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Rousian M, Schoenmakers S, Eggink AJ, Gootjes DV, Koning AHJ, Koster MPH, Mulders AGMGJ, Baart EB, Reiss IKM, Laven JSE, Steegers EAP, Steegers-Theunissen RPM. Cohort Profile Update: the Rotterdam Periconceptional Cohort and embryonic and fetal measurements using 3D ultrasound and virtual reality techniques. Int J Epidemiol 2021; 50:1426-1427l. [PMID: 34097026 PMCID: PMC8580268 DOI: 10.1093/ije/dyab030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Melek Rousian
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Dionne V Gootjes
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, University Medical Center, Rotterdam, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | | | - Esther B Baart
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
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2
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Wiertsema CJ, Erkamp JS, Mulders AGMGJ, Steegers EAP, Duijts L, Koning AHJ, Gaillard R, Jaddoe VWV. First trimester fetal proportion volumetric measurements using a Virtual Reality approach. Prenat Diagn 2021; 41:868-876. [PMID: 33811672 PMCID: PMC8251560 DOI: 10.1002/pd.5947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/27/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To establish feasibility and reproducibility of fetal proportion volumetric measurements, using three-dimensional (3D) ultrasound and a Virtual Reality (VR) system. METHODS Within a population-based prospective birth cohort, 3D ultrasound datasets of 50 fetuses in the late first trimester were collected by three ultrasonographers in a single research center. V-scope software was used for volumetric measurements of total fetus, extremities, head-trunk, head, trunk, thorax, and abdomen. All measurements were performed independently by two researchers. Intraobserver and interobserver reproducibility were analyzed using Bland and Altman methods. RESULTS Intraobserver and interobserver analyses of volumetric measurements of total fetus, head-trunk, head, trunk, thorax and abdomen showed intraclass correlation coefficients above 0.979, coefficients of variation below 7.51% and mean difference below 3.44%. The interobserver limits of agreement were within the ±10% range for volumetric measurements of total fetus, head-trunk, head and trunk. The interobserver limits of agreement for extremities, thorax and abdomen were -26.09% to 4.77%, -14.14% to 10.00% and -14.47% to 8.83%, respectively. CONCLUSION First trimester fetal proportion volumetric measurements using 3D ultrasound and VR are feasible and reproducible, except volumetric measurements of the fetal extremities. These novel volumetric measurements may be used in future research to enable detailed studies on first trimester fetal development and growth.
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Affiliation(s)
- Clarissa J. Wiertsema
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Jan S. Erkamp
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Eric A. P. Steegers
- Departments of Obstetrics and GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Liesbeth Duijts
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsDivision of Respiratory Medicine and AllergologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Anton H. J. Koning
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Clinical Bioinformatics UnitDepartment of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Romy Gaillard
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
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3
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Frudiger A, Mulders AGMGJ, Rousian M, Plasschaert SCN, Koning AHJ, Willemsen SP, Steegers-Theunissen RPM, de Vries JIP, Steegers EAP. Evaluation of embryonic posture using four-dimensional ultrasound and virtual reality. J Obstet Gynaecol Res 2020; 47:397-406. [PMID: 33145949 PMCID: PMC7821160 DOI: 10.1111/jog.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Aim To assess the possibility of embryonic posture evaluation (=feasibility, reproducibility, variation) at rest at 9 weeks' (+0–6 days) gestational age (GA) using four‐dimensional ultrasound and virtual reality (VR) techniques. Moreover, it is hypothesized that embryonic posture shows variation at the same time point in an uneventful pregnancy. Methods In this explorative prospective cohort study, 23 pregnant women were recruited from the Rotterdam periconceptional cohort. A transvaginal four‐dimensional ultrasound examination of 30 min per pregnancy was performed between 9 and 10 weeks' GA. The acquired datasets were offline evaluated longitudinally (i.e. per frame) using VR techniques. Results The ultrasound data of 16 (70%) out of 23 pregnancies were eligible for evaluation. At rest the analysis of the embryonic posture was feasible and showed a strong (>80%) intraobserver and interobserver reproducibility for most body parts. The majority of the body parts were in similar anatomic positions at rest. However, variations in anatomic positions (e.g. 6% rotated head, 9% laterally bent spine), within and between embryos, were seen at 9 weeks' GA. Conclusion In this unique study, we showed for the first time that embryonic posture measurements at rest can be performed in a reliable way using state‐of‐the‐art four‐dimensional ultrasound and VR techniques. Already early in prenatal life there are differences regarding posture within and between embryos.
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Affiliation(s)
- Anne Frudiger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sophie C N Plasschaert
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, Division of Clinical Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, Amsterdam Movement Science, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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4
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Pietersma CS, Mulders AGMGJ, Moolenaar LM, Hunink MGM, Koning AHJ, Willemsen SP, Go ATJI, Steegers EAP, Rousian M. First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial. BMC Pregnancy Childbirth 2020; 20:515. [PMID: 32894073 PMCID: PMC7487721 DOI: 10.1186/s12884-020-03180-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background In recent years it has become clear that fetal anomalies can already be detected at the end of the first trimester of pregnancy by two-dimensional (2D) ultrasound. This is why increasingly in developed countries the first trimester anomaly scan is being offered as part of standard care. We have developed a Virtual Reality (VR) approach to improve the diagnostic abilities of 2D ultrasound. Three-dimensional (3D) ultrasound datasets are used in VR assessment, enabling real depth perception and unique interaction. The aim of this study is to investigate whether first trimester 3D VR ultrasound is of additional value in terms of diagnostic accuracy for the detection of fetal anomalies. Health-related quality of life, cost-effectiveness and also the perspective of both patient and ultrasonographer on the 3D VR modality will be studied. Methods Women in the first trimester of a high risk pregnancy for a fetus with a congenital anomaly are eligible for inclusion. This is a randomized controlled trial with two intervention arms. The control group receives ‘care as usual’: a second trimester 2D advanced ultrasound examination. The intervention group will undergo an additional first trimester 2D and 3D VR ultrasound examination. Following each examination participants will fill in validated questionnaires evaluating their quality of life and healthcare related expenses. Participants’ and ultrasonographers’ perspectives on the 3D VR ultrasound will be surveyed. The primary outcome will be the detection of fetal anomalies. The additional first trimester 3D VR ultrasound examination will be compared to ‘care as usual’. Neonatal or histopathological examinations are considered the gold standard for the detection of congenital anomalies. To reach statistical significance and 80% power with a detection rate of 65% for second trimester ultrasound examination and 70% for the combined detection of first trimester 3D VR and second trimester ultrasound examination, a sample size of 2800 participants is needed. Discussion First trimester 3D VR detection of fetal anomalies may improve patients’ quality of life through reassurance or earlier identification of malformations. Results of this study will provide policymakers and healthcare professionals with the highest level of evidence for cost-effectiveness of first trimester ultrasound using a 3D VR approach. Trial registration Dutch Trial Registration number NTR6309, date of registration 26 January 2017.
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Affiliation(s)
- C S Pietersma
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - L M Moolenaar
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M G M Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, USA
| | - A H J Koning
- Department of Pathology, Clinical Bioinformatics Unit, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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5
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Zhou C, Cai G, Meng F, Xu Z, He Y, Hu Q, Zheng E, Huang S, Xu Z, Gu T, Hu B, Wu Z, Hong L. Deep-Sequencing Identification of MicroRNA Biomarkers in Serum Exosomes for Early Pig Pregnancy. Front Genet 2020; 11:536. [PMID: 32528535 PMCID: PMC7264423 DOI: 10.3389/fgene.2020.00536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/04/2020] [Indexed: 12/23/2022] Open
Abstract
Early pregnancy diagnosis in sows can significantly improve the efficiency of pig industry. Exosomes are membrane-covered nanovesicles that can transport microRNAs (miRNAs) and other molecular signals between cells. In other species, serum exosome-derived miRNAs can serve as good biomarkers of diseases and different physiological states, including pregnancy status. We hypothesized that circulating exosome-derived miRNAs might be used to differentiate the pregnancy status as early as several days after insemination in pigs. To test this hypothesis, we randomly assigned pigs for artificial insemination with fertile or dead semen (control group). Serum samples were obtained from pregnant pigs on days 9, 12, and 15 after insemination and from non-pregnant pigs on days 0, 9, 12, and 15 after insemination. Exosomes were isolated for RNA extraction. The exosomal RNA samples from pigs on day 9 of the estrus cycle and pregnancy were used for small-RNA sequencing. A total 321 miRNAs were identified in all samples. Twenty eight differentially abundant miRNAs were identified between the pregnant and control groups. miRNAs with | log2 (fold change)| > 2 from sequencing results were selected for validation by quantitative reverse-transcription-polymerase chain reaction (RT-qPCR) in larger samples. Finally two upregulated miRNAs (miR-92b-3p and miR-17-5p) in the pregnant groups (on days 9, 12, and 15 of pregnancy) were confirmed by RT-qPCR. In summary, we have successfully identified circulating exosomal miRNA profiles in the serum of pigs in early pregnancy. miR-92b-3p and miR-17-5p could be used as potential circulating biomarkers for early pregnancy diagnosis.
