Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Anatomical Asymmetry in Goiter: A Demonstration by Three-dimensional Power Doppler Ultrasound

A 58-Year-Old Man in Respiratory Distress After Lung Lobectomy

Effect of the copper-intrauterine device (TCu 380A) on subendometrial microvascularization and uterine artery blood flow

Background and aim The aim of this study was to evaluate ovarian reserve, uterine artery blood flow, and endometrial and subendometrial blood flow in women with unexplained recurrent miscarriage compared with normal fertile women. Patients and methods The study design was a case–control one. The study was conducted in the Department of Obstetrics and Gynaecology, Benha University, Benha, Egypt. Women were divided into two groups: those with a history of unexplained recurrent miscarriage (the study group, n=50), and those who had no history of miscarriage and had at least one child born at term (the control group, n=50). At days 3–4 of the cycle, ovarian reserve testing was performed for all women by measuring follicle-stimulating hormone, luteinizing hormone and oestradiol levels. Thereafter, two-dimensional (2D) and 3D transvaginal ultrasonography and power Doppler were performed to detect antral follicle count, ovarian volume, and ovarian stromal Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI). Between days 18 and 23 of the cycle, transvaginal ultrasonography was performed for all women using 2D, pulsed Doppler and 3D-power Doppler mode to detect endometrial thickness, Uterine Artery Pulsatility Index, endometrial volume and endometrial and subendometrial blood flow presented by the indices VI, FI and VFI. The indices between the two groups were compared. Results Uterine Artery Pulsatility Index was significantly higher in the study group (P=0.001), whereas endometrial VI (P≤0.001), FI (P=0.01) and VFI (P≤0.001) and subendometrial VI, FI and VFI (P≤0.001) were significantly lower in the study group. The ovarian reserve tests, endometrial thickness and endometrial volume, however, were not significantly different between the two groups. Conclusion The presence of good uterine and endometrial blood flow is an important prerequisite for successful implantation and continuation of pregnancy as shown by higher uterine artery blood flow resistance and lower endometrial and subendometrial blood flow in recurrent unexplained miscarriage cases. We could not find any cutoff values that could predict the occurrence of miscarriage, and hence larger prospective studies are needed to confirm such results and reaching values that can accurately predict the occurrence of miscarriage.

After completing this article, readers should be able to: 1. Describe the calculations used to measure fetal systemic and placental vascular impedance in the umbilical artery via Doppler ultrasonography. 2. Delineate the two primary uses of measurement of middle cerebral artery flow velocity. 3. List the fetal conditions in which Doppler flow velocity has been studied. The Doppler principle, discovered by Johann Christian Andreas Doppler in 1842, (1) was used initially in astronomy and later in the military, in various branches of industry, and more recently in medicine. Doppler shift is based on the perceived change in frequency of an energy waveform as the source and the receiver move toward or away from each other. The Doppler shift principle applies to light waves as well as sound waves. In biology, Doppler ultrasonography is used noninvasively, primarily to measure flow velocity in blood vessels. Flow velocity depends on the volume and speed of effluent relative to the diameter of the vessel. Estimating fetal vascular resistance through study of Doppler flow velocity provides a means to assess, albeit indirectly, fetal physiology and pathology. Johnson and colleagues (2) in 1965, made the earliest mention of the use of Doppler effect in obstetrics. The use of Doppler ultrasonography to investigate the pattern of waveforms in the umbilical artery during pregnancy initially was reported in 1977 by Fitzgerald and Drumm. (3) Subsequently, Wladimiroff and associates (4) reported on Doppler assessment of cerebral blood flow in the human fetus. The addition of color mapping has enhanced the utility of the Doppler effect in sonographic assessment of the fetus. The fetal umbilical artery (UA) and middle cerebral artery (MCA) have evolved as the primary targets of fetal Doppler studies (Figs. 1 and 2). Figure 1. Color Doppler view of circle of Willis. Arrows show anterior (ACA), middle (MCA), and posterior cerebral …

Objective: To explore the application of a new 10 French intracardiac echocardiography (ICE) catheter with phased array and Doppler capable transducer for the assessment of epicardial and intramyocardial coronary blood...

Fetal cardiovascular system and placenta appear at the same time in embryology, so the morphology and function of placenta will change in the presence of congenital heart disease (CHD). The purpose of this study was to compare placental blood perfusion and function between normal fetus and CHD fetus. In this study, 40 fetuses were collected prospectively, including 20 cases of normal group and 20 cases of CHD group. CHD group included tetralogy of Fallot (n = 9), complete transposition of great arteries (n = 3), single ventricle (n = 2), congenital anomaly of aorta (n = 4) and total anomalous pulmonary venous drainage (n = 2). We engaged the SlowflowHD mode to visualise placental blood flow, and procured three-dimensional images. SlowflowHD can vividly display the placental basal plate, chorionic plate, primary villi, secondary villi, and tertiary villi and 3D reconstruction of the placental blood flow. Further, the spectral characteristics of all hierarchical levels of the villi can be extracted using spectral Doppler. Utilising virtual organ computer-assisted analysis (VOCAL) measurement software, the colour blood flow signal of the placental region of interest was numerically quantified as a histogram, and vascular index (VI), flow index (FI) and vascular flow index (VFI) were calculated automatically. The results showed that the umbilical vein blood flow, VI, FI and VFI in CHD group were lower than those in normal fetus. However, there was no significant difference in Doppler blood flow parameters of placental villi between the two groups. The distribution density of placental villi of CHD fetus is lower than that of normal fetus, and the blood flow index of placental parenchyma is lower than that of normal fetus. SlowflowHD imaging can be used as a scientific tool to study fetal heart-placental axis. This method helps to better understand the role of placenta in placental development, especially the placental differences in CHD.

