gray value evaluation of cyst content in endometriomas using VOCAL. J Med Ultrason (2001) 2014; 41:325-32. [PMID: 27277906 DOI: 10.1007/s10396-013-0514-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 10/21/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare two different methods (manual sampling of the entire cyst and semi-automated spherical sampling from the central part of the cyst) for calculating the mean gray value (MGV) from the cystic content in endometriomas using virtual organ computer-aided analysis (VOCAL). METHODS Forty-one volumes from histologically confirmed endometriomas were retrieved from our database and the volumes were analyzed to compare the MGVs obtained via the two modalities. In addition, to evaluate the reproducibility in a sample of 20 volumes, two different observers calculated the MGV from cyst content using VOCAL software. For each method, each examiner analyzed the volumes twice, 3 weeks apart, for assessment of intra-observer agreement. First, manual sampling of the internal contour of all the cysts was performed, and 1 week later semi-automated 2-cm sphere sampling from the central part of the cyst was carried out. In addition, the observers recorded the time spent performing each analysis. Inter- and intra-observer reproducibility was evaluated for each method using intra-class correlation coefficients (ICC). RESULTS There was no difference in the mean MGV between manual sampling (22.211 ± 7.541) and the semi-automated modality of sampling (23.840 ± 8.621, p = 0.439). The correlation between manual and semi-automated sampling measurement was high (r = 0.92). According to the ICCs, there was no significant difference in interobserver reliability between manual sampling (0.931; 95 % CI, 0.824-0.973) and the semi-automated modality of sampling (0.924; 95 % CI, 0.809-0.970). Intra-observer reproducibility for both examiners was good (ICC > 0.94). Semi-automated measurements were obtained faster than those obtained by manual evaluation (p = 0.0001 for observer 1 and p = 0.083 for observer 2). CONCLUSIONS Both methods seem to be reliable, but the semi-automated method using the sphere should be preferred because it is a less time-consuming procedure.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy.
| | - Juan Luis Alcazar
- Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain
| | - Monica Pilloni
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy
| | - Silvia Ajossa
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy
| | | | - Federica Sedda
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy
| | - Gian Benedetto Melis
- Department of Obstetrics and Gynaecology, Ospedale San Giovanni di Dio, University of Cagliari, Via Ospedale 46, 09124, Cagliari, Italy
| | - Luca Saba
- AOU of Cagliari, University of Cagliari, Cagliari, Italy
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Alcázar JL, Aubá M, Ruiz-Zambrana Á, Olartecoechea B, Diaz D, Hidalgo JJ, Pineda L, Utrilla-Layna J. Ultrasound assessment in adnexal masses: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Miyague AH, Raine-Fenning NJ, Polanski L, Martinez LH, Araujo Júnior E, Pavan TZ, Martins WP. 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; 42:571-576. [PMID: 23362022 DOI: 10.1002/uog.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To compare the variability in vascularization flow index (VFI) seen in serial acquisitions obtained using spatiotemporal image correlation (STIC) and using conventional static three-dimensional (3D) power Doppler (PD), for both in-vitro and in-vivo models, and to evaluate whether the curves formed by VFI values obtained from successive 'frames' in a STIC dataset are consistent and resemble the waveforms obtained by spectral Doppler analysis. METHODS The study was divided into two parts: in the first part (the in-vitro model) we scanned a flow phantom, while in the second part (the in-vivo model) we scanned a common carotid artery. Conventional static 3D and STIC-PD datasets were alternately acquired from these two models. VFI values were assessed from 0.38-cm(3) spherical samples of the main flow region in the static 3D datasets and in every frame of the STIC datasets. The variance of the minimum, mean and maximum VFI values from each STIC dataset was compared with the variance of VFI values from the static 3D datasets. RESULTS Ten static 3D and 10 STIC datasets were acquired from each model. Analysis of the in-vitro and in-vivo models showed a significant reduction in the variance of VFI values obtained using STIC as compared to static datasets. Additionally, we observed that the curves formed by VFI values obtained from successive frames in each STIC dataset were consistent across different datasets and that they resembled the waveforms obtained by spectral Doppler in both models. CONCLUSIONS 3D-PD indices derived from STIC are more stable than those obtained from conventional static 3D-PD datasets. The curves of VFI throughout a reconstructed cardiac cycle using STIC are repeatable and resemble those obtained by spectral Doppler analysis of the vessel.
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Affiliation(s)
- A H Miyague
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (FMRP-USP), Ribeirao Preto, Brazil; Ultrasonography and Retraining Medical School of Ribeirao Preto (EURP), Ribeirao Preto, Brazil
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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, 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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Wu MH, Cheng YC, Chang CH, Ko HC, Chang FM. Three-dimensional Ultrasound in Evaluation of the Ovary. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martins WP, Lima JC, Welsh AW, Araujo Júnior E, Miyague AH, Filho FM, Raine-Fenning NJ. Three-dimensional Doppler evaluation of single spherical samples from the placenta: intra- and interobserver reliability. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:200-206. [PMID: 22173929 DOI: 10.1002/uog.11076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the intra- and interobserver reliability of assessment of three-dimensional power Doppler (3D-PD) indices from single spherical samples of the placenta. METHODS Women with singleton pregnancies at 24-40 weeks' gestation were included. Three scans were independently performed by two observers; Observer 1 performed the first and third scan, intercalated by the scan of Observer 2. The observers independently analyzed the 3D-PD datasets that they had previously acquired using four different methods, each using a spherical sample: random sample extending from basal to chorionic plate; random sample with 2 cm(3) of volume; directed sample to the region subjectively determined as containing more color Doppler signals extending from basal to chorionic plate; or directed sample with 2 cm(3) of volume. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were evaluated in each case. The observers were blinded to their own and each other's results. Additional evaluation was performed according to placental location: anterior, posterior and fundal or lateral. Intra- and interobserver reliability was assessed by intraclass correlation coefficients (ICC). RESULTS Ninety-five pregnancies were included in the analysis. All three placental 3D-PD indices showed only weak to moderate reliability (ICC < 0.66 and ICC < 0.48, intra- and interobserver, respectively). The highest values of ICC were observed when using directed spherical samples from basal to chorionic plate. When analyzed by placental location, we found lower ICCs for lateral and fundal placentae compared to anterior and posterior ones. CONCLUSION Intra- and interobserver reliability of assessment of placental 3D-PD indices from single spherical samples in pregnant women greater than 24 weeks' gestation is poor to moderate, and clinical usefulness of these indices is likely to be limited.