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Affiliation(s)
- Chen Zhou
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Gengyuan Cai
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Fanming Meng
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Zhiqian Xu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Yanjuan He
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Qun Hu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Enqin Zheng
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Sixiu Huang
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Zheng Xu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Ting Gu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Bin Hu
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Zhenfang Wu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
| | - Linjun Hong
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding, College of Animal Science, South China Agricultural University, Guangzhou, China.,Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou, China
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6
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Gootjes DV, Koster MPH, Willemsen SP, Koning AHJ, Steegers EAP, Steegers-Theunissen RPM. The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort. J Clin Med 2019; 8:jcm8111913. [PMID: 31717297 PMCID: PMC6912493 DOI: 10.3390/jcm8111913] [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] [Received: 10/17/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Neighbourhood deprivation is a risk factor for impaired health and adverse pregnancy outcomes. We investigated whether living in a deprived neighbourhood is associated with embryonic growth. Methods: From the Predict cohort, we studied 566 women who underwent repeated first trimester ultrasound examinations. Crown rump length (CRL; n = 1707) and embryonic volume (EV; n = 1462) were measured using three-dimensional techniques. Neighbourhood deprivation was assessed using the neighbourhood status scores (NSS) of the Dutch Social Cultural Planning office. A high NSS represents a non-deprived neighbourhood. Associations between the NSS and embryonic growth were investigated using linear mixed models. Adjustment was performed for individual-level factors: maternal age, geographic origin, educational level, BMI, folic acid supplement use, fruit and vegetable intake, alcohol use and smoking habits. Results: The NSS was negatively associated with embryonic growth: a higher score (a less deprived neighbourhood) was associated with a smaller CRL and EV; adjusted β: −0.025 (95% CI −0.046, −0.003) and adjusted β: −0.015 (95% CI −0.026, −0.003). At 11 weeks of pregnancy, we observed a 0.55 cm3 smaller EV (7.65 cm3 vs. 7.10 cm3) and 1.08 mm smaller CRL (43.14 mm vs. 42.06 mm) in the highest compared to the lowest category. Conclusion: In deprived neighbourhoods, embryos are larger than in non-deprived neighbourhoods.
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Affiliation(s)
- Dionne V. Gootjes
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands (M.P.H.K.); (S.P.W.); (E.A.P.S.)
| | - Maria P. H. Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands (M.P.H.K.); (S.P.W.); (E.A.P.S.)
| | - Sten P. Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands (M.P.H.K.); (S.P.W.); (E.A.P.S.)
- Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Anton H. J. Koning
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands;
| | - Eric A. P. Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands (M.P.H.K.); (S.P.W.); (E.A.P.S.)
| | - Régine P. M. Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam 3015 GD, The Netherlands (M.P.H.K.); (S.P.W.); (E.A.P.S.)
- Correspondence: ; Tel.: +31-010-703-8255
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Renal Consequences of Gestational Diabetes Mellitus in Term Neonates: A Multidisciplinary Approach to the DOHaD Perspective in the Prevention and Early Recognition of Neonates of GDM Mothers at Risk of Hypertension and Chronic Renal Diseases in Later Life. J Clin Med 2019; 8:jcm8040429. [PMID: 30925803 PMCID: PMC6518288 DOI: 10.3390/jcm8040429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 12/29/2022] Open
Abstract
Fetal exposure to gestational diabetes mellitus (GDM) seems to stimulate a negative impact on the kidneys. Renal volumes and urinary biomarkers of renal function and tubular impairment and injury were evaluated in 30–40-day old newborns of GDM mothers (n = 139) who needed insulin therapy during pregnancy. We found that neonates of mothers who maintained strict control over normoglycemia (n = 65) during pregnancy and fulfilled the other criteria of the GDM management program showed no differences compared to control (n = 55). Conversely, those (n = 74), whose mothers did not maintain glycemic control and were not compliant to the management program, exhibited significantly lower levels of renal volumes and higher activity of N-acetyl-β-d-glucosaminidase and cathepsin B. Differences due to maternal pre-gestational and gestational body mass index (BMI) as well as to maternal weight gain were demonstrated. Our findings indicate that a multidisciplinary approach, which involves an appropriate management of GDM, prevents the negative effects of GDM on the kidneys at 30–40 days of postnatal age, indicating the fundamental role of glycemic control, as well as of an adequate range of maternal weight gain. Total renal volume, cortical volume, and urinary activity of N-acetyl-β-d-glucosaminidase and cathepsin B may be suggested as indicators for the early recognition of GDM neonates at long-term risk of hypertension and kidney disease.
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8
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Rousian M, Koster MPH, Mulders AGMGJ, Koning AHJ, Steegers-Theunissen RPM, Steegers EAP. Virtual reality imaging techniques in the study of embryonic and early placental health. Placenta 2018; 64 Suppl 1:S29-S35. [PMID: 29409677 DOI: 10.1016/j.placenta.2018.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
Abstract
Embryonic and placental growth and development in the first trimester of pregnancy have impact on the health of the fetus, newborn, child and even the adult. This emphasizes the importance of this often neglected period in life. The development of three-dimensional transvaginal ultrasonography in combination with virtual reality (VR) opens the possibility of accurate and reliable visualization of embryonic and placental structures with real depth perception. These techniques enable new biometry and volumetry measurements that contribute to the knowledge of the (patho)physiology of embryonic and early placental health. Examples of such measurements are the length of complex structures like the umbilical cord, vitelline duct, limbs and cerebellum or the volume of the whole embryo and brain cavities. Moreover, for the first time, embryos can now be staged in vivo (Carnegie stages) and vasculature volumes of both the embryo and the early placenta can be measured when VR is combined with power Doppler signals. These innovative developments have already been used to study associations between periconceptional maternal factors, such as age, smoking, alcohol use, diet and vitamin status, and embryonic and early placental growth and development. Future studies will also focus on the identification of abnormal embryonic and early placental development already in the earliest weeks of pregnancy, which provides opportunities for early prevention of pregnancy complications.
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Affiliation(s)
- Melek Rousian
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, Division Clinical Bioinformatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Division Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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9
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Reijnders IF, Mulders AGMGJ, Koster MPH, Koning AHJ, Frudiger A, Willemsen SP, Jauniaux E, Burton GJ, Steegers-Theunissen RPM, Steegers EAP. New imaging markers for preconceptional and first-trimester utero-placental vascularization. Placenta 2017; 61:96-102. [PMID: 29277277 DOI: 10.1016/j.placenta.2017.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/30/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The availability of imaging makers of early placental circulation development is limited. This study aims to develop a feasible and reliable method to assess preconceptional and early first-trimester utero-placental vascular volumes using three-dimensional power Doppler (3D PD) ultrasound on two different Virtual Reality (VR) systems. METHODS 3D PD ultrasound images of the uterine and placental vasculature were obtained in 35 women, either preconceptionally (n = 5), or during pregnancy at 7 (n = 10), 9 (n = 10) or 11 (n = 10) weeks of gestation. Preconceptional uterine vascular volume (UVV), first-trimester placental vascular volume (PVV) and embryonic vascular volume (EVV) were measured by two observers on two VR systems, i.e., a Barco I-Space and VR desktop. Intra- and inter-observer agreement and intersystem agreement were assessed by intra-class correlation coefficients (ICC) and absolute and relative differences. RESULTS Uterine-, embryonic- and placental vascular volume measurements showed good to excellent intra- and inter-observer agreement and inter-system reproducibility with most ICC above 0.80 and relative differences of less than 20% preconceptionally and almost throughout the entire gestational age range. Inter-observer agreement of PVV at 11 weeks gestation was suboptimal (ICC 0.69, relative difference 50.1%). DISCUSSION Preconceptional and first-trimester 3D PD ultrasound utero-placental and embryonic vascular volume measurements using VR are feasible and reliable. Longitudinal cohort studies with repeated measurements are needed to further validate this and assess their value as new imaging markers for placental vascular development and ultimately for the prediction of placenta-related pregnancy complications.