To develop ultrasound-based methods for detection and localization of internal vascular bleeding, we investigated the bleeding signatures using color and pulsed Doppler. Under ultrasound guidance, femoral arteries (n=13) and veins (n=12) in seven pigs were catheterized with 6, 9, and 11 F catheters. Color and pulsed Doppler were acquired from the injury site and the surrounding positions after withdrawal of the catheter. The bleeding rates were 3.8–38 ml/s. Color Doppler revealed that the injured vessels were in spasm. The checkered color pattern at the injury site indicated flow turbulence. Pulsed Doppler spectrum of the color jet (extravasated blood) represented a unique arterial bleeding pattern with increased baseline velocity (from 0 up to 25.8 cm/s) and elevated systolic velocity (from 23.2 up to 62.5 cm/s) at the puncture site, as compared to the normal arterial pattern. Venous bleeding showed a narrow-band vibration signal at the bleeding site. Local blood turbulence contained multiple velocity components which were illustrated as checkered color in color Doppler. Pulsed Doppler spectrum showed increased baseline due to turbulence and elevated velocity due to narrowed vessel. In future studies pulsed Doppler radio-frequency data will be used to analyze bleeding patterns for detection and localization of internal bleeding.

：Objective To explore theclinical value of color Doppler flow imaging(CDFI) combined with quantitative analysistechnique to evaluate renal flow perflusion. Methods Twenty patients with different renaldiseases matched with healthy control subjects were examined with Philips iU22 CDFIsystem. CDFI system and Qlab quantitative technique were used to measure renal restrictiveindex(RI), vascularization index(VI), flow index(FI), vascularization-flow index (VFI).The patients all received renal single-photon emission computed tomography (SPECT)examination. Results The RI of 32 kidney with lower flow perfusion in SPECT were higherthan in the contol group (P <0.01). VI,FI, VFI were lower than those in control(VI,VFI, P <0.01 ;FI, P <0.05). Conelusious The renal blood flow perfusion of patientswith renal diseases are lower than that of healthy people. It has high clinical valueusing CDFI combined with quantitative analysis technique to evaluate the renal perfusionof the patients with renal diseases.

Value of placental volume and vascular flow indices as predictors of intrauterine growth retardation

American society of echocardiography guidelines and standards for performance of the fetal echocardiogram

Objective: To analyze the diagnostic value of transvaginal three-dimensional ultrasound (3D-TVS) in evaluating endometrial receptivity (ER) for ovulation disorder infertility (ODI), and to investigate the impact of subendometrial endometrial vascular index (VI) and endometrial vascular flow index (VFI) levels on ODI. Methods: A total of 110 patients diagnosed with ODI admitted between January 2023 and June 2024 were selected. All patients underwent ovulation induction therapy, 3D-TVS examination, and sex hormone testing. Based on pregnancy outcomes, patients were divided into a successful pregnancy group (73 cases) and an unsuccessful pregnancy group (37 cases). ER parameters, sex hormone levels, and endometrial blood flow patterns were compared between the two groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of ER for ODI. Results: The spiral artery peak systolic velocity (PSV), endometrial volume (EMV), endometrial flow index (FI), and VFI in the successful pregnancy group were significantly higher than those in the unsuccessful pregnancy group (p &lt; 0.05). No significant differences were observed in other ER parameters between the two groups (p &gt; 0.05). There was no significant difference in sex hormone levels between the two groups on the day of human chorionic gonadotropin (hCG) treatment (p &gt; 0.05). Among the endometrial blood flow classifications in the pregnant group, the proportion of Type II was lower than that in the non-pregnant group (p &lt; 0.05). The Receiver Operating Characteristic (ROC) curve demonstrated that the area under the curve (AUC) for Endometrial Volume (EMV) in predicting pregnancy after Ovarian Dysfunction Infertility (ODI) treatment was 0.854, with a sensitivity of 92.61% and a specificity of 71.75%. The AUC for Vascularization Index (VI) was 0.771, with a sensitivity of 52.18% and a specificity of 88.70%. The AUC for Vascularization Flow Index (VFI) of the endometrium was 0.887, with a sensitivity of 80.01% and a specificity of 69.20%. Conclusion: Three-dimensional transvaginal sonography (3D-TVS) assessment of endometrial receptivity (ER) can effectively detect ODI, and the levels of subendometrial VI and VFI demonstrate superior predictive performance for pregnancy outcomes in this condition, serving as commonly used predictive indicators for the disease.

