Eisuke Inubashiri

Does three‐dimensional power Doppler ultrasound improve the diagnostic accuracy for the prediction of adnexal malignancy?

Objective:  The aim of the present study was to investigate the diagnostic accuracy of three‐dimensional power Doppler ultrasound (3DPD) in the differentiation between benign and malignant adnexal masses and evaluate 3DPD for assessing malignancy in comparison with two‐dimensional transvaginal gray‐scale sonography (2DTVS), magnetic resonance imaging (MRI) and positron emission tomography (PET).

Positron emission tomography with the glucose analog [18F]-fluoro-2-deoxy-D-glucose for evaluating pelvic lymph node metastasis in uterine corpus cancer: Comparison with CT and MRI findings

Objective:  The aims of this study were to investigate the ability of positron emission tomography (PET) with the glucose analog [18F]‐fluoro‐2‐deoxy‐D‐glucose (FDG) to detect pelvic lymph node metastasis of uterine corpus cancer and to perform a retrospective comparison with computed tomography (CT) and magnetic resonance imaging (MRI) findings.

Three-Dimensional Sonographic Features of Placental Abnormalities

Objective: To describe three-dimensional (3D) sonographic features of placental abnormalities in utero. Methods: A total of 6 cases with placental abnormalities (1 chorioangioma, 1 subchorionic hematoma, 2 placental cysts, and 2 subplacental fibromas) from 22 to 34 weeks of gestation were studied with transabdominal 3D sonography. Results: Placental abnormalities could be easily imaged with both two-dimensional (2D) and 3D sonography; however, visualization of the continuity and curvature of structures was more easily accomplished with 3D sonography. In the case with chorioangioma, the thick and rough surface of the tumor was clearly depicted. With the use of color Doppler ultrasound, only a case of chorioangioma was shown to have abundant blood flow within the tumor. In cases with placental cyst and subchorionic hematoma, the wall of the cyst becomes a transparent-like structure, so internal textures can be clearly identified. In the case with subplacental fibroma, the location in relation to the placenta was clearly recognized. Conclusion: These results suggest that 3D sonography has the potential to be a supplement to 2D sonography and color Doppler ultrasound in identifying placental masses and provides a novel means of visualizing placental abnormalities in utero.

Nuchal Translucency Thickness and Fetal Cardiac Flow Velocity in Normal Fetuses at 11–13 Weeks of Gestation

Objective: To investigate the relationship between nuchal translucency thickness and cardiac flow velocity in normal fetuses at 11–13 weeks of gestation. Subjects and Methods: Eighteen normal pregnancies were prospectively studied with transvaginal sonography and pulsed and color Doppler ultrasound. Flow velocities at the fetal atrioventricular valves (mitral and tricuspid valve) and outflow tract levels (ascending aorta and pulmonary artery), and at the descending aorta were recorded. Nuchal translucency thickness was also measured. Results: Mitral peak velocity during early diastolic filling correlated with gestational age. Mitral peak velocities during early diastolic filling and atrial contraction, tricuspid peak velocity during early diastolic filling, ascending aorta peak velocity, and pulmonary artery peak velocity correlated well with nuchal translucency thickness. There was an inverse correlation between umbilical artery pulsatility index and gestational age. Conclusions: These results suggest that the increase of nuchal translucency thickness in normal fetuses at 11–13 weeks of gestation may be the consequence of changes in fetal cardiac functions.

Four‐dimensional sonography with B‐flow imaging and spatiotemporal image correlation for visualization of the fetal heart

To use B‐flow imaging with 4‐dimensional (4D) sonography and spatiotemporal image correlation (STIC) in the evaluation of normal fetal heart and congenital heart disease during pregnancy.

Three‐dimensional sonographic volume measurement of the fetal spleen

Aim:  The objective of this longitudinal study was to evaluate the growth of the fetal lung in normal pregnancies, using 3‐D ultrasound.

Real-time three-dimensional color Doppler fetal echocardiographic features of congenital heart disease

The purpose of this report is to describe the real‐time three‐dimensional (3D) color Doppler fetal echocardiographic findings of congenital heart diseases. Two cases of fetal congenital heart disease were diagnosed antenatally by conventional two‐dimensional fetal echocardiography and real‐time 3D color Doppler fetal echocardiography. Conventional two‐dimensional (2D) fetal echocardiography showed a hypoplastic left heart in one case, and a double‐outlet right ventricle in the second case. Real‐time 3D fetal echocardiography with instantaneous volume‐rendered displays showed surgeons eye views of intracardiac abnormal cardiac structures of the beating heart in both cases. Real‐time 3D color Doppler fetal echocardiography depicted a subtle tricuspid regurgitant jet in hypoplastic left heart syndrome, and great arteries, left from the right ventricle, in parallel in a double‐outlet right ventricle. Real‐time 3D color Doppler fetal echocardiography may assist in the evaluation of fetal cardiac anatomy and hemodynamics, and offer the potential advantages relative to conventional 2D fetal echocardiography and Doppler flow mapping.