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Affiliation(s)
- I F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - A H J Koning
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - A Frudiger
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E Jauniaux
- Department of Obstetrics and Gynecology, University College London Hospitals, Institute for Women's Health, University College London, London, United Kingdom
| | - G J Burton
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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10
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First-Trimester Crown-Rump Length and Embryonic Volume of Fetuses with Structural Congenital Abnormalities Measured in Virtual Reality: An Observational Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1953076. [PMID: 28421190 PMCID: PMC5379074 DOI: 10.1155/2017/1953076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/08/2017] [Accepted: 03/02/2017] [Indexed: 12/13/2022]
Abstract
Background. With the introduction of three-dimensional (3D) ultrasound it has become possible to measure volumes. The relative increase in embryonic volume (EV) is much larger than that of the crown-rump length (CRL) over the same time period. We examined whether EV is a better parameter to determine growth restriction in fetuses with structural congenital abnormalities. Study Design, Subjects, and Outcome Measures. CRL and EV were measured using a Virtual Reality (VR) system in prospectively collected 3D ultrasound volumes of 56 fetuses diagnosed with structural congenital abnormalities in the first trimester of pregnancy (gestational age 7+5 to 14+5 weeks). Measured CRL and EV were converted to z-scores and to percentages of the expected mean using previously published reference curves of euploid fetuses. The one-sample t-test was performed to test significance. Results. The EV was smaller than expected for GA in fetuses with structural congenital abnormalities (−35% p < 0.001, z-score −1.44 p < 0.001), whereas CRL was not (−6.43% p = 0.118, z-score −0.43 p = 0.605). Conclusions. CRL is a less reliable parameter to determine growth restriction in fetuses with structural congenital abnormalities as compared with EV. By measuring EV, growth restriction in first-trimester fetuses with structural congenital abnormalities becomes more evident and enables an earlier detection of these cases.
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11
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Aisa MC, Cappuccini B, Barbati A, Orlacchio A, Baglioni M, Di Renzo GC. Biochemical parameters of renal impairment/injury and surrogate markers of nephron number in intrauterine growth-restricted and preterm neonates at 30-40 days of postnatal corrected age. Pediatr Nephrol 2016; 31:2277-2287. [PMID: 27557556 DOI: 10.1007/s00467-016-3484-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Premature and/or intrauterine growth-restricted neonates have an increased risk of developing postnatal renal injuries in later life. Studies on renal physiology in these neonates at a corrected age of 30-40 days are scarce and mostly relate to preterm infants. The data from these studies often lack the results of correlation analyses between biochemical parameters and nephron number-data which could provide additional insight and/or improve recognition of individuals at higher risk of renal failure. METHODS Urinary total protein and albumin levels and N-acetyl-β-D-glucosaminidase and cathepsin B activity were evaluated in preterm and intrauterine growth-restricted infants at a corrected age of 30-40 days and compared to data from a healthy control neonate population. The data were then associated with predominant susceptibility factors of renal damage related to low nephron number, such as gestational age, birth weight, total renal volume and renal cortex volume. RESULTS Compared to the control neonate population, we found significantly increased levels of all biochemical parameters tested in the intrauterine growth-restricted neonates, whereas in the preterm infants we observed a significant increase in cathepsin B activity, total protein level and, to a lesser extent, albumin level. Cathepsin B activity showed a significant, strong and inverse correlation with all surrogate markers of nephron number and was also strongly and positively correlated with urinary albumin level. CONCLUSIONS At this postnatal age, we found that lower nephron number in low birth weight neonates was associated to tubular impairment/injury that could be concurrent with a dysfunction of glomerular permeability. Urinary cathepsin B activity may be a candidate marker for the early prediction of renal susceptibility to damage in low birth weight neonates.
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Affiliation(s)
- Maria Cristina Aisa
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy. .,Section of Biochemistry, Department of Agricultural Sciences, Food and Environment, University of Perugia, Perugia, Italy.
| | - Benito Cappuccini
- Department of Neonatology, Hospital S. M. della Misericordia, Perugia, Italy.,Centre of Perinatal Medicine, University of Perugia, Perugia, Italy.,GeBiSa, Research Foundation, Perugia, Italy
| | - Antonella Barbati
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Aldo Orlacchio
- Centre of Perinatal Medicine, University of Perugia, Perugia, Italy.,GeBiSa, Research Foundation, Perugia, Italy
| | | | - Gian Carlo Di Renzo
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.,Centre of Perinatal Medicine, University of Perugia, Perugia, Italy.,GeBiSa, Research Foundation, Perugia, Italy
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12
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Speksnijder L, Oom DMJ, Koning AHJ, Biesmeijer CS, Steegers EAP, Steensma AB. Agreement and reliability of pelvic floor measurements during rest and on maximum Valsalva maneuver using three-dimensional translabial ultrasound and virtual reality imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:243-249. [PMID: 26483139 DOI: 10.1002/uog.15785] [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: 05/21/2015] [Revised: 09/17/2015] [Accepted: 10/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Imaging of the levator ani hiatus provides valuable information for the diagnosis and follow-up of patients with pelvic organ prolapse (POP). This study compared measurements of levator ani hiatal volume during rest and on maximum Valsalva, obtained using conventional three-dimensional (3D) translabial ultrasound and virtual reality imaging. Our objectives were to establish their agreement and reliability, and their relationship with prolapse symptoms and POP quantification (POP-Q) stage. METHODS One hundred women with an intact levator ani were selected from our tertiary clinic database. Information on clinical symptoms were obtained using standardized questionnaires. Ultrasound datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm, at the level of minimal hiatal dimensions, during rest and on maximum Valsalva. The levator area (in cm(2) ) was measured and multiplied by 1.5 to obtain the levator ani hiatal volume (in cm(3) ) on conventional 3D ultrasound. Levator ani hiatal volume (in cm(3) ) was measured semi-automatically by virtual reality imaging using a segmentation algorithm. Twenty patients were chosen randomly to analyze intra- and interobserver agreement. RESULTS The mean difference between levator hiatal volume measurements on 3D ultrasound and by virtual reality was 1.52 cm(3) (95% CI, 1.00-2.04 cm(3) ) at rest and 1.16 cm(3) (95% CI, 0.56-1.76 cm(3) ) during maximum Valsalva (P < 0.001). Both intra- and interobserver intraclass correlation coefficients were ≥ 0.96 for conventional 3D ultrasound and > 0.99 for virtual reality. Patients with prolapse symptoms or POP-Q Stage ≥ 2 had significantly larger hiatal measurements than those without symptoms or POP-Q Stage < 2. CONCLUSIONS Levator ani hiatal volume at rest and on maximum Valsalva is significantly smaller when using virtual reality compared with conventional 3D ultrasound; however, this difference does not seem clinically important. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Speksnijder
- Department of Obstetrics and Gynecology, Division of Urogynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D M J Oom
- Department of Obstetrics and Gynecology, Division of Urogynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A H J Koning
- Department of Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C S Biesmeijer
- Department of Obstetrics and Gynecology, Division of Urogynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A B Steensma
- Department of Obstetrics and Gynecology, Division of Urogynecology, Erasmus Medical Center, Rotterdam, The Netherlands
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13
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Koning IV, Baken L, Groenenberg IAL, Husen SC, Dudink J, Willemsen SP, Gijtenbeek M, Koning AHJ, Reiss IKM, Steegers EAP, Steegers-Theunissen RPM. Growth trajectories of the human embryonic head and periconceptional maternal conditions. Hum Reprod 2016; 31:968-76. [PMID: 26965435 DOI: 10.1093/humrep/dew043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/26/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Can growth trajectories of the human embryonic head be created using 3D ultrasound (3D-US) and virtual reality (VR) technology, and be associated with second trimester fetal head size and periconceptional maternal conditions? SUMMARY ANSWER Serial first trimester head circumference (HC) and head volume (HV) measurements were used to create reliable growth trajectories of the embryonic head, which were significantly associated with fetal head size and periconceptional maternal smoking, age and ITALIC! in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) treatment. WHAT IS KNOWN ALREADY Fetal growth is influenced by periconceptional maternal conditions. STUDY DESIGN, SIZE, DURATION We selected 149 singleton pregnancies with a live born non-malformed fetus from the Rotterdam periconception cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Bi-parietal diameter and occipital frontal diameter to calculate HC, HV and crown-rump length (CRL) were measured weekly between 9 + 0 and 12 + 6 weeks gestational age (GA) using 3D-US and VR. Fetal HC was obtained from second trimester structural anomaly scans. Growth trajectories of the embryonic head were created with general additive models and linear mixed models were used to estimate associations with maternal periconceptional conditions as a function of GA and CRL, respectively. MAIN RESULTS A total of 303 3D-US images of 149 pregnancies were eligible for embryonic head measurements (intra-class correlation coefficients >0.99). Associations were found between embryonic HC and fetal HC ( ITALIC! ρ = 0.617, ITALIC! P < 0.001) and between embryonic HV and fetal HC ( ITALIC! ρ = 0.660, ITALIC! P < 0.001) in ITALIC! Z-scores. Maternal periconceptional smoking was associated with decreased, and maternal age and IVF/ICSI treatment with increased growth trajectories of the embryonic head measured by HC and HV (All ITALIC! P < 0.05). LIMITATIONS, REASONS FOR CAUTION The consequences of the small effect sizes for neurodevelopmental outcome need further investigation. As the study population consists largely of tertiary hospital patients, external validity should be studied in the general population. WIDER IMPLICATIONS OF THE FINDINGS Assessment of growth trajectories of the embryonic head may be of benefit in future early antenatal care. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre and Sophia Foundation for Medical Research, Rotterdam, The Netherlands (SSWO grant number 644). No competing interests are declared.
