Luiz Cláudio de Silva Bussamra

Assessment of placental blood flow between 22 and 34 weeks of gestation by 3D-sonography power Doppler vascular indices

PurposeTo analyze and compare the vascular flow in different parts of the placenta of normal pregnant women between 22 and 34xa0weeks of gestation through three-dimensional power Doppler ultrasonography (3D power Doppler) vascular indices.MethodsThis is a cross-sectional study involving 55 normal pregnant women with gestational ages between 22 and 34xa0weeks. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained using the virtual organ computer-aided analysis (VOCAL) method both in the region of placental cord insertion and the peripheral region of the placenta. The Wilcoxon test was applied, adopting a significance level of 5% to evaluate possible differences in these indices between study areas.ResultsFor the three indices examined (VI, FI and VFI), a statistically significant difference was obtained between the insertion of the umbilical cord, designated as the center, and the placental periphery on both the right (pxa0<xa00.001 for VI, pxa0=xa00.001 for FI and pxa0<xa00.001 for VFI) and the left (pxa0<xa00.001 for VI, pxa0<xa00.001 for FI and pxa0=xa00.001 for VFI), taken as the average of the rates obtained in the two peripheries (pxa0<xa00.001 for VI, pxa0<xa00.001 for FI and pxa0=xa00.003 for VFI). Differences were not found when the two peripheral areas were compared or if placenta was anterior or posterior (pxa0>xa00.05).ConclusionThere is a statistically significant difference between the vascular indices obtained with a 3D power Doppler at different points of the placenta.

Reference range of fetal lung volume by 3D-ultrasonography using the rotational method (VOCAL).

Abstract Aim: To determine reference ranges for fetal lung volume by 3-dimensional ultrasonography using the VOCAL (Virtual Organ Computed-aided Analysis) method. Methods: A longitudinal prospective study was conducted with 61 uncomplicated pregnancies between 24 and 32 weeks of gestation. A separate measurement of both lungs volume was conducted by VOCAL with 30° rotation angle. For each gestational age, an average, standard deviation and maximal and minimal values were established in addition to the percentiles 5, 10, 25, 50, 75 and 90 for right and left lung volume. To evaluate the correlation between lung volume and gestational age, and estimated fetal weight, a polynomial regression with determination coefficient adjustment (R2) was used. The intra-observer reproducibility was evaluated by the intraclass correlation coefficient (ICC), whereas the inter-observer reproducibility was evaluated by Cronbach alpha statistic test. Results: The average right lung volume varied from 12.5±0.7 cm3 at the 24th week to 31.8 cm3±1.8 cm3 at the 32nd week. The average left lung volume varied from 9.2±0.9 cm3 at the 24th week to 22.0 cm3±1.6 cm3 at the 32nd week. We observed a strong correlation between right lung volume and gestational age (R2=0.975) and estimated fetal weight (R2=0.905), as well as between the left lung volume with gestational age (R2=0.970) and estimated fetal weight (R2=0.908). We observed a good intra-observer reproducibility for the right lung volume (ICC=0.990) and for the left lung volume (ICC=0.986). Similarly, we observed good inter-observer reproducibility for right lung volume (0.975) and left lung volume (0.962). Conclusion: Reference range of fetal lung volume by 3D-ultrasonography using the VOCAL method was determined.

Prenatal diagnosis of Ebstein’s anomaly using spatio-temporal image correlation (STIC) and inversion mode

BackgroundEbstein’s anomaly is a rare cardiac defect where the septal and posterior leaflets are displaced, towards the right ventricle. The leaflets are dysplastic and stuck to the ventricular wall. Its antenatal diagnosis is usually made through bidimensional echocardiography, which also has prognostic value. Recently, the technological breakthrough of three-dimensional ultrasound (3D-US) offered new diagnostic tools for congenital heart defects, less dependent on the ultrasonographer experience, when compared to two-dimensional ultrasound (2D-US). The spatio-temporal image correlation (STIC) technique allows the acquisition of the fetal heart volume and its structures as a 4D cineloop sequence showing the complete cardiac cycle. Inversion mode is a new image analysis tool for the examination of fluid-filled fetal structures that inverts the gray scale.Case reportWe present a case of Ebstein’s anomaly diagnosed at 26xa0weeks of pregnancy through bidimensional echocardiography. We emphasize its main findings in 3D-US using the STIC and inversion mode techniques.

