Junko Noguchi

Three-dimensional ultrasound evaluation of the placenta

Conventional two-dimensional (2D) ultrasound has been widely used for the evaluation of the placenta during pregnancy. This 2D ultrasound evaluation includes the morphology, anatomy, location, implantation, anomaly, size, and color/power and pulsed Doppler sonographic assessment of the placenta. The introduction of three-dimensional (3D) ultrasound would facilitate the novel assessment of the placenta, such as surface-rendered imaging and volume measurement. With the recent advances in 3D power Doppler (3DPD) ultrasound as well as quantitative 3DPD histogram analysis, quantitative and qualitative assessments of the vascularization and blood flow of the placenta have become feasible. These novel techniques may assist in the evaluation of the feto-placental function, and offer potential advantages relative to conventional 2D sonographic assessments. 3D ultrasound may be an important modality in future placental research, in the evaluation of feto-placental insufficiency in clinical practice, and in the prediction of fetal growth restriction and pre-eclampsia, although some limitations regarding the assessment of the placenta employing 3D ultrasound still remain unresolved.

4D ultrasound evaluation of fetal facial expressions during the latter stages of the second trimester

To assess the frequency of fetal facial expressions at 25–27 weeks of gestation using 4D ultrasound.

Four-dimensional volume-rendered imaging of the fetal ventricular outflow tracts and great arteries using inversion mode for detection of congenital heart disease

Aim:  Using four‐dimensional (4D) sonography with an inversion mode, we evaluated fetal ventricular outflow tracts and great vessels for the detection of congenital heart disease.

4D ultrasound study of fetal facial expressions at 20–24 weeks of gestation

To assess the frequency of fetal facial expressions at 20–24 weeks of gestation using four‐dimensional (4D) ultrasonography and to determine whether there was any correlation between facial expression and gestational age (20–34 weeks).

Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations.

Abstract Aim: This study aimed to evaluate the ethnic difference in fetal behavior between Asian and Caucasian populations. Methods: Fetal behavior was assesed by Kurjak’s antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 28 and 38 weeks of gestation. Eighty-nine Japanese (representative of Asians) and seventy-eight Croatian (representative of Caucasians) pregnant women were studied. The total value of KANET score and values of each parameter (eight parameters) were compared. Results: The total KANET score was normal in both populations, but there was a significant difference in total KANET scores between Japanese (median, 14; range, 10–16) and Croatian fetuses (median, 12; range, 10–15) (P<0.0001). When individual KANET parameters were compared, we found significant differences in four fetal movements (isolated head anteflexion, isolated eye blinking, facial alteration or mouth opening, and isolated leg movement). No significant differences were noted in the four other parameters (cranial suture and head circumference, isolated hand movement or hand to face movements, fingers movements, and gestalt of general movements). Conclusion: Our results suggest that ethnicity should be considered when evaluating fetal behavior, especially during assessment of fetal facial expressions. Although there was a difference in the total KANET score between Japanese and Croatian populations, all the scores in both groups were within normal range. Our results indicate that ethnical differences in fetal behaviour do not affect the total KANET score, but close follow-up should be continued in some borderline cases.

Three-dimensional sonographic volume measurement of the fetal stomach.

The objective of this study was to measure the fetal gastric volume using three-dimensional (3-D) ultrasound during pregnancy. Three-dimensional sonographic examinations were performed involving 35 pregnant women from 12 to 38 weeks of gestation. The fetal gastric volume was monitored every 5 min for a minimum of 40 min (40-60 min) in each woman. The rotational technique with Virtual Organ Computer-aided AnaLysis (VOCAL) was used to calculate the fetal gastric volume. Maximum and minimum gastric volumes were curvilinearly associated with the gestational age, respectively (R(2) = 0.611, p < 0.0001, and R(2) = 0.407, p < 0.0001, respectively). A curvilinear relationship was noted between the functional capacity (maximum volume - minimum volume) of the fetal stomach and gestational age (R(2) = 0.531, p < 0.0001). The maximum volume change [(maximum volume - minimum volume/maximum volume) × 100] did not change during pregnancy (mean and standard deviation, 64.1% ± 16.1%). However, gastric emptying cycles could not be determined in this study because of the short observation period and small number of subjects. Our findings suggest that the fetal gastric volume calculated by conventional two-dimensional ultrasound in previous investigations is approximately one-third of the maximum volume using 3-D ultrasound in the present study and that 3-D ultrasound is a superior means of evaluating the fetal gastric volume in utero. However, the data and their interpretation in the present study should be viewed with some degree of caution because of the small number of subjects. Further studies involving a larger sample size are needed to confirm these findings.