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Affiliation(s)
- I V Koning
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam 3000 CA, The Netherlands
| | - L Baken
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - I A L Groenenberg
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - S C Husen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - J Dudink
- Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam 3000 CA, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam 3000 CA, The Netherlands
| | - M Gijtenbeek
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - A H J Koning
- Department of Bioinformatics, Erasmus MC University Medical Center, Rotterdam 3000 CA, The Netherlands
| | - I K M Reiss
- Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam 3000 CA, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam 3000 CA, The Netherlands
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14
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Baken L, van Gruting IMA, Steegers EAP, van der Spek PJ, Exalto N, Koning AHJ. Design and validation of a 3D virtual reality desktop system for sonographic length and volume measurements in early pregnancy evaluation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:164-170. [PMID: 25041997 DOI: 10.1002/jcu.22207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/28/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To design and validate a desktop virtual reality (VR) system, for presentation and assessment of volumetric data, based on commercially off-the-shelf hardware as an alternative to a fully immersive CAVE-like I-Space VR system. METHODS We designed a desktop VR system, using a three-dimensional (3D) monitor and a six degrees-of-freedom tracking system. A personal computer uses the V-Scope (Erasmus MC, Rotterdam, The Netherlands) volume-rendering application, developed for the I-Space, to create a hologram of volumetric data. Inter- and intraobserver reliability for crown-rump length and embryonic volume measurements are investigated using Bland-Altman plots and intraclass correlation coefficients. Time required for the measurements was recorded. RESULTS Comparing the I-Space and the desktop VR system, the mean difference for crown-rump length is -0.34% (limits of agreement -2.58-1.89, ±2.24%) and for embryonic volume -0.92% (limits of agreement -6.97-5.13, ±6.05%). Intra- and interobserver intraclass correlation coefficients of the desktop VR system were all >0.99. Measurement times were longer on the desktop VR system compared with the I-Space, but the differences were not statistically significant. CONCLUSIONS A user-friendly desktop VR system can be put together using commercially off-the-shelf hardware at an acceptable price. This system provides a valid and reliable method for embryonic length and volume measurements and can be used in clinical practice.
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Affiliation(s)
- Leonie Baken
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Room Na15.23, PO Box 2040, 3000, CA Rotterdam, The Netherlands
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15
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Revelli A, Martiny G, Delle Piane L, Benedetto C, Rinaudo P, Tur-Kaspa I. A critical review of bi-dimensional and three-dimensional ultrasound techniques to monitor follicle growth: do they help improving IVF outcome? Reprod Biol Endocrinol 2014; 12:107. [PMID: 25420733 PMCID: PMC4255967 DOI: 10.1186/1477-7827-12-107] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/01/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This review focuses on the possibility of improving the outcome of human IVF by studying the follicles where oocytes grow by ultrasound techniques. A comprehensive analysis of bi-dimensional (2D) and three-dimensional (3D) ultrasound (US) assessment of the follicle size and volume is presented. METHODS Published reports from the year 1999 to 2014 analyzing the relationship between oocyte competence, IVF outcome and ultrasound assessment of the follicle size and volume have been critically analyzed. RESULTS US assessment of growing follicles has been performed mainly by 2D-US, and while overall very useful, it has been found to be of limited usefulness in predicting oocyte competence, recognize which follicles will release a mature metaphase II oocytes and decide the ideal time to trigger ovulation. In fact, a quite wide follicle size range (16-22 mm) has been reported to be associated with mature oocytes with good competence toward fertilization and embryo development. It has been also shown that smaller follicles sometimes contain mature, fertilizable oocytes. However, embryos derived from smaller follicles have probably a lower implantation potential, while follicles larger than 22 mm often contain post-mature eggs. CONCLUSIONS The study of follicular size by 2D-US is of limited usefulness in helping in the identification of follicles containing the best oocytes and in choosing the best moment to trigger ovulation. Possibly the value of US in this area will be improved by large prospective studies in which automated 3D-US will be used.
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Affiliation(s)
- Alberto Revelli
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
- LIVET Infertility and IVF Clinic, Torino, Italy
| | - Giorgia Martiny
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
| | | | - Chiara Benedetto
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
| | - Paolo Rinaudo
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA USA
| | - Ilan Tur-Kaspa
- Institute for Human Reproduction (IHR) and the Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL USA
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16
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Vos EL, Koning AHJ, Obdeijn IM, van Verschuer VMT, Verhoef C, van der Spek PJ, Menke-Pluijmers MB, Koppert LB. Preoperative prediction of cosmetic results in breast conserving surgery. J Surg Oncol 2014; 111:178-84. [PMID: 25332158 DOI: 10.1002/jso.23782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/07/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preoperative objective predictions of cosmetic result after breast conserving surgery (BCS) has the potential to aid in surgical treatment decision making. Our aim was to investigate the predictive value of tumor volume in relation to breast volume (TV/BV ratio) for cosmetic result. METHODS Sixty-nine invasive breast cancer women with preoperative MRI and treated by BCS and radiotherapy in 2007-2012 were prospectively included. Simple excision or basic oncoplastic techniques were used, but no volume displacement. TV/BV ratio was measured in the MRI while 3D-projected in virtual reality environment (I-Space). Cosmetic result was assessed by patient questionnaire, panel evaluation, and breast retraction assessment (BRA). Quality-of-life was assessed by EORTC QLQ-C30 and BR23. RESULTS Intraobserver and interobserver correlation coefficients for tumor and breast volume were all >0.95. Increasing TV/BV ratio correlated with decreasing cosmetic result as determined by patient, panel, and BRA. TV/BV ratio was a significant independent predictor for the panel evaluation (P=0.028), as was tumor location (P<0.05), and together they constituted a good prediction model (AUC 0.83). CONCLUSIONS TV/BV ratio was a precise and independent predictor for cosmetic result determined by a panel and can be used as preoperative prediction tool to enable more informed surgical treatment decision making.
