K. K. Haratz

Reliability and Validity of In Vitro Volume Calculations by 3-Dimensional Ultrasonography Using the Multiplanar, Virtual Organ Computer-Aided Analysis (VOCAL), and Extended Imaging VOCAL Methods

Objective. The purpose of this study was to assess the reliability and validity of in vitro volume calculations by 3‐dimensional ultrasonography. Methods. This observational study was performed by 2 examiners to obtain volumes of 3 objects of different shapes and sizes filled with ultrasound gel and immersed in water. The examiners used the multiplanar (5‐mm interval), virtual organ computer‐aided analysis (VOCAL, 30°) and extended imaging (XI) VOCAL (5, 10, 15, and 20 planes) methods to estimate the volumes of each object. A paired Student t test (P) and intraclass correlation coefficients (ICCs) were used to assess reproducibility of the methods. Validity was assessed comparing the percent differences between the estimated and the real volumes using the P value, mean differences, and ICC for each method. Results. All methods were highly reliable and valid. There were no significant differences in interobserver variability; there was a strong interobserver correlation. There were no significant differences in the percent differences between the estimated and real volumes of the objects using the 3 methods. The XI VOCAL method was superior to the multiplanar and VOCAL methods in the measurement of irregularly shaped objects. The XI VOCAL method with 10 planes estimated volumes closest to the real volumes. Conclusions. All 3 methods were reliable and valid; however, XI VOCAL was superior to the other methods in the measurement of irregularly shaped objects.

Reference Intervals for Fetal Heart Volume From 3-Dimensional Sonography Using the Extended Imaging Virtual Organ Computer-Aided Analysis Method at Gestational Ages of 20 to 34 Weeks

The purpose of this study was to establish the reference range for fetal heart volume from 3‐dimensional (3D) sonography using the extended imaging virtual organ computer‐aided analysis method.

Fetal cerebral ventricle volumetry: comparison between 3D ultrasound and magnetic resonance imaging in fetuses with ventriculomegaly

Objectives. The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI). Methods. This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland–Altman plots were constructed. Results. A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland–Altman plots confirmed the high correlation (mean of differences: 1.62 cm3 and standard deviation: ± 8.41 cm3). Conclusion. Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.

Análise da reprodutibilidade do Doppler de amplitude tridimensional na avaliação da circulação do cérebro fetal

OBJECTIVE: To evaluate the intra- and interobserver reproducibility of three-dimensional power Doppler sonography (3D power Doppler) in the assessment of fetal brain blood flow in the middle cerebral artery territory. MATERIALS AND METHODS: A cross-sectional study was developed with 20 healthy pregnant women between 26 and 34 gestational weeks. The middle cerebral artery territory closest to the transducer was scanned and the blood flow volume was calculated with the method Virtual Organ Computer-aided AnaLysis. The following 3D power Doppler indices were later obtained: vascularization index (VI), flow index (FI) and vascularization-flow index (VFI). The intraclass correlation coefficient (ICC) and Bland-Altman plots were utilized for calculating the intra- and interobserver variability. RESULTS: A good intra- and interobserver agreement was observed, with ICC > 0.90 for all the 3D power Doppler indices: VI [ICC = 0.992 (CI 95%: 0.981-0.997)], FI [ICC = 0.999 (CI 95%: 0.998-0.999)], VFI [ICC = 0.995 (CI 95%: 0.987-0.998)]. Interobserver reproducibility: VI [ICC = 0.988 (CI 95%: 0.970-0.995)], FI [ICC = 0.999 (CI 95%: 0.997- 1.000)], VFI [ICC = 0.994 (CI 95%: 0.994-0.998)]. CONCLUSION: 3D power Doppler has shown to be a practical and easy method in the assessment of fetal brain blood flow, with good intra- and interobserver reproducibility. The FI presented the best intra- and interobserver agreement

Fetal optic nerve sheath measurement as a non-invasive tool for assessment of increased intracranial pressure

To describe the sonographic technique for assessment of the fetal optic nerve sheath and to report on three fetuses with intracranial lesions and enlarged optic nerve sheath diameter (ONSD) compared with normal controls matched for gestational age (GA).

Reproducibility of fetal heart volume by 3D-sonography using the XI VOCAL method

BackgroundTo assess the reliability of fetal heart volume measurement by three-dimensional sonography (3DUS) using the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) method.MethodsThis reliability study enrolled 30 pregnant women with singleton healthy pregnancies between 19 and 34 weeks of gestation. All volume acquirements were performed with a convex volumetric transducer (C3-7ED) coupled to an Accuvix XQ sonography device (Medison, Korea). The XI VOCAL 10 planes was the method of choice for volumetric measurement. 3D datasets were analyzed by two observers (EQSB and HJFM); fetal heart volume was measured twice by the first and once by the second observer to calculate intra and interobserver reproducibility. Statistical analysis used pareated Students t test (p) and calculated Intraclass correlation coefficients (ICC). Bland-Altman plots were also constructed.ResultsWe observed an excellent intra- and interobserver reliability for fetal cardiac volume assessed by XI VOCAL. For the intraobserver the ICC was 0.998 (95% CI: 0.997; 0.999), with mean of differences of 0.12 cm3 (95% limits of agreement: -0.84; +0.84; p = 0.130). For interobserver the ICC was 0.899 (95%CI: 0.996; 0.998), mean of differences 0.05 cm3 (95% limits of agreement: -0.84; +0.84; p = 0.175).ConclusionFetal cardiac volume assessed by 3DUS using XI VOCAL method is highly reproducible between 19 to 34 gestational weeks.