Valor preditivo do resultado fetal da dopplervelocimetria de ducto venoso entre a 11ª e a 14ª semanas de gestação

PURPOSE: to study the value of Doppler velocimetry of the ductus venosus, between the 11th and 14th weeks of pregnancy, associated to the nuchal translucency thickness measurement, in the detection of adverse fetal outcome. METHODS: a transversal and prospective study in which a total of 1,268 fetuses were studied consecutively. In 56 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus and, in 1,181 cases, the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the ductus venosus. Aiming at prevalence and accuracy indices, sensitivity, specificity, positive predictive value, negative predictive value, probability of false-positive, probability of false-negative, reason of positive probability and reason of negative probability were calculated and analyzed. RESULTS: from the total of 1,268 fetuses, 1,183 cases were selected for analysis. From this number, 1,170 fetuses were normal (98.9%) and 13 fetuses presented adverse outcome at birth (1.1%), including fetal death (trisomy 21 and 22) in two cases; genetic syndrome (Nooman) in one case; two cases of polymalformed fetuses; cardiopathy in three cases; and other structural defects in five cases. The prevalence of the modified ductus venosus (wave A zero/reverse) in the studied population was of 14 cases (1.2%), with a false-positive rate of 0.7%. CONCLUSIONS: there is a significant correlation between the alteration of the ductus venosus Doppler velocimetry and the thickness of the nuchal translucency as an ultrasonographic marker for the first trimester of gestation, in the detection of adverse fetal outcome, especially serious malformations. The ductus venosus was able to diminish the false-positive result in comparison to the isolated use of the nuchal translucency thickness, improving considerably the positive predictive value of the test.

Thrombocytopenia-absent radius syndrome: prenatal diagnosis of a rare syndrome

Radiol Bras. 2016 Mar/Abr;49(2):126–132 128 http://dx.doi.org/10.1590/0100-3984.2015.0063 found in males, at a ratio of 2–3:1, and can be diagnosed at any age. The pancake kidney malformation results from complete medial fusion of the metanephric blastema at an early stage of embryonic development and is characterized by a single, flat, nonreniform mass, in a medial position within the pelvic cavity or at the level of the aortic bifurcation. The renal collecting system is anterior and typically drains via two ureters or, less commonly, via a single ureter. The renal vasculature is also anomalous; blood flow can be supplied by multiple branches of the internal and external iliac arteries or of the abdominal aorta. In most cases, pancake kidney is asymptomatic but can be accompanied by nephrolithiasis, hydronephrosis, and vesicoureteral reflux resulting in recurrent urinary infections, all of which are attributable to the anomalous rotation of the collecting system and the short ureters, which are prone to stasis and obstruction, as well as by renovascular hypertension, ureteropelvic junction stenosis, anomalous implantation of the renal pelvis, and polycystic kidney disease. Among individuals with pancake kidney, the incidence of neoplasms, Wilms tumor in particular, is higher. A little more than 20 cases of pancake kidney have been described in the literature, and a single ureter was reported in fewer than 10 of those cases. Early identification of renal abnormalities is important to the investigation of associated conditions and for the differential diagnosis of pelvic masses, in order to preventing unnecessary injury or removal. Here, we have reported Renata Mendes da Silva, Moaci Ferreira de Morais Júnior, Francisco Edward Mont’Alverne Filho

Medida do comprimento do osso nasal entre 11 e 15 semanas de gestação em uma população brasileira: estudo preliminar

OBJECTIVE: To establish reference values for fetal nasal bone length measurements between 11 and 15 gestational weeks in a Brazilian population. MATERIALS AND METHODS: A cross-sectional study was developed with 171 normal pregnant women between their 11th and 15th gestational weeks. The fetal nasal bone was measured by means of transabdominal ultrasound in all of the cases. The 5th and 95th percentiles for the nasal bone length were calculated by the formula: mean ± 1.645 standard deviation. The Spearman correlation coefficient with 95% confidence interval was utilized to correlate the nasal bone length with fetal anthropometric parameters. RESULTS: The nasal bone could be measured in all of the cases with the mean length ranging between 1.69 mm and 2.94 mm. Nasal bone length demonstrated to be strongly correlated with all of the fetal anthropometric parameters (p < 0.001) and with the gestational age (R² = 0.59). CONCLUSION: Despite the preliminary character of the present study, a reference range of fetal nasal bone length was established.

Comparison of Fetal Cerebellum and Cisterna Magna Length by 2D and 3D Ultrasonography between 18 and 24 Weeks of Pregnancy