Three-dimensional sonographic volume measurement of the fetal cerebellum

PurposeThe objective of this longitudinal study was to evaluate the growth of the fetal cerebellum in normal pregnancy by using three-dimensional ultrasound.MethodsThree-dimensional sonographic examinations were performed for 13 appropriate-for-gestational-age fetuses. Fetal cerebellar volume was measured every 2 to 3 weeks after 20 weeks of gestational age until delivery. The common multiplanar technique was used to calculate the fetal cerebellar volume.ResultsA curvilinear relationship was found between gestational age and cerebellar volume (R2 = 78.6%, P < 0.0001), and normal ranges of cerebellar volume measurements for estimating the growth of the fetal cerebellum during normal pregnancy were generated. The data gathered in this study were fairly comparable with previous data obtained using three-dimensional ultrasound. However, the normal ranges of cerebellar volume that we determined were relatively wide throughout pregnancy.ConclusionsOur findings suggest that a standard curve for fetal cerebellar volume using three-dimensional ultrasound can play a role in the evaluation of normal cerebellar growth in the fetus. However, we do cast doubt on the reliability and reproducibility of cerebellar volume measurement using three-dimensional ultrasound. Further studies involving a larger sample size and another technique (the rotational method with VOCAL) would be needed to confirm these findings.

Three-dimensional power Doppler sonographic features of uterine vascular malformation.

Pelvic arteriovenous malformations (AVMs) are uncommon lesions of frequently unknown cause. Congenital AVMs are considered to be undifferentiated vascular structures resulting from arrest of embryonic development at various stages1,2. Acquired AVMs are usually caused by neoplasms, trophoblastic disease or trauma, and procedures such as curettage and uterine surgery have been implicated3–5. These malformations are characterized by their slow growth with a period of latency before becoming symptomatic. They may produce local or systemic effects, including vaginal bleeding, abdominal pain, urinary symptoms, and high-output congestive heart failure. Many methods have been used to diagnose pelvic AVMs. Angiography, which is the gold standard for diagnosis, has the advantage of demonstrating the feeding arteries and draining veins of the AVM6. However, angiography is an invasive procedure, and should be reserved for cases in which surgical intervention or therapeutic embolization of the lesion is planned such as those with persistent and severe uterine hemorrhage7–9. Recently, color and power Doppler sonography has provided a valuable, non-invasive method for the definitive diagnosis of AVM10,11. We present our initial experience with applying three-dimensional sonography in the diagnosis of uterine vascular malformation. A 27-year-old Japanese woman, gravida 3 para 2, was referred to our outpatient department because of persistent high serum β-human chorionic gonadotropin (β-hCG) levels. Gray-scale sonography (GE Voluson 730 Expert, Yokogawa, Tokyo, Japan) revealed an ill-defined mildly echogenic lesion with multiple small hypoechoic spaces on the right side of the uterus. Twodimensional color and power Doppler flow imaging showed a hypervascular lesion with turbulent flow, with a peak velocity of 80.3 cm/s and low pulsatility index of 0.445. The clinical diagnosis of invasive mole was made, and five courses of chemotherapy with Etoposide were administered. After 3 courses of chemotherapy, the serum β-hCG levels normalized. Six months after chemotherapy, three-dimensional power Doppler sonography clearly showed an aneurysm-like structure typical of uterine vascular malformation including its feeding vessels and drainage within the right mesosalpinx (Figure 1). The diagnosis of uterine vascular malformation was confirmed by magnetic resonance angiography. The patient had no manifestation of clinical symptoms. The aneurysm-like structure of the uterine vascular malformation was still evident 17 months after the initial examination. The typical color Doppler sonographic pattern of an AVM is ‘chaotic’ flow characterized by a turbulent flow velocity waveform. The ‘chaotic’ or turbulent flow results from the area being filled with numerous individual velocity vectors randomly occurring in all directions. The diagnosis of AVM might be made from these findings on color Doppler ultrasound but confirmation of the diagnosis is usually achieved by angiography12. There has been only one report on the three-dimensional power Doppler sonographic diagnosis of AVM of the mesosalpinx12. In our case, the aneurysm-like structure of the uterine vascular malformation with its feeding vessels and drainage within the right mesosalpinx was shown beautifully by means of three-dimensional power Doppler sonography. Moreover, it could be observed from any angle, which enables a much easier and quicker understanding of the spatial relationships of the vessels involved12. As surgical manipulation for uterine or pelvic AVM may sometimes result in hemorrhage or even death, conservative management by means of serial observations, may be preferable8,12. Timmerman et al.10 reported that conservative management is possible in more than two-thirds of patients presenting with uterine vascular malformation diagnosed by color Doppler sonography, and that peak systolic velocity values appear to be useful in distinguishing lowfrom highrisk patients. Peak systolic velocities of ≥ 83 cm/s were associated with higher probabilities of further treatment such as embolization whereas no vascular malformation with a peak systolic velocity value

3D and 4D sonographic imaging of amniotic band syndrome in early pregnancy.

We present a case of amniotic band syndrome diagnosed with two‐dimensional (2D), three‐dimensional (3D), and four‐dimensional (4D) sonography at 14 weeks and 5 days of gestation. Conventional 2D sonography revealed multiple amniotic bands, fetal acrania, deformed hand, gastroschisis, kyphoscoliosis, and club foot. 3D and 4D sonography revealed multiple amniotic bands swinging in the amniotic cavity with 1 of them attached to the fetal head, and the severe deformity of the fetal face.