Jailson Costa Lima

Three‐dimensional Doppler evaluation of single spherical samples from the placenta: intra‐ and interobserver reliability

To evaluate the intra‐ and interobserver reliability of assessment of three‐dimensional power Doppler (3D‐PD) indices from single spherical samples of the placenta.

The "volumetric" pulsatility index as evaluated by spatiotemporal imaging correlation (STIC): a preliminary description of a novel technique, its application to the endometrium and an evaluation of its reproducibility.

We propose new volumetric indices derived from three-dimensional (3-D) power Doppler (PD) using spatiotemporal imaging correlation (STIC) to overcome the influence of machine settings and attenuation. In this study, we describe these indices and evaluate their interobserver reliability: two static-3-D and two STIC PD datasets were acquired from 60 women and two observers (blinded analysis) evaluated vascularization index (VI), the flow index (FI) and the vascularization flow index (VFI) of standardized spherical samples of endometrium. Three new indices were determined based on maximum, minimum and mean values (vPI, vRI(max-min), vS/D(max-min)) and two indices from frames subjectively defined as systole and diastole (vRI(sys-dia), vS/D(sys-dia)). Highest intraclass coefficient correlations (ICCs) were obtained from vPI derived from VI or VFI (0.77-0.76), followed by vRI(max-min) (0.72-0.72) and vS/D(max-min) (0.52-0.49). ICCs from indices based on subjectively systole and diastole or FI were consistently lower (<0.40). We conclude that the subjective choice of systolic and diastolic frames only lacks reliability but indices based on complete evaluation may reliably be used.

Biometry and fetal weight estimation by two‐dimensional and three‐dimensional ultrasonography: an intraobserver and interobserver reliability and agreement study

To evaluate and compare the intraobserver and interobserver reliability and agreement for the biparietal diameter (BPD), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) obtained by two‐dimensional ultrasound (2D‐US) and three‐dimensional ultrasound (3D‐US).

Pulsatility Index Change of Brachial Artery Shows Better Reproducibility than Flow-Mediated Vasodilation

We aim to evaluate intra- and interobserver reproducibility of brachial artery flow-mediated dilation (FMD) and of pulsatility index change (PI-C) 1 min after a 5-min forearm compression in pregnant women. Flow-mediated dilation and PI-C were assessed in 31 healthy pregnant women in 3 consecutive days, by two observers. A broader range of response to the stimulus was observed for PI-C (-58.99%-86.71%) than FMD (2.38%-27.01%). The intraclass correlation coefficients were higher for PI-C than for FMD (intra = 0.90 vs. 0.69, p = 0.047; inter = 0.94 vs. 0.61, p = 0.007). Therefore, PI-C measurements were more reliable than FMD. However, studies comprising of subjects with cardiovascular risk factors relating FMD and PI-C become necessary to validate this method for the study of endothelial dysfunction.

P01.08: Fetal umbilical and middle cerebral arteries during the 2nd and 3rd trimester in low risk pregnancies: intra- and inter-observer reliability and agreement

Objectives: To compare the accuracy and repeatability of the volume perfusion index (VPI), -a mathematical model for calculation of flow developed by our team-, with the current available indexes for threedimensional power Doppler quantification (VI,FI and VFI) in an experimental in-vitro study. Methods: A phantom of flow was designed by using a mechanical pump generating a pulsatile flow with known values and by using elastic artificial vessels and blood mimicking fluid. A set of three and four-dimensional power Doppler volumes was obtained at different flow settings. Three dimensional volumes were quantified by using the VOCAL software included in the machine’s software. Fourdimensional flow measurement was evaluated by using a previously validated algorithm. Repeatability was evaluated through the intraclass correlation coefficient (ICC)for single unpaired tests and the Bland-Altmann (B-A) plot. Accuracy was tested by comparing the actual values against the obtained indexes with a polynomial regression model. Results: Phantom design was successful in generating a pulsatilelike flow and volumes could be taken in 92% of cases. ICC (95% CI) was 0.34 (0.23–0.51) for VI; 0.41 (0.3–0.51) for FI and 0.56 (0.43–0.69) for VFI. For VPI, it was 0.69 (0.48–0.79). B-A plot showed an inter-observer variability (%) (95% CI) of 48 (23–76) for VI; 62 (33–68) for FI; 29 (21–48) for VFI and 22 (15–29) for VPI. r-value (95% CI) was 0.45 (0.33–0.49) for VI; 0.53 (0.38–0.6) for FI; 0.62 (0.51–0.79) and 0.83 (0.65–0.9) for VPI (P < 0.01). Conclusions: Volume Perfusion Index exhibits a more robust internal validity than the traditional three-dimensional power Doppler indexes and might reflect more accurately actual changes in flow.