To compare the fetal cerebellum and cisterna magna length measurements by means of two- (2DUS) and three-dimensional (3DUS) ultrasonography using the three-dimensional extended imaging (3D XI), a cross-sectional study with 69 healthy pregnant women between 18 and 24 weeks was performed. For the measurements by 2DUS, the axial planes were used and for the 3DUS a sequence of adjacent axial slices (multislice view). To evaluate the difference between the two techniques, we used the Wilcoxon test. To evaluate the correlation between the cerebellum and cisterna magna length measurements and the gestational age, we used the Spearman correlation coefficient (r). For the calculation of reproducibility, we used the intraclass correlation coefficient (ICC). The mean of the transverse and anterior-posterior diameter of cerebellum and cisterna magna by 3DUS was 9.23 and 6.62u2009mm, respectively. It was observed that the average of the measurements obtained by 3DUS was significantly higher, 0.76 and 1.02u2009mm for the length of the cerebellum and cisterna magna, respectively (P < 0.001). There was a high correlation between the length measurement of the cerebellum 3D (r = 0.940, P < 0.001), but low correlation of cisterna magna 3D (r = 0.462, P = 0.080) with the gestational age. There was good intra- and interobserver reproducibility for the cerebellum and cisterna magna 3D with ICC = 0.792 , 0.668, 0.691, and 0.287, respectively. The measurements of the fetal cerebellum and cisterna magna length by 3DUS using the software 3D XI were significantly higher than those obtained by 2DUS.

Comparison of Fetal Nuchal Fold Thickness Measurements by Two- and Three-Dimensional Ultrasonography (3DXI Multislice View).

Purpose. To compare the measurements of fetal nuchal fold (NF) thickness by two-dimensional (2D) and three-dimensional (3D) ultrasonography using the three-dimensional extended imaging (3DXI). Methods. A cross-sectional study was performed with 60 healthy pregnant women with a gestational age between 16 and 20 weeks and 6 days. The 2D-NF measurements were made as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head. For the 3D we employed the 3DXI multislice view software, in which 3 × 2 tomographic planes was displayed on the screen and the distance between the tomographic slices was 0.5u2009mm. Maximum, minimum, mean, and standard deviation were calculated for 2D and 3D ultrasonography, as well the maximum and minimum, mean, and standard deviation for the difference between both methods. The Wilcoxon signed-rank test was used to compare the two different techniques. Results. 2D-NF showed a mean of thickness of 3.52 ± 0.95u2009mm (1.69–7.14). The mean of 3D-NF was 3.90 ± 1.02u2009mm (2.13–7.72). The mean difference between the methods was 0.38u2009mm, with a maximum difference of 3.12u2009mm. Conclusion. The NF thickness measurements obtained by 3D ultrasonography were significantly larger than those detected with 2D ultrasonography.

Análise do rastreamento combinado no primero trimestre da gestação para detecção de anomalias cromossômicas

PURPOSEnto evaluate the performance of the combined first trimester screening for chromosomal abnormalities in a group of the Brazilian population.nnnMETHODSna retrospective study including pregnant women with single fetuses referred to a fetal medicine center to perform the first trimester screening that combines maternal age, nuchal translucency measurement and two maternal serum biochemical markers: free B-hCG and PAPP-A. To evaluate the performance of the test, the detection rate, specificity, negative and positive predicted values and false-positive rates were calculated, considering as high risk the cut-off value above 1 in 300.nnnRESULTSnwe studied 456 patients submitted to the test. Advanced maternal age above 35 years was observed in 36.2% of cases. The incidence of chromosomal abnormalities in the study population was 2.2%. Twenty-one patients (4.6%) presented a high risk (above 1:300) by the combined test. Using this cut-off level, the detection rate of the test was 70% for all chromosomal abnormalities and 83.3% for trisomy 21, for a false-positive rate of 3.1%.nnnCONCLUSIONSnthe combined first trimester screening was effective to detect chromosomal abnormalities, mainly for trisomy 21, with low false-positive rates. The combined test contributed to decreasing the indication of an invasive test if we compare to maternal age alone as a risk factor.

Prenatal Diagnosis of a Fetus with Ring Chromosomal 15 by Two- and Three-Dimensional Ultrasonography

We report on a prenatal diagnosis of ring chromosome 15 in a fetus with left congenital diaphragmatic hernia (CDH) and severe intrauterine growth restriction (IUGR). A 31-year-old woman, gravida 2 para 1, was referred because of increased nuchal translucency at gestational age of 13 weeks. Comprehensive fetal ultrasound examination was performed at 19 weeks revealing an early onset IUGR, left CDH with liver herniation, and hypoplastic nasal bone. Three-dimensional ultrasound (rendering mode) showed low set ears and depressed nasal bridge. Amniocentesis was performed with a result of a 46,XX,r(15) fetus after a cytogenetic study. A 1,430u2009g infant (less than third percentile) was born at 36 weeks. The infant presented with respiratory failure and died at 2u2009h of life. Postnatal karyotype from the umbilical cord confirmed the diagnosis of 15-ring chromosome. We described the main prenatal 2D- and 3D-ultrasound findings associated with ring chromosome 15. The interest in reporting the present case is that CDH can be associated with the diagnosis of 15-ring chromosome because the critical location of the normal diaphragm development is at chromosome 15q26.1-q26.2.