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Affiliation(s)
- Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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17
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Eindhoven SC, van Uitert EM, Laven JSE, Willemsen SP, Koning AHJ, Eilers PHC, Exalto N, Steegers EAP, Steegers-Theunissen RPM. The influence of IVF/ICSI treatment on human embryonic growth trajectories. Hum Reprod 2014; 29:2628-36. [PMID: 25316447 DOI: 10.1093/humrep/deu271] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY QUESTION Is in vitro fertilization treatment with or without intracytoplasmatic sperm injection (IVF/ICSI) associated with changes in first and second trimester embryonic and fetal growth trajectories and birthweight in singleton pregnancies? SUMMARY ANSWER Embryonic and fetal growth trajectories and birthweight are not significantly different between pregnancies conceived with IVF/ICSI treatment and spontaneously conceived pregnancies with reliable pregnancy dating. WHAT IS KNOWN ALREADY IVF/ICSI treatment has been associated with increased risks of preterm birth, fetal growth restriction and low birthweight. Decreased first-trimester crown-rump length (CRL) in the general population has been inversely associated with the same adverse pregnancy outcomes. STUDY DESIGN, SIZE, DURATION In a prospective periconception birth cohort study conducted in a tertiary centre, 146 singleton pregnancies with reliable pregnancy dating and nonmalformed live borns were investigated, comprised of 88 spontaneous and 58 IVF/ICSI pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS Serial 3D ultrasound scans were performed from 6 to 12 weeks of gestation. As estimates of embryonic growth, CRL and embryonic volume (EV) were measured using the I-Space virtual reality system. General characteristics were obtained from self-administered questionnaires at enrolment. Fetal growth parameters at 20 weeks and birthweight were obtained from medical records. To assess associations between IVF/ICSI and embryonic growth trajectories, estimated fetal weight and birthweight, stepwise linear mixed model analyses and linear regression analyses were performed using square root transformed CRL and fourth root transformed EV. MAIN RESULTS AND THE ROLE OF CHANCE In 146 pregnancies, 934 ultrasound scans were performed of which 849 (90.9%) CRLs and 549 (58.8%) EVs could be measured. Embryonic growth trajectories were comparable between IVF/ICSI pregnancies and spontaneously conceived pregnancies (CRL: βIVF/ICSI = 0.10√mm; P = 0.10; EV: βIVF/ICSI = 0.03(4)√cm³; P = 0.13). Estimated fetal weight and birthweight were also comparable between both groups (βIVF/ICSI = 6 g; P = 0.36 and βIVF/ICSI = 80 g; P = 0.24, respectively). LIMITATIONS, REASONS FOR CAUTION Variations in embryonic growth trajectories of spontaneously conceived pregnancies with reliable pregnancy dating may partially be a result of less precise pregnancy dating and differences in endometrium receptivity compared with IVF/ICSI pregnancies. WIDER IMPLICATIONS OF THE FINDINGS The absence of a significant difference in embryonic and fetal growth trajectories suggests safety of IVF/ICSI treatment with regard to early embryonic growth. However, further research is warranted to ascertain the influence of IVF/ICSI treatments in a larger study population, and to estimate the impact of the underlying causes of the subfertility and other periconceptional exposures on human embryonic and fetal growth trajectories. FUNDING STATEMENT This study was supported by the Department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Centre. CONFLICT OF INTEREST No competing interests are declared.
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Affiliation(s)
- S C Eindhoven
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - E M van Uitert
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - J S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - S P Willemsen
- Division of Biostatistics, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - A H J Koning
- Division of Bioinformatics, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - P H C Eilers
- Division of Biostatistics, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - N Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - E A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - R P M Steegers-Theunissen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands Division of Clinical Genetics, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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18
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Reus AD, Klop-van der Aa J, Rifouna MS, Koning AHJ, Exalto N, van der Spek PJ, Steegers EAP. Early pregnancy placental bed and fetal vascular volume measurements using 3-D virtual reality. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1796-803. [PMID: 24798392 DOI: 10.1016/j.ultrasmedbio.2014.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/27/2014] [Accepted: 02/16/2014] [Indexed: 05/26/2023]
Abstract
In this study, a new 3-D Virtual Reality (3D VR) technique for examining placental and uterine vasculature was investigated. The validity of placental bed vascular volume (PBVV) and fetal vascular volume (FVV) measurements was assessed and associations of PBVV and FVV with embryonic volume, crown-rump length, fetal birth weight and maternal parity were investigated. One hundred thirty-two patients were included in this study, and measurements were performed in 100 patients. Using V-Scope software, 100 3-D Power Doppler data sets of 100 pregnancies at 12 wk of gestation were analyzed with 3D VR in the I-Space Virtual Reality system. Volume measurements were performed with semi-automatic, pre-defined parameters. The inter-observer and intra-observer agreement was excellent with all intra-class correlation coefficients >0.93. PBVVs of multiparous women were significantly larger than the PBVVs of primiparous women (p = 0.008). In this study, no other associations were found. In conclusion, V-Scope offers a reproducible method for measuring PBVV and FVV at 12 wk of gestation, although we are unsure whether the volume measured represents the true volume of the vasculature. Maternal parity influences PBVV.
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Affiliation(s)
- Averil D Reus
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Josine Klop-van der Aa
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maria S Rifouna
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Bioinformatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Bioinformatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Vandekerckhove F, Bracke V, De Sutter P. The Value of Automated Follicle Volume Measurements in IVF/ICSI. Front Surg 2014; 1:18. [PMID: 25593942 PMCID: PMC4286967 DOI: 10.3389/fsurg.2014.00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/16/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS The objective of this literature study is to investigate the place of recent software technology sonography-based automated volume count (SonoAVC) for the automatic measurement of follicular volumes in IVF/ICSI. Its advantages and disadvantages and potential future developments are evaluated. METHODS A total of 74 articles were read via a PubMed literature study. The literature study included 53 articles, 32 of which for the systematic review. RESULTS The SonoAVC software shows excellent accuracy. Comparing the technology with the "golden standard" two-dimensional (2D) manual follicle measurements, SonoAVC leads to a significantly lower intra- and inter-observer variability. However, there is no significant difference in clinical outcome (pregnancy rate). We noted a significant advantage in the time gained, both for doctor and patient. By storing the images, the technology offers the possibility of including a quality control and continuous training and further standardization of follicular monitoring can be expected. Ovarian reserve testing by measuring the antral follicle count with SonoAVC is highly reliable. CONCLUSION This overview of previously published literature shows how SonoAVC offers advantages for clinical practice, without losing any accuracy or reliability. Doctors should be motivated to the general use of follicular volumes instead of follicular diameters.
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Affiliation(s)
| | - Victoria Bracke
- Centre for Reproductive Medicine, University Hospital Ghent , Ghent , Belgium
| | - Petra De Sutter
- Centre for Reproductive Medicine, University Hospital Ghent , Ghent , Belgium
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20
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Baken L, Rousian M, Koning AHJ, Bonsel GJ, Eggink AJ, Cornette JMJ, Schoonderwaldt EM, Husen-Ebbinge M, Teunissen KK, van der Spek PJ, Steegers EAP, Exalto N. First-Trimester Detection of Surface Abnormalities: A Comparison of 2- and 3-Dimensional Ultrasound and 3-Dimensional Virtual Reality Ultrasound. Reprod Sci 2014; 21:993-999. [PMID: 24440996 DOI: 10.1177/1933719113519172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim was to determine the diagnostic performance of 3-dimensional virtual reality ultrasound (3D_VR_US) and conventional 2- and 3-dimensional ultrasound (2D/3D_US) for first-trimester detection of structural abnormalities. Forty-eight first trimester cases (gold standard available, 22 normal, 26 abnormal) were evaluated offline using both techniques by 5 experienced, blinded sonographers. In each case, we analyzed whether each organ category was correctly indicated as normal or abnormal and whether the specific diagnosis was correctly made. Sensitivity in terms of normal or abnormal was comparable for both techniques (P = .24). The general sensitivity for specific diagnoses was 62.6% using 3D_VR_US and 52.2% using 2D/3D_US (P = .075). The 3D_VR_US more often correctly diagnosed skeleton/limb malformations (36.7% vs 10%; P = .013). Mean evaluation time in 3D_VR_US was 4:24 minutes and in 2D/3D_US 2:53 minutes (P < .001). General diagnostic performance of 3D_VR_US and 2D/3D_US apparently is comparable. Malformations of skeleton and limbs are more often detected using 3D_VR_US. Evaluation time is longer in 3D_VR_US.
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Affiliation(s)
- Leonie Baken
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anton H J Koning
- Department of Bioinformatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ernst M Schoonderwaldt
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Margreet Husen-Ebbinge
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Katinka K Teunissen
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter J van der Spek
- Department of Bioinformatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Niek Exalto
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Diagnostic Techniques and Criteria for First-Trimester Conjoined Twin Documentation. Obstet Gynecol Surv 2013; 68:743-52. [DOI: 10.1097/ogx.0000000000000000] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Reus AD, El-Harbachi H, Rousian M, Willemsen SP, Steegers-Theunissen RPM, Steegers EAP, Exalto N. Early first-trimester trophoblast volume in pregnancies that result in live birth or miscarriage. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:577-584. [PMID: 23996572 DOI: 10.1002/uog.13197] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/12/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the validity of trophoblast volume measurements on three-dimensional ultrasound (3D-US) with Virtual Organ Computer-aided AnaLysis (VOCAL(TM) ), to create reference values between 6 and 12 weeks of gestation and to compare trophoblast volume between pregnancies ending in miscarriage and those resulting in live birth. METHODS In a prospective periconceptional cohort, we performed weekly 3D-US in 112 singleton pregnancies resulting in a non-malformed live birth and in 56 ending in miscarriage. Scans were performed between 6 and 12 weeks. Trophoblast volumes were calculated by subtracting the gestational sac volume from the volume of the total pregnancy. The interobserver and intraobserver agreement of measurements were determined to assess validity. Reference values were created for trophoblast volume in relation to crown-rump length and gestational age. RESULTS A total of 722 3D-US examinations were available for offline VOCAL measurements, but measurements could be performed in only 53% of these due to non-targeted scanning and incomplete framing. Interobserver and intraobserver agreement for trophoblast volume measurements were excellent, with intraclass correlation coefficients > 0.97. Trophoblast volumes of pregnancies ending in miscarriage were significantly smaller (P < 0.01) than were those of pregnancies that resulted in live birth. Trophoblast growth in pregnancies ending in miscarriage was also reduced compared with that in pregnancies that resulted in live birth. CONCLUSION VOCAL is a valid technique for measuring trophoblast volume during the early first trimester of pregnancy. Pregnancies ending in miscarriage have smaller trophoblast volumes as well as reduced trophoblast growth compared with those that result in live birth.