ULTRASONOGRAPHIC MARKERS OF CARDIOVASCULAR DISEASE RISK IN OBESE CHILDREN

ASTRACT Objective: To evaluate whether the obesity alters ultrasonographical markers of metabolic and cardiovascular disease risk in children. Methods: A cross-sectional study evaluated 80 children aged between 6 and 10 years, comparing 40 obese with 40 normal children. The following parameters were assessed: weight; height; body mass index; arterial blood pressure; body fat; basal metabolic rate; HDL-cholesterol, LDL-cholesterol and total cholesterol; fasting insulin and glucose; quantitative insulin sensitivity check index (QUICKI); homeostasis model of assessment - insulin resistance (HOMA-IR); basal diameter of the brachial artery; brachial artery flow mediated dilation (FMD) and of pulsatility index change (PI-C). Results: Significant differences were observed between obese vs. non-obese children: systolic blood pressure (97.7±8.4 vs. 89.0±5.8 mmHg; p<0.01), diastolic blood pressure (64.3±7.9 vs. 52.9±5.1 mmHg; p<0.01), proportion of body fat (45.1±5.9 vs. 21.3±6.0%; p<0.01), basal metabolic rate (1216.1±102.1 vs. 1072.9±66.4 Kcal; p<0.01), total cholesterol (164.7±25.2 vs. 153.4±15.8 mg/dL; p=0.03), fasting insulin (7.1±5.2 vs. 2.8±1.8 pIU/mL; p<0.01), HOMA-IR (1.5±1.1 vs. 0.6±0.4; p<0.01), basal diameter of the brachial artery (2.5±0.3 vs. 2.1±0.3 mm; p<0.01); PI-C (-15.5±27.2 vs. -31.9±15.5%; p<0.01), decreased QUICKI (0.4±0.05 vs. 0.4±0.03; p<0.01), and FMD (6.6±3.2 vs. 15.6±7.3%; p<0.01). Conclusions: Obesity worsens ultrasonographical and laboratorial markers of metabolic and cardiovascular disease risk in children.

P28.12: Fetal volume in the first gestational trimester by three‐dimensional ultrasonography: intra‐ and inter‐observer reliability and agreement

Objectives: To estimate and compare the spent time and the intra/inter-observer reliability and agreement from methods of measuring fetal head and trunk volume (FV) between 11w0d and 13w6d. Methods: 2 observers measured FV from fetuses with crownrump length (CRL) = 45–84 mm. FV was measured using 30◦ step rotation evaluating unmodified multiplanar view (UMV = just placing the fetal chest on the central point) delineating the fetus in any plane, and standardized multiplanar view (SMV = fetal sagittal plane should in A plan, head to the left, back lying down, with the central point just below fetal heart) delineating the fetus in both A (SMV-A = fetus rotated over its small axis) and C plane (SMV-C = fetus rotated over its long axis). We also evaluate whether reducing step rotation using 15◦ and 9◦ could improve reliability/agreement using only the method with the best results in the first part of the study. We used Kolmogorov-Smirnov; repeated measures ANOVA to assess systematic errors and time spent; intraclass correlation coefficient (ICC) to assess reliability; and limits of agreement (LoA) width to assess agreement. Results: 40 fetuses were examined. No systematic errors were observed. Reliability and agreement were better for SMV-C. Reducing step rotation didn’t improve the results (table 1). Less time was spent using UMV and larger rotation steps. Conclusions: SMV-C using 30◦ was the best method to assess FV.

Variation of the brachial artery diameter in obese children: present and future

Objective: Literature review on the use of the variation measure of the brachial artery diameter by highresolution ultrasound (flow-mediated dilation) as a predictor of cardiovascular disease risk in children and adolescents. Data source: Survey of studies indexed in Medline/Pubmed, which were published between 2002 and 2011 using the following keywords in various combinations:“endothelium,” “child”, “ultrasonography” and “obesity”, as well as classic texts on the subject. We found 54 publications and 32 were included in this review. Synthesis of data: The study of endothelial dysfunction has been used as a predictor of risk for cardiovascular diseases such as atherosclerosis and coronary heart disease, since endothelial injury is an important event in the physiopathology of these diseases. Conclusions: The flow-mediated dilation of the brachial artery seems to be important as a diagnostic and prognostic tool to assess endothelial function in children and adolescents who are overweight, because it is a noninvasive method with good profile regarding cost, safety, and benefits.

Variación del diámetro de la arteria braquial en niños obesos: presente y futuro

Objective: Literature review on the use of the variation measure of the brachial artery diameter by highresolution ultrasound (flow-mediated dilation) as a predictor of cardiovascular disease risk in children and adolescents. Data source: Survey of studies indexed in Medline/Pubmed, which were published between 2002 and 2011 using the following keywords in various combinations:“endothelium,” “child”, “ultrasonography” and “obesity”, as well as classic texts on the subject. We found 54 publications and 32 were included in this review. Synthesis of data: The study of endothelial dysfunction has been used as a predictor of risk for cardiovascular diseases such as atherosclerosis and coronary heart disease, since endothelial injury is an important event in the physiopathology of these diseases. Conclusions: The flow-mediated dilation of the brachial artery seems to be important as a diagnostic and prognostic tool to assess endothelial function in children and adolescents who are overweight, because it is a noninvasive method with good profile regarding cost, safety, and benefits.

Variação do diâmetro da artéria braquial em crianças obesas: presente e futuro

Objective: Literature review on the use of the variation measure of the brachial artery diameter by highresolution ultrasound (flow-mediated dilation) as a predictor of cardiovascular disease risk in children and adolescents. Data source: Survey of studies indexed in Medline/Pubmed, which were published between 2002 and 2011 using the following keywords in various combinations:“endothelium,” “child”, “ultrasonography” and “obesity”, as well as classic texts on the subject. We found 54 publications and 32 were included in this review. Synthesis of data: The study of endothelial dysfunction has been used as a predictor of risk for cardiovascular diseases such as atherosclerosis and coronary heart disease, since endothelial injury is an important event in the physiopathology of these diseases. Conclusions: The flow-mediated dilation of the brachial artery seems to be important as a diagnostic and prognostic tool to assess endothelial function in children and adolescents who are overweight, because it is a noninvasive method with good profile regarding cost, safety, and benefits.