Hsing-I Wang

Quantitative analysis of normal fetal brain volume and flow by three-dimensional power Doppler ultrasound

Background: Assessment of the fetal brain volume and blood flow is important in the evaluation of fetal growth. We used three‐dimensional (3D) ultrasound and power Doppler to assess the fetal brain volume and the blood flow index during normal gestation. The relationships of these parameters were further analyzed. Methods: We assessed the total volume and the blood flow index of the fetal brain in normal pregnancies using 3D ultrasound (Voluson 730). The bilateral parietal diameter (BPD) plane was measured by a 3D transabdominal probe to scan the fetal brain under the power Doppler mode. Then, we quantitatively assessed the total volume of the fetal brain, mean grey area (MG), vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI) by applying Kretz VOCAL software. Results: The study included 126 fetuses, ranging from 15 to 38 weeks of gestation. The total volume of the fetal brain was highly positively correlated with the gestational age (GA) (correlation coefficient [r] = 0.976, p < 0.0001). The MG, VI, and VFI were negatively correlated with the GA (correlation coefficient [r] = −0.520, p < 0.0001; [r] = −0.421, p < 0.001; [r] = −0.319, p < 0.0001). The FI was positively correlated with the GA (correlation coefficient [r] = 0.483, p < 0.0001). Conclusion: 3D ultrasound can be used to assess the fetal brain volume and blood flow development quantitatively. Our study indicates that the fetal brain vascularization and blood flow correlates significantly with the advancement of GA. This information may serve as a reference point for further studies of the fetal brain volume and blood flow in abnormal conditions.

Delayed postpartum hemorrhage secondary to idiopathic rupture of right uterine artery: A case report and literature review

a Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan b Department of Obstetrics and Gynecology, National Yang-Ming University, School of Medicine, Taipei, Taiwan c Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan d Taipei Mackay Memorial Hospital, Taipei, Taiwan e Mackay Medicine, Nursing and Management College, Taipei, Taiwan f Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

Mean grey value is lower in endometriomas: Differentiating a hypoechogenic adnexal cyst by 3-dimensional power Doppler ultrasound—A preliminary study

Background: To assess parameters of 3‐dimensional power Doppler ultrasound in differentiating an endometrioma from other hypoechogenic adnexal cysts. Methods: We collected 58 patients with classic‐appearing endometriomas (homogeneous hypoechogenic adnexal cysts with round shapes) on a 2‐dimensional conventional sonography. The serum level of CA‐125, parameters of 3‐dimensional pelvic ultrasound including the volume of the cyst, the mean grey value (MGV), and three vascular indices: vascularization index, flow index, and vascularization flow index, were measured and then, after surgical intervention, were compared between the group with histologically proven endometriomas and the group with other histological diagnoses. Results: In the chocolate cyst group, the parity was significantly lower (0.68 ± 0.17, p = 0.012). The MGV and lesion volume of histologically proven endometriomas were significantly lower (14.78 ± 0.7; 118.34 ± 15.5) than those of other hypoechogenic benign adnexal cysts (17.17 ± 0.74; 227.18 ± 47.46), and the p values were 0.038 and 0.041, respectively. No differences in vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were found between the two groups. No relationship between lesion volume and MGV in the two groups, either (p = 0.127 and 0.353). We also found little correlation between CA‐125 and the volume of a histologically proven endometrioma as well as between CA‐125 and its MGV. Conclusion: MGV might be useful to differentiate an endometrioma from other homogeneous hypoechogenic adnexal cysts.