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Affiliation(s)
- A D Reus
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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23
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Baken L, van Heesch PNACM, Wildschut HIJ, Koning AHJ, van der Spek PJ, Steegers EAP, Exalto N. First-trimester crown-rump length and embryonic volume of aneuploid fetuses measured in virtual reality. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:521-525. [PMID: 23225608 DOI: 10.1002/uog.12365] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To examine whether embryonic volume (EV), as measured using three-dimensional (3D) ultrasound and a virtual reality approach, is a better measure of growth restriction than is crown-rump length (CRL) in aneuploid fetuses. METHODS We retrospectively measured CRL and EV in prospectively collected 3D ultrasound volumes of 55 aneuploid fetuses using the Barco I-Space VR system. The gestational age ranged from 11 + 2 to 14 + 4 weeks. We compared our measured data with previously published reference curves for euploid fetuses. Delta-values were calculated by subtracting the expected mean for euploid fetuses of the same gestational age from observed values. The one-sample t-test was used to test the significance of differences observed. RESULTS The CRL measurements of fetuses with trisomy 21 (n = 26), trisomy 13 (n = 5) and monosomy X (n = 5) were comparable with those of euploid fetuses, but in fetuses with trisomy 18 (n = 19) the CRL was 14.5% smaller (P < 0.001). The EV in fetuses with trisomies 21, 18 and 13 and monosomy X was smaller than in euploid fetuses (-27.8%, P < 0.001; -39.4%, P < 0.001; -40.9%, P = 0.004; and -27.3%, P = 0.055, respectively). CONCLUSIONS When relying on CRL measurements alone, first-trimester growth restriction is especially manifest in trisomy 18. Using EV, growth restriction is also evident in trisomies 21 and 13 and monosomy X. EV seems to be a more effective measurement for the assessment of first-trimester growth restriction in aneuploid fetuses.
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Affiliation(s)
- L Baken
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
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Rousian M, Hop WC, Koning AHJ, van der Spek PJ, Exalto N, Steegers EAP. First trimester brain ventricle fluid and embryonic volumes measured by three-dimensional ultrasound with the use of I-Space virtual reality. Hum Reprod 2013; 28:1181-9. [PMID: 23466669 DOI: 10.1093/humrep/det035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is it possible to evaluate first trimester brain ventricle development in human pregnancies using an innovative virtual reality (VR) application and to analyze the relation of the embryonic volume (EV) and brain ventricle fluid volume (BVFV) with gestational age (GA), crown-rump length (CRL) and the Carnegie stage? SUMMARY ANSWER Volumetry and staging of the human embryo using a VR application make it possible to obtain unique information about in-vivo embryonic normal and abnormal development and about the sizes of the ventricles and body. WHAT IS KNOWN ALREADY Human brain development is complex and has a rapidly changing anatomy during the first trimester of pregnancy. New insights will enable early detection of cerebral pathology. STUDY DESIGN, SIZE, DURATION In a prospective cohort study, we weekly performed three-dimensional (3D) ultrasound examinations in 112 uncomplicated pregnancies between 6 + 0 and 12 + 6 weeks GA. MATERIALS, SETTING, METHODS The examinations resulted in 696 3D ultrasound scans that were transferred to the I-Space VR system and analyzed using V-Scope volume rendering software. V-Scope is used to create a 'hologram' of the ultrasound image and allows depth perception and interaction with the rendered objects. The CRL measurements were performed with a tracing tool, and the volume measurements were automatically performed with a segmentation algorithm. The embryos were staged according to the internal and external characteristics of the Carnegie staging system. All longitudinal outcomes were analyzed using repeated measures ANOVA. MAIN RESULTS AND THE ROLE OF CHANCE CRL could be measured in 91% of the datasets and ranged from 2.5 to 79.0 mm. EV could be measured in 66% of the datasets and ranged from 2.4 to 23 812.0 mm³, whereas the BVFV could be measured in 38% of the datasets and ranged from 10.4 to 226.3 mm³. Finally, in 74% of the datasets, the embryos were staged according to the Carnegie criteria, starting as early as stage 12. Reference charts of volumes versus GA, CRL and stage were constructed. There was no significant relationship between the CRL or EV and the birthweight. LIMITATIONS, REASONS FOR CAUTIONS The low success rate is a limitation of this study that can be explained mainly by non-targeted scanning of the embryonic head. WIDER IMPLICATIONS OF THE FINDINGS The I-Space VR system and the V-Scope software enable automatic EV and BVFV measurements and 3D observations of embryonic development in the first trimester. This allows in-vivo staging of human embryos based on both internal and external morphological characteristics. STUDY FUNDING, COMPETING INTERESTS None.
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Affiliation(s)
- M Rousian
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Rousian M, Groenenberg IAL, Hop WC, Koning AHJ, van der Spek PJ, Exalto N, Steegers EAP. Human Embryonic Growth and Development of the Cerebellum Using 3-Dimensional Ultrasound and Virtual Reality. Reprod Sci 2013; 20:899-908. [DOI: 10.1177/1933719112468950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Rousian
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - I. A. L. Groenenberg
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - W. C. Hop
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A. H. J. Koning
- Department of Bioinformatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P. J. van der Spek
- Department of Bioinformatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N. Exalto
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E. A. P. Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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26
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Speksnijder L, Rousian M, Steegers EAP, Van Der Spek PJ, Koning AHJ, Steensma AB. Agreement and reliability of pelvic floor measurements during contraction using three-dimensional pelvic floor ultrasound and virtual reality. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:87-92. [PMID: 22045504 DOI: 10.1002/uog.10129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Virtual reality is a novel method of visualizing ultrasound data with the perception of depth and offers possibilities for measuring non-planar structures. The levator ani hiatus has both convex and concave aspects. The aim of this study was to compare levator ani hiatus volume measurements obtained with conventional three-dimensional (3D) ultrasound and with a virtual reality measurement technique and to establish their reliability and agreement. METHODS 100 symptomatic patients visiting a tertiary pelvic floor clinic with a normal intact levator ani muscle diagnosed on translabial ultrasound were selected. Datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm at the level of minimal hiatal dimensions during contraction. The levator area (in cm(2)) was measured and multiplied by 1.5 to get the levator ani hiatus volume in conventional 3D ultrasound (in cm(3)). Levator ani hiatus volume measurements were then measured semi-automatically in virtual reality (cm(3) ) using a segmentation algorithm. An intra- and interobserver analysis of reliability and agreement was performed in 20 randomly chosen patients. RESULTS The mean difference between levator ani hiatus volume measurements performed using conventional 3D ultrasound and virtual reality was 0.10 (95% CI, - 0.15 to 0.35) cm(3). The intraclass correlation coefficient (ICC) comparing conventional 3D ultrasound with virtual reality measurements was > 0.96. Intra- and interobserver ICCs for conventional 3D ultrasound measurements were > 0.94 and for virtual reality measurements were > 0.97, indicating good reliability for both. CONCLUSION Levator ani hiatus volume measurements performed using virtual reality were reliable and the results were similar to those obtained with conventional 3D ultrasonography.