Preeclampsia is associated with placental vascularization disorders. Ultrasonographic sphere biopsy (USSB) of the placenta can estimate the vascularization of the placenta and potentially the risk of preeclampsia. We aimed to explore the factors related to placental vascularization measured with USSB in the first trimester. A prospective cohort was conducted in women recruited at 11 to 14 weeks. Three-dimensional acquisition of the placenta with power Doppler was undertaken along with crown-rump length (CRL). Using USSB of the full placental thickness at its center, vascularization index, flow index, and vascular flow index were measured. Pearson's correlation coefficients and multivariate linear regression were used to correlate the vascularization indices with CRL and maternal characteristics. A total of 5,612 women were recruited at a mean gestational age of 12.8 ± 0.6 weeks. We observed that vascularization indices increase with CRL. After adjustment, we observed that maternal age, ethnicity other than Caucasian, and body mass index were associated with lower vascularization indices, while diabetes, smoking, and assisted reproduction technology were not. We observed that parous women without history of preeclampsia had greater vascularization indices compared with nulliparous women. Placental vascularization indices assessed by USSB fluctuate with gestational age, ethnicity, maternal age, body mass index, and previous pregnancy history.

To determine the ability of contrast material-enhanced ultrasonography (US) to depict tumor growth and vascularity in a murine model of prostate carcinoma treated with an angiogenic inhibitor. Thirty-five genetically engineered mice with spontaneously occurring prostate tumors were monitored on a weekly basis with gray-scale and color Doppler US with a 15-MHz linear transducer. Eighteen mice were treated with an adenoviral vector to deliver a soluble form of the Flk1 receptor (VEGFR-2), a vascular endothelial growth factor receptor designed to block tumor angiogenesis. The remaining 17 animals were injected with saline and used as controls. Tumor volumes were calculated on the basis of serial US measurements. Color Doppler US was performed in every tumor before and after intravenous injection of 0.1 mL per kilogram of body weight of a US contrast agent. US images were evaluated for tumor size, pattern of vascularity, and extent of vascularity (vascularity index). Findings at US were correlated with findings at autopsy in 30 animals. Estimates of tumor volume at US correlated well with tumor measurements at autopsy (r =.89, P <.001). Marked differences in tumor size and slope of increasing tumor volume were evident at US between treated and control mice after treatment (P <.016, analysis of variance). The US contrast agent markedly increased color Doppler US signal intensity with an 800% (from 10% to 12,700%) change in the mean number of color pixels per imaging field, and showed vascularity in areas of tumor not identified on precontrast images in 70% (109 of 156 studies). No correlation was found between the pattern of vascularity or vascularity index before or after contrast material administration and tumor size, treatment status, or histologic assessment of tumor vascularity. Contrast-enhanced US improves visualization of tumor vascularity. However, histologic patterns of tumor vascularity do not correlate with Doppler US depiction of blood flow in these vessels.

To analyze the relationship and predictive value of Netrin-1 expression and ultrasonic blood flow parameters with the severity of cervical intraepithelial neoplasia (CIN). A retrospective analysis was performed on 115 patients diagnosed with CIN and 37 patients with chronic cervicitis, all of whom underwent surgical intervention. The expression levels of Netrin-1 were evaluated through immunohistochemical staining and quantitative fluorescence PCR. Doppler ultrasound was employed to quantify flow index (FI), vascularization index (VI), and vascularization flow index (VFI) using VOCAL software. Statistical analyses, including correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis, were conducted to assess the predictive value of Netrin-1 expression and ultrasound-derived blood flow parameters. FI, VI, and VFI increased with CIN grade, showing significant differences between CIN II, CIN III, and the control group (P < 0.05). Netrin-1 levels were negatively correlated with FI, VI, and VFI (correlation coefficients of -0.287, -0.309, and -0.298; P < 0.05). Logistic regression indicated that Netrin-1 positivity was a protective factor against CIN III, while FI, VI, and VFI were risk factors. The AUC for Netrin-1 was 0.712, with sensitivity and specificity of 76.4% and 79.5% (P < 0.05). Netrin-1 expression is significantly reduced in CIN patients, whereas Doppler ultrasound-derived blood flow parameters-FI, VI, and VFI-are markedly elevated. Both Netrin-1 levels and these ultrasound parameters exhibit a strong correlation with the severity of cervical lesions. Notably, Netrin-1 is negatively correlated with FI, VI, and VFI. Furthermore, Netrin-1 positivity serves as a protective factor against CIN III lesions, while elevated levels of FI, VI, and VFI are associated with increased risk for these lesions. The expression levels of both Netrin-1 and ultrasound parameters provide valuable predictive insights for the early screening, diagnosis, and prevention of cervical cancer.