Ductus venosus Doppler velocimetry in normal pregnancies from 11 to 13 + 6 weeks' gestation—A Taiwanese study

Background: To investigate flow in the ductus venosus at 11–13 + 6 weeks of gestation in women with normal pregnancies in the Taiwanese population. Methods: Two hundred and fifty‐two normal singleton pregnancies with gestational ages ranging from 11 to 13 + 6 weeks were examined in this study. The pulsatility index for veins (PIV), resistance index (RI), peak velocity during ventricular systole (S‐wave), and peak velocity during ventricular diastole (D‐wave) were recorded from the ductus venosus. Results: We analyzed 252 participants who all fulfilled the inclusion and exclusion criteria of our study. The mean maternal age was 31 (range 19–45 years), with a corresponding gestational age of 12 + 4 weeks (range 11–13 + 6). No significant change was found in the vascular indices as gestational age increased for the S‐wave (S‐wave = 1.4214 (GA) + 17.448, r = 0.09, P = 0.154), PIV (PIV = −0.0358 (GA) + 1.4143, r = −0.05, P = 0.378) and RI (RI = −0.035 (GA) + 1.1478, r = −0.064, P = 0.468). In contrast, the D‐wave behaved differently from the other variables. There was a significant increase (r = 0.155, P = 0.013) in the D‐wave with gestational age (D‐wave = 1.4896 (GA) – 7.1547). Conclusion: D‐wave velocity in the ductus venosus increased with gestational age. S‐wave peak velocity showed an increasing trend and PIV showed a decreasing trend with gestational age, but they did not reach statistical significance.

Assessment of placental volume and vascularization at 11-14 weeks of gestation in a Taiwanese population using three-dimensional power Doppler ultrasound.

Background: The placental volume and vascular indices are crucial in helping doctors to evaluate early fetal growth and development. Inadequate placental volume or vascularity might indicate poor fetal growth or gestational complications. This study aimed to evaluate the placental volume and vascular indices during the period of 11–14 weeks of gestation in a Taiwanese population. Methods: From June 2006 to September 2009, three‐dimensional power Doppler ultrasound was performed in 222 normal pregnancies from 11–14 weeks of gestation. Power Doppler ultrasound was applied to the placenta and the placental volume was obtained by a rotational technique (VOCAL). The three‐dimensional power histogram was used to assess the placental vascular indices, including the mean gray value, the vascularization index, the flow index, and the vascularization flow index. The placental vascular indices were then plotted against gestational age (GA) and placental volume. Results: Our results showed that the linear regression equation for placental volume using gestational week as the independent variable was placental volume = 18.852 × GA − 180.89 (r = 0.481, p < 0.05). All the placental vascular indices showed a constant distribution throughout the period 11–14 weeks of gestation. A tendency for a reduction in the placental mean gray value with gestational week was observed, but without statistical significance. Conclusion: All the placental vascular indices estimated by three‐dimensional power Doppler ultrasonography showed a constant distribution throughout gestation.

Measurement of fetal maxillary and mandibular angles for first-trimester prenatal screening among Taiwanese women

Background Early fetal structure evaluation is crucial. Fetal abnormalities might indicate chromosomal anomalies or abnormal fetal growth. The aim of this study was to establish the appropriate reference range of maxillary and mandibular angles among the Taiwanese population at 11+0–13+6 weeks of gestation in normal singleton pregnancy as reference values for prenatal ultrasonographic examinations. Methods Fetal ultrasonographic data on maxillary angles and mandibular angles at a gestational age ranging from 11+0 weeks to 13+6 weeks were recorded in this study. Maternal background and pregnancy outcome were obtained from hospital records. Results A total of 87 patients were included in this study. Maxillary and mandibular angles were successfully recorded in 87 (100%) and 84 (96.6%) patients, respectively. The mean maternal age was 31 (range, 19–41) years, with a corresponding gestational age of 12+4 (range, 11+0–13+6) weeks. The maxillary and mandibular angles were 79.9° ± 15.6° and 71.0° ± 12.8°, respectively. First‐degree correlation was not found to exist between gestational age and maxillary and mandibular angles. Conclusion Normative data for ultrasonographic measurements of maxillary and mandibular angles among the Taiwanese population are presented. Our results may serve as reference values in congenital anomaly screening during prenatal examination.