Is there a sex difference in fetal behavior? A comparison of the KANET test between male and female fetuses.

Abstract Aim: To evaluate the sex difference in fetal behavior between male and female fetuses. Methods: Fetal behavior was assesed by Kurjak’s antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 28 and 39 weeks of gestation. Fifty-nine male and 53 female fetuses in middle- and high-class nulliparaous Japanese women were studied. The total value of the KANET score and values of each parameter (eight parameters) were compared. Results: The total KANET score was normal in both groups, and there was no significant difference in the total KANET score. When individual KANET parameters were compared, no significant differences were noted in all eight parameters. Conclusion: Our results show that there is no difference in fetal behavior between male and female fetuses in the third trimester of pregnancy. These results suggest that 4D ultrasound study examining fetal behavior does not need to consider the factor of fetal sex.

Ultrasound for evaluation of adnexal malignancy: From 2D to 3D ultrasound

Conventional two‐dimensional (2D) ultrasound has been widely used for the evaluation of adnexal malignancy in gynecologic fields. This 2D ultrasound evaluation includes a morphological assessment, color/power and pulsed Doppler sonographic assessment, scoring system, and contrast agent assessment of adnexal masses. The introduction of three‐dimensional (3D) ultrasound would facilitate the novel assessment of adnexal masses. With the recent advance in 3D power Doppler (3DPD) ultrasound as well as quantitative 3DPD histogram analysis, quantitative and qualitative assessments of the vascularization and blood flow of adnexal masses have become feasible. These novel techniques may assist in the evaluation of adnexal malignancy, and offer potential advantages relative to conventional 2D sonographic assessments. 3D ultrasound may be an important modality in future gynecologic oncology research and in the evaluation of adnexal malignancy in clinical practice, although some limitations regarding the assessment of adnexal malignancy employing 3D ultrasound remain unresolved.

Ultrasound study of fetal movements in singleton and twin pregnancies at 12–19 weeks

Abstract Objective To evaluate fetal behavioral differences between singleton and twin fetuses before 20 weeks of gestation using four-dimensional (4D) ultrasound. Methods 4D ultrasound was used to examine fetal movements in 58 singleton and 48 twin normal fetuses at 12–19 weeks. The frequencies of eight fetal movements were assessed through 15-min recordings. The fetuses were divided into two gestational age groups (12–13 and 14–19 weeks) to evaluate the changes with advancing gestation in twin versus singleton fetuses. Results Arm and general movements were the most frequent movements in singleton fetuses, whereas only general movement was significantly more frequent than the other seven fetal movements in twin fetuses at 12–13 weeks. At 14–19 weeks, frequencies of arm and leg movements were significantly higher than those of the other six movements in singleton fetuses, while only arm movement was significantly more frequent than the other fetal movements in twin fetuses. Comparisons of fetal movements between singleton and twin fetuses revealed that only arm movement showed a significant difference at 12–13 weeks, while the frequencies of all movements in singleton fetuses were significantly higher than those in twin fetuses at 14–19 weeks. Conclusion Our results suggest that the limitation of available space and crowding of twin fetuses with advancing gestation may have a marked impact on twin fetal movements compared with singleton fetuses, even in the first half of pregnancy. Further studies are needed to assess whether decreased fetal movements in twin pregnancy can affect fetal and neonatal development and maturation before and after birth.

P13.17: Transvaginal 3D power Doppler (3DPD) sonographic evaluation of the fetal brain at 10–13 weeks' gestation

Objectives: The objective of this study was to measure the fetal brain volume (FBV) and vascularization and blood flow using transvaginal 3DPD sonography late in the first trimester of pregnancy. Methods: 3DPD sonographic examinations with the VOCAL imaging analysis program were performed involving 36 normal fetuses from 10 to 13 weeks of gestation. FBV and 3DPD indices related to the fetal brain vascularization (vascularization index (VI), flow index (FI), and vascularization flow index (VFI)) were caluculated in each fetus. Intraand inter-class correlation coefficients were used as an expression of reliability and intraand inter-observer agreements of measurements were caluculated according to the Bland-Altman test. P < 0.05 was considered significant. The research protocol was approved by the Ethics Committee of Kagawa University School of Medicine. Results: FBV was curvilinearly correlated well with the gestional age (R2 = 0.861, P < 0.0001). All 3DPD indices (VI, FI, and VFI) showed no change at 10–13 weeks’ gestation. In this study, good intraand inter-class correlation coefficients and intraand interobserver agreements were confirmed. Conclusions: Oure findings suggest that transvaginal 3DPD sonography may provide new information on the assessment of fetal brain volume and perfusion late in the first trimester of pregnancy.