Assessment of cerebral circulation in normal fetuses by three-dimensional power Doppler ultrasonography

OBJECTIVE To assess the three-dimensional power Doppler ultrasonography (3D power Doppler) vascular indices in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) territories. METHODS A cross-sectional study was carried out on 111 normal pregnancies between 26 and 34 weeks. The MCA, ACA and PCA territories closest to the transducer were scanned and volumes were calculated by using the VOCAL (Virtual Organ Computer-aided Analysis) program. The 3D power Doppler indices--vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. Scatter graphs, Pearson correlation coefficients (r) and linear regression models were used. RESULTS Only the FI-MCA (r=0.38 and p<0.001), VFI-MCA (r=0.23 and p=0.016) and FI-PCA (r=0.191 and p=0.040) had a low correlation with gestational age. The other 3D power Doppler indices VI-MCA (r=0.153 and p=0.150), VI-ACA (r=0.105 and p=0.271), FI-ACA (r=0.154 and p=0.106), VFI-ACA (r=0.134 and p=0.161), VI-PCA (r=0.105 and p=0.270) and VFI-PCA (r=0.126 and p=0.180) showed no statistically significant correlation with gestational. CONCLUSION It was observed a low correlation between gestational age and the FI-MCA, VFI-MCA and FI-PCA.

Hidden maternal autoimmune thrombocytopenia complicated by fetal subdural hematoma-case report and review of the literature.

Fetal intracranial hemorrhage (IH) is a quite rare event, with an incidence of 1 in 10,000 pregnancies and may present in five different types: intraventricular, cerebellar, miscellaneous intraparenchymal, subdural, and primary subarachnoid hemorrhages [1, 2]. Whereas neonatal hemorrhage is relatively common and affects especially infants delivered before 32 gestational weeks, the majority of prenatally detected cases of IH occur during the third trimester of gestation. Subdural hemorrhages (SDH) are the less frequent type of fetal IH and usually occur due to the tearing of loose bridging subdural veins that drain the brain blood flow to the dural sinuses [3]. Fetal SDH generally have an unfavorable prognosis, but may resolve spontaneously, with varying long-term outcomes reported in the literature [2, 4]. Fetal subdural hematomas may be diagnosed by ultrasound and magnetic resonance imaging and are seen mainly in the supratentorial region [5]. The most frequent etiology is intrauterine or birth trauma. Deficiency of coagulation factors and alloimune thrombocytopenia are frequent causes of spontaneous intraventricular and intraparenchymatous hemorrhages, although rarely related to SDH [6]. We report a case of subdural hematoma related to fetal autoimmune thrombocytopenia with a good outcome, along with a review of the sparse literature available on this issue.

P09.15: Three‐dimensional sonographic volumetry of phantom objects: comparing rotational method Virtual Organ Computer‐aided AnaLysis (VOCAL) to multi slice method Extended Imaging (XI) VOCAL

obtain the values of EV: XI VOCAL method. Using a sequential section, the contour of each gestational embryo was drawn manually in the fifteen different rotation planes to obtain the 3D volume measurement. To evaluate the relation between EV and gestational age (GA), Person’s correlation coefficient (r) was used. The paired Student’s t-test (P) and ANOVA were used to compare the methods. Results: The study showed there was correlation between EV and GA (r = 0.83 for VOCAL 30 degrees, r = 0.83 for XI VOCAL and r = 0.80 for multiplanar). There was a strong correlation between EV measured by the XI VOCAL e multiplanar methods (RICC = 0,941) and XI VOCAL and VOCAL methods (RICC= 0,965). There weren’t difference statistics between EV measured by the VOCAL, XI VOCAL and the multiplanar by the paired Student’s t-test, but ANOVA showed differences between all methods (p < 0.001). Conclusion: We have demonstrated a strong correlation with the age gestational and embryo volume measurements obtained using the XI VOCAL, VOCAL and multiplanar methods in first trimester gestational. The methods were concordant, but there were differences statistics.

OC23.01: Fetal optic nerve sheath measurement as a potential non-invasive tool for assessment of increased intracranial pressure

VOCAL tool within 4D View (GE Medical Systems) was used to outline the placenta. The power Doppler signal within this volume was counted in a three-dimensional manner adapting the random but systematic techniques used in stereology. Results: The mean (SD) placental FrVolBV was higher in the non-diabetic than in the diabetic group at each gestation; 0.144 (0.05) versus 0.104 (0.03) at 20 weeks, 0.145 (0.05) versus 0.128 (0.03) at 24 weeks, 0.159 (0.05) versus 0.133 (0.02) at 28 weeks and 0.154 (0.03) versus 0.123 (0.04) at 32 weeks. There was a significant difference in FrVolBV between normal and diabetic subjects [F(1.31) = 5.396, P = 0.027] and across gestation [F(3.93) = 3.633, P = 0.016]. Conclusions: Placental FrVolBV is reduced in women with diabetes from 20 weeks gestation using this novel stereological technique. This contrasts with the known increase in volume of the villous vasculature determined histologically. Structural changes in the large and apparently vascular placenta are therefore accompanied by altered function, with reduced perfusion demonstrable in-vivo.