T. Waseda

Analysis of Renal Artery Hemodynamics in Normal Fetuses Using the Color Doppler Method

Objective: From analysis of fetal renal artery hemodynamics, we attempted to reveal renal glomerular and tubular function in normal fetuses during pregnancy. Design: The study included 36 cases of normal fetuses from the 20th to the 40th week of gestation; Vmax (the systolic peak velocity of main renal artery), Vmean (time averages of trace of peak velocity) blood flow were initially measured between 20 and 24 weeks of gestation and every 4 weeks thereafter. The measurement was performed a total of five times in a longitudinal study. In addition, the blood flow waveform was concurrently examined. Results: The Vmax was 22.02 ± 0.50 cm/s at 20–24 weeks of gestation. This standard value (100%) was found to increase for each group as follows: 125.2, 149.1, 156.1, and 181.5%. Furthermore, using 20–24weeks of gestation as the standard, the Vmean increased after the 37th week of gestation: 186.7%, respectively. At 20–24 weeks of gestation, the blood flow wave forms consisted of 43.2% type I (only systolic waveforms), and 56.8% type II (both systolic and diastolic waveforms). Type III waveforms (waveforms that extended beyond the diastolic to the next systolic component) were not recognized. In the 33- to 36-week group, 82.6% of the waveforms were type II, and in the 37- to 40-week group, 76.2% of the waveforms were type III. Conclusions: The Vmax and Vmean of the renal artery in normal fetuses exhibit a similar rate increase when 20–24 weeks of gestation is compared to 37–40 weeks of gestation. The blood flow waveforms changed as pregnancy progresses; thus, it was inferred that this finding was related to the development of the renal glomerular and renal tubular function.

Prenatal diagnosis of fetal respiratory function: evaluation of fetal lung maturity using lung-to-liver signal intensity ratio at magnetic resonance imaging

The purpose of this retrospective study is to determine the fetal lung‐to‐liver signal intensity ratio (LLSIR) on T2‐weighted images for the prediction of neonatal respiratory outcome.

Hemodynamic analysis of cephalothoracopagus by the color doppler method : A comparison to normal fetuses via a longitudinal study

In a case of cephalothoracopagus, the umbilical artery (UA) was observed with color Doppler method, and the findings were compared with the hemodynamics of 46 normal fetuses. The patient was a 25-year-old primigravida who had appeared for routine prenatal visits since her 6th week of pregnancy. At a later time, the patient was examined after an interval of 4 weeks. Although an ultrasonography was also conducted, unfortunately, any findings of cephalothoracopagus were not detected. In the 25th week of gestation, we hospitalized her for marked polyhydramnios (amniotic fluid index: 280 mm), at which time an ultrasound examination revealed cephalothoracopagus. In the UA, the Vmax was 30.3 cm/s (normal fetus at 25–28 weeks: 33.5 ± 3.9 cm/s). The UA hemodynamics fell below the normal range. At 26 weeks, the UA Vmax was 56.5 cm/sec, a level which significantly exceeded the normal range. The patient underwent a cesarean section at 27 weeks of gestation; the indication was fetal distress. This is caused by the condition in which the fetal heart beats decreases to 90 beats per minute 3 times during a 10-min period as measured on the cardiotocograms. She delivered a 1,392-gram female with an Apgar score of 2 points (respiratory 1 point and heart rate 1 point). The infant was a cephalothoracopagus, with one head, two hearts, four upper limbs, and four lower limbs. The neonate died from circulatory failure 56 min after birth.

Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound--longitudinal comparison to normal fetuses.

Abstract Objective: To examine the hemodynamic values of the renal artery (RA) and descending aorta (DA) in normal fetuses, and to compare these values to those of fetuses with renal disease, thus evaluating the usefulness of hemodynamic analysis for the diagnosis of fetal renal disease. Materials and methods: We examined 46 normal fetuses and 15 fetuses with renal disease (six cases of polycystic kidney (PCK) and nine cases of hydronephrosis). We measured the maximum systolic velocity (Vmax) of the RA and DA using color Doppler. Measurements were made five times, from the 20th to the 40th week, in both the control and the renal disease group. Results: In the fetuses with PCK (Potters syndrome) that died postpartum from non-functional kidneys, the Vmax of the RA and DA in the 35th week were 13 cm/s and 25.4 cm/s, respectively. In the fetus with PCK (Trisomy 9) that died due to non-functional kidneys in the 34th week, the values were 13.3 cm/s and 29.6 cm/s, respectively. These values were well below those of the normal group: more than 1.5 SD below the mean. In two fetuses from the nine with hydronephrosis that had a unilateral non-functional kidney, the RA did not clearly show identifiable blood flow. Conclusions: The Vmax of the RA and DA in fetuses with renal disease correlates with fetal kidney function, particularly the RA Vmax. Vmax of 1.5 SD below the mean should be the lower normal limit.

Hemodynamic response of ovarian artery after hCG injection

We have analyzed ovarian hemodynamics immediately after human chorionic gonadotropin (hCG) administration in patients treated by clomiphene-hCG and human menopausal gonadotropin-hCG. This study involved 40 infertile women who signed consents to participate in this study. After intramuscular injection of 10000 IU hCG, the change of ovarian arterial blood flow (BF) was evaluated by color Doppler. Pulsatility index, resistance index, maximum velocity (V(max)), mean velocity, minimum velocity, cross-sectional area of ovarian artery (Area) and BF were measured before and 15-180 min after hCG administration. In the 36 subjects in which ovulation was induced successfully, V(max) and BF increased significantly even at 15 min after hCG administration and thereafter. In the 4 non-ovulatory subjects, no significant changes in any of indices at any of measured time points were observed. Comparative study of non-ovulatory and ovulatory subjects suggested that ovulation may be predicted by the ovarian hemodynamic analysis immediately after hCG administration.

Granulocyte colony-stimulating factor as a potential inducer of ovulation in infertile women with luteinized unruptured follicle syndrome

Luteinized unruptured follicle (LUF) syndrome is one of the intractable ovulation disorders that are commonly observed during cycles of treatment with ovulation inducers, for which no effective therapy other than assisted reproductive technology is available. Here, we investigated whether granulocyte colony-stimulating factor (G-CSF) could prevent the onset of LUF syndrome. We analyzed the effects of G-CSF in 68 infertile women with LUF syndrome who received