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Affiliation(s)
- W P Martins
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
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Kudla MJ, Alcázar JL. Spatiotemporal image correlation with spherical sampling and high-definition flow: new 4-dimensional method for assessment of tissue vascularization changes during the cardiac cycle: reproducibility analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:73-80. [PMID: 22215772 DOI: 10.7863/jum.2012.31.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe and assess the interobserver reproducibility of a new method for evaluation of ovarian vascularization using spatiotemporal image correlation-high definition flow (STIC-HDF). METHODS Stored 4-dimensional (4D) STIC-HDF volume data from 39 healthy pre-menopausal fertile women (aged <35 years) examined in the follicular part of the menstrual cycle by transvaginal sonography were assessed by two different examiners blinded from each other (one in Spain the other in Poland). Using 1-cm(3) spherical sampling, the vascularization index (VI) from the most vascularized part of the ovarian stroma was calculated at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all patients (pulse repetition frequency, 0.6 kHz; gain, 0.2) with a depth of 40 mm. Analysis was performed offline using 4D software on a personal computer. On the basis of VI and vascularization-flow index (VFI) values during systole and diastole, 4 new 4D indices were defined: 4D systolic/diastolic volumetric index (4D-SDVI = VI(syst)/VI(diast)), 4D hemodynamic volumetric index (4D-HVI = [VI(syst) + VI(diast)]/[VI(syst) - VI(diast)]), 4D systolic/diastolic vascularization-flow index (4D-SDVFI = VFI(syst)/VFI(diast)), and 4D hemodynamic vascularization-flow index (4D-HVFI = [VFI(syst) + VFI(diast)]/[VFI(syst)- VFI(diast)]). Reproducibility of measurements was estimated by calculating the intraclass correlation coefficient (ICC). RESULTS The systolic VI, diastolic VI, 4D-SDVI, 4D-HVI, systolic VFI, diastolic VFI, and 4D-HVFI showed good reproducibility (ICC, 0.992, 0.994, 0.879, 0.915, 0.995, 0.995, and 0.893, respectively). The 4D-SDVFI showed moderate reproducibility (ICC, 0.797). CONCLUSIONS We describe 4 new 4D vascular indices for assessing tissue vascularization using STIC-HDF technology. Assessment of ovarian vascularization using this STIC-HDF spherical sampling is reliable. The calculation of these new indices is reproducible between two different examiners.
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Affiliation(s)
- Marek J Kudla
- Department of Obstetrics and Gynecology, Medical University of Silesia, Katowice, Poland
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Martins WP, Welsh AW, Lima JC, Nastri CO, Raine-Fenning NJ. The "volumetric" pulsatility index as evaluated by spatiotemporal imaging correlation (STIC): a preliminary description of a novel technique, its application to the endometrium and an evaluation of its reproducibility. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:2160-2168. [PMID: 21963030 DOI: 10.1016/j.ultrasmedbio.2011.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/18/2011] [Accepted: 08/22/2011] [Indexed: 05/31/2023]
Abstract
We propose new volumetric indices derived from three-dimensional (3-D) power Doppler (PD) using spatiotemporal imaging correlation (STIC) to overcome the influence of machine settings and attenuation. In this study, we describe these indices and evaluate their interobserver reliability: two static-3-D and two STIC PD datasets were acquired from 60 women and two observers (blinded analysis) evaluated vascularization index (VI), the flow index (FI) and the vascularization flow index (VFI) of standardized spherical samples of endometrium. Three new indices were determined based on maximum, minimum and mean values (vPI, vRI(max-min), vS/D(max-min)) and two indices from frames subjectively defined as systole and diastole (vRI(sys-dia), vS/D(sys-dia)). Highest intraclass coefficient correlations (ICCs) were obtained from vPI derived from VI or VFI (0.77-0.76), followed by vRI(max-min) (0.72-0.72) and vS/D(max-min) (0.52-0.49). ICCs from indices based on subjectively systole and diastole or FI were consistently lower (<0.40). We conclude that the subjective choice of systolic and diastolic frames only lacks reliability but indices based on complete evaluation may reliably be used.
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Affiliation(s)
- Wellington P Martins
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
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Alcázar JL, Jurado M. Three-dimensional ultrasound for assessing women with gynecological cancer: A systematic review. Gynecol Oncol 2011; 120:340-6. [DOI: 10.1016/j.ygyno.2010.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/19/2010] [Indexed: 12/26/2022]
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