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Affiliation(s)
- L Speksnijder
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Smeets NAC, Dvinskikh NA, Winkens B, Oei SG. A new semi-automated method for fetal volume measurements with three-dimensional ultrasound: preliminary results. Prenat Diagn 2012; 32:770-6. [PMID: 22592970 DOI: 10.1002/pd.3900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Complications in pregnancy are suggested to be the result of intrauterine conditions in the first trimester of pregnancy. Three-dimensional ultrasound volume measurements might give more information, compared with two-dimensional measurements. Commonly available methods for volume measurements are not suited for daily practice. This is a report of preliminary results of a promising, more practical semi-automated method for volume calculations with three-dimensional ultrasound. METHOD Volume datasets of 16 objects (10.2-41.5 cm(3) ) were obtained. Euclidean shortening flow and Perona and Malik were used as image enhancement techniques. The image gradient was calculated. The points of interest were detected by the iso-intensity and the edge-detection technique. Volume measurements with Volume Computer-aided AnaLysis (VOCAL) are used as a reference. A volume dataset of a first trimester fetus was acquired to test this method in vivo. RESULTS The mathematical calculations with iso-intensity (Perona and Malik: average= -1.57 cm(3) , SD=4.05; and Euclidean shortening flow: average= -1.38 cm(3) , SD=2.47) showed results comparable with the VOCAL method (average= +1.28 cm(3) , SD=2.07). We also succeeded in detecting all voxels in the whole contour of a 12-week fetus. CONCLUSION Mathematical volume calculations are possible with the semi-automated method. We were able to apply this new method on a first trimester fetus. This new method is promising for future use in the daily practice.
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Affiliation(s)
- Nicol A C Smeets
- Department of Gynaecology and Obstetrics, Atrium Medical Centre, Parkstad, The Netherlands.
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Sur SD, Clewes JS, Campbell BK, Raine-Fenning NJ. Embryo volume measurement: an intraobserver, intermethod comparative study of semiautomated and manual three-dimensional ultrasound techniques. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:516-523. [PMID: 21793080 DOI: 10.1002/uog.10046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare the reliability of our recently introduced technique for first-trimester embryo volume measurement, the 'semiautomated technique' using both Virtual Organ Computer-aided AnaLysis (VOCAL(™) ) and Sonography-based Automated Volume Count (SonoAVC) with a manual technique using VOCAL alone. METHODS Seventy-four subjects with viable, singleton first-trimester in-vitro fertilization (IVF) pregnancies were recruited. Each subject underwent transvaginal sonography, at which a three-dimensional ultrasound dataset of the entire gestational sac was acquired. Each embryo volume was measured by two techniques, each performed twice. In the semiautomated technique VOCAL was used to calculate the volume of the gestational and yolk sacs, and SonoAVC was used to quantify the fluid volume within the amniotic and extra-amniotic cavities. Embryo volume was calculated by subtracting the sum of yolk sac, amniotic and extra-amniotic fluid volumes from gestational sac volume. In the manual technique, VOCAL was used to delineate the entire embryo using 9° rotations. Reliability was assessed using limits of agreement and intraclass correlation coefficient. RESULTS Datasets were included from 52 eligible subjects. Median gestational age was 7 + 4 weeks; median crown-rump length (CRL) was 13 (range, 2-29) mm; and median embryo volume was 1.8 (range, 0.03-8.1) cm(3) using the semiautomated technique and 0.7 (range 0.009-3.6) cm(3) using the manual technique. There was a significant discrepancy in the volumes measured by the two different techniques. Assessment of the limits of agreement suggested that the semiautomated technique (-15.8% to 14.0% of the mean embryo volume) was more reliable than was the manual technique (-22.4% to 26.6%). CONCLUSION The semiautomated technique is more reliable than is the manual technique for embryo volume measurement. However, the discrepancy in measurements between the two methods raises concerns over the validity of the semiautomated technique that require further investigation.
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Affiliation(s)
- S D Sur
- Nottingham University Research and Treatment Unit in Reproduction (NURTURE), Division of Obstetrics and Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, UK.
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Rousian M, Koning AHJ, Hop WC, van der Spek PJ, Exalto N, Steegers EAP. Gestational sac fluid volume measurements in virtual reality. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:524-529. [PMID: 21520478 DOI: 10.1002/uog.9033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate a virtual reality (VR) application for gestational sac fluid volume (GSFV) measurements in first-trimester pregnancies and to study the correlation between different embryonic growth parameters. METHODS This was a prospective cohort study analyzing 180 three-dimensional (3D) ultrasound scans of 42 healthy women, performed between 5 + 5 and 12 + 6 weeks' gestational age (GA). The 3D datasets were transferred to the I-Space immersive VR system. The V-Scope application was used to create a 'hologram' of the ultrasound image, allowing depth perception and interaction with the rendered objects. Volumes were measured semi-automatically using a segmentation algorithm. In addition to the GSFV, the total gestational sac volume (GSV) and its diameter (GSD) were measured. The GSV was also calculated using the ellipsoid formula. Previously obtained measurements of embryonic volume and crown-rump length (CRL) were included in the study. The outcomes were analyzed using repeated-measures analysis of variance. RESULTS The GSFV was measured in 78 scans, and varied from 434 to 81 491 mm(3). A positive correlation between GSFV and GA, CRL and GSD was found. Comparison of the GSD formula constructed in our study in relation to GA with a formula that is commonly used clinically showed an increasing difference with increasing GA either side of 8 + 5 weeks. The GSFV/embryonic volume ratio showed a decrease with GA. The GSV calculated using the ellipsoid formula was on average 19.8% larger compared with the GSV measured in VR. CONCLUSION New charts for first-trimester GSFV were constructed using VR. These growth charts could be promising tools for studying normal and abnormal embryonic development.
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Affiliation(s)
- M Rousian
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Ata B, Tulandi T. Ultrasound automated volume calculation in reproduction and in pregnancy. Fertil Steril 2011; 95:2163-70. [PMID: 21549363 DOI: 10.1016/j.fertnstert.2011.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 03/25/2011] [Accepted: 04/05/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review studies assessing the application of ultrasound automated volume calculation in reproductive medicine. DESIGN We performed a literature search using the keywords "SonoAVC, sonography-based automated volume calculation, automated ultrasound, 3D ultrasound, antral follicle, follicle volume, follicle monitoring, follicle tracking, in vitro fertilization, controlled ovarian hyperstimulation, embryo volume, embryonic volume, gestational sac, and fetal volume" and conducted the search in PubMed, Medline, EMBASE, and the Cochrane Database of Systematic Reviews. Reference lists of identified reports were manually searched for other relevant publications. RESULT(S) Automated volume measurements are in very good agreement with actual volumes of the assessed structures or with other validated measurement methods. The technique seems to provide reliable and highly reproducible results under a variety of conditions. Automated measurements take less time than manual measurements. CONCLUSION(S) Ultrasound automated volume calculation is a promising new technology which is already used in daily practice especially for assisted reproduction. Improvements to the technology will undoubtedly render it more effective and increase its use.
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Affiliation(s)
- Baris Ata
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
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Rousian M, Koning AH, van der Spek PJ, Steegers EA, Exalto N. Virtual reality for embryonic measurements requiring depth perception. Fertil Steril 2011; 95:773-4. [DOI: 10.1016/j.fertnstert.2010.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 11/25/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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Rousian M, Verwoerd-Dikkeboom CM, Koning AHJ, Hop WC, van der Spek PJ, Steegers EAP, Exalto N. First trimester umbilical cord and vitelline duct measurements using virtual reality. Early Hum Dev 2011; 87:77-82. [PMID: 21131146 DOI: 10.1016/j.earlhumdev.2010.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/28/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND the umbilical cord and vitelline duct are of vital importance to the fetus, but they are rarely the subject of first trimester two-dimensional (2D) ultrasound evaluation due to the complexity of their shape and morphology. Virtual reality (VR) allows efficient visualisation and measurement of complex structures like the umbilical cord and vitelline duct. AIM to measure normal first trimester human growth of the umbilical cord length (UCL) and vitelline duct length (VDL) using a VR system; and to correlate both measurements with the gestational age (GA) and crown-rump length (CRL) and the VDL with the yolk sac volume (YSV). STUDY DESIGN prospective cohort study. Serial three-dimensional (3D) ultrasound measurements were performed from six to 14weeks GA, resulting in 125 3D volumes. These volumes were analysed using an I-Space VR system. SUBJECTS Thirty-two healthy pregnant women with an ongoing, normal pregnancy. OUTCOME MEASURES the UCL, VDL, YSV and other related structures were measured. RESULTS The UCL, measurable in 55% of cases, was positively correlated to advancing GA and CRL (p<0.001). The VDL could be measured in 42% of cases and showed a positive relationship with GA and CRL (p<0.001). There was a significant (p<0.001) relationship between YSV and VDL. CONCLUSIONS the present study, facilitated by a VR system, is the first to provide an in-vivo longitudinal description of normal first trimester growth of the human umbilical cord and vitelline duct. Further studies will reveal whether these parameters can be used in detection of abnormal fetal development.
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Affiliation(s)
- Melek Rousian
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Uittenbogaard LB, Haak MC, Tromp CHN, Terwee CB, Van Vugt JMG. Reliability of fetal cardiac volumetry using spatiotemporal image correlation: assessment of in-vivo and in-vitro measurements. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:308-314. [PMID: 20131339 DOI: 10.1002/uog.7582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the reliability of measurement of fetal cardiac ventricular volume, stroke volume, and ejection fraction with four-dimensional ultrasound using spatiotemporal image correlation (STIC). METHODS Volume datasets were collected from two sources: 24 from fetuses over a range of gestational ages and 12 from a miniature balloon model. Datasets were analyzed by three observers, repeatedly in 12 fetal datasets and all balloon datasets. Volume calculations were obtained by manually tracing multiple parallel slices (three-dimensional (3D) slice method). Measurement error was assessed by calculating standard errors of measurement (SEM) and coefficients of variation (CV). Reliability was assessed by calculating interobserver and intraobserver intraclass correlation coefficients (ICC). RESULTS Measurement errors of balloon volumes were small and reliability was good (SEM <or= 0.07 mL, ICC 0.98-1.00). Fetal ventricle volume measurement error ranged from 0.09 to 0.20 mL and CV from 14.6 to 28.3%. Ventricular volume reliabilities for intra- and interobserver comparisons were greater than or equal to 0.94 and 0.75, respectively. Fetal stroke volume measurement error (SEM 0.17 mL), CV (21.9%) and reliability were measured (intraobserver ICC: left ventricle stroke volume (LVSV), 0.93 vs. right ventricle stroke volume (RVSV), 0.88; interobserver ICC: LVSV, 0.75 vs. RVSV, 0.86). The measurement error decreased with increasing operator experience. The reliability of ejection fraction calculations was poor (ICC < 0.7) for intra- and interobserver comparisons. CONCLUSIONS Volume measurements obtained with STIC and 3D slice methods using a balloon model were reliable. In the fetus, measurement errors decreased with increasing operator experience, and reliability was better for stroke volume than for ejection fraction.
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Affiliation(s)
- L B Uittenbogaard
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Rousian M, Koning AHJ, van Oppenraaij RHF, Hop WC, Verwoerd-Dikkeboom CM, van der Spek PJ, Exalto N, Steegers EAP. An innovative virtual reality technique for automated human embryonic volume measurements. Hum Reprod 2010; 25:2210-6. [PMID: 20643693 DOI: 10.1093/humrep/deq175] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The recent introduction of virtual reality (VR) enables us to use all three dimensions in a three-dimensional (3D) image. The aim of this prospective study was to evaluate an innovative VR technique for automated 3D volume measurements of the human embryo and yolk sac in first trimester pregnancies. METHODS We analysed 180 3D first trimester ultrasound scans of 42 pregnancies. Scans were transferred to an I-Space VR system and visualized as 3D 'holograms' with the V-Scope volume-rendering software. A semi-automatic segmentation algorithm was used to calculate the volumes. The logarithmically transformed outcomes were analysed using repeated measurements ANOVA. Interobserver and intraobserver agreement was established by calculating intraclass correlation coefficients (ICCs). RESULTS Eighty-eight embryonic volumes (EVs) and 118 yolk sac volumes (YSVs) were selected and measured between 5(+5) and 12(+6) weeks of gestational age (GA). EV ranged from 14 to 29 877 mm(3) and YSV ranged from 33 to 424 mm(3). ANOVA calculations showed that when the crown-rump length (CRL) doubles, the mean EV increases 6.5-fold and when the GA doubles, the mean EV increases 500-fold (P < 0.001). Furthermore, it was found that a doubling in GA results in a 3.8-fold increase of the YSV and when the CRL doubles, the YSV increases 1.5-fold (P < 0.001). Interobserver and intraobserver agreement were both excellent with ICCs of 0.99. CONCLUSION We measured the human EV and YSV in early pregnancy using a VR system. This innovative technique allows us to obtain unique information about the size of the embryo using all dimensions, which may be used to differentiate between normal and abnormal human development.
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Affiliation(s)
- M Rousian
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
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Assessment of yolk sac volume by 3D-sonography using the XI VOCAL method from 7 to 10 + 6 weeks of pregnancy. Arch Gynecol Obstet 2010; 283 Suppl 1:1-4. [DOI: 10.1007/s00404-010-1521-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/10/2010] [Indexed: 11/26/2022]
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Sur SD, Jayaprakasan K, Jones NW, Clewes J, Winter B, Cash N, Campbell B, Raine-Fenning NJ. A novel technique for the semi-automated measurement of embryo volume: an intraobserver reliability study. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:719-725. [PMID: 20381945 DOI: 10.1016/j.ultrasmedbio.2010.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 05/29/2023]
Abstract
The aim was to assess intraobserver reliability of a new semi-automated technique of embryo volumetry. Power calculations suggested 46 subjects with viable, singleton pregnancies were required for reliability analysis. Crown rump length (CRL) of each embryo was analyzed using 2-D and a 3-D dataset acquired using transvaginal ultrasound. Virtual organ computer-aided analysis (VOCAL) was used to calculate volume of gestation sac (GSV) and yolk sac (YSV) and SonoAVC (sonography-based automated volume count) was used to quantify fluid volume (FV). Embryo volume was calculated by subtracting FV and YSV from GSV. Each dataset was measured twice. Reliability was assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Fifty-two datasets were analyzed. Median embryo volume was 1.8 cm(3) (0.1 to 8.1 cm(3)); median gestational age 7 + 4 weeks; median CRL 13 mm (2 to 29 mm). Mean difference of embryo volume measurements was 0.1cm(3) (limits of agreement [LOA] -0.3 to 0.4 cm(3)); multiples of mean (MoM) 0.38; mean difference of CRL measurements 0.3 mm (LOA -1.4 to 2.0 mm), MoM = 0.26. ICC for embryo volume was 0.999 (95%CI 0.998 to 0.999), confirming excellent intraobserver agreement. ICC for CRL was 0.996 (95%CI 0.991 to 0.998). Regression analysis showed good correlation between embryo volume and CRL (R(2) = 0.60). The new semi-automated 3-D technique provides reliable measures of embryo volume. Further work is required to assess the validity of this technique.
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Affiliation(s)
- Shyamaly D Sur
- Nottingham University Research & Treatment Unit in Reproduction (NURTURE), Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Barreto EQDS, Milani HJF, Araujo Júnior E, Haratz KK, Rolo LC, Nardozza LMM, Moron AF. Reliability and validity of in vitro volume calculations by 3-dimensional ultrasonography using the multiplanar, virtual organ computer-aided analysis (VOCAL), and extended imaging VOCAL methods. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:767-774. [PMID: 20427789 DOI: 10.7863/jum.2010.29.5.767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the reliability and validity of in vitro volume calculations by 3-dimensional ultrasonography. METHODS This observational study was performed by 2 examiners to obtain volumes of 3 objects of different shapes and sizes filled with ultrasound gel and immersed in water. The examiners used the multiplanar (5-mm interval), virtual organ computer-aided analysis (VOCAL, 30 degrees) and extended imaging (XI) VOCAL (5, 10, 15, and 20 planes) methods to estimate the volumes of each object. A paired Student t test (P) and intraclass correlation coefficients (ICCs) were used to assess reproducibility of the methods. Validity was assessed comparing the percent differences between the estimated and the real volumes using the P value, mean differences, and ICC for each method. RESULTS All methods were highly reliable and valid. There were no significant differences in interobserver variability; there was a strong interobserver correlation. There were no significant differences in the percent differences between the estimated and real volumes of the objects using the 3 methods. The XI VOCAL method was superior to the multiplanar and VOCAL methods in the measurement of irregularly shaped objects. The XI VOCAL method with 10 planes estimated volumes closest to the real volumes. CONCLUSIONS All 3 methods were reliable and valid; however, XI VOCAL was superior to the other methods in the measurement of irregularly shaped objects.
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Verwoerd-Dikkeboom C, Koning A, Hop W, van der Spek P, Exalto N, Steegers E. Innovative virtual reality measurements for embryonic growth and development. Hum Reprod 2010; 25:1404-10. [DOI: 10.1093/humrep/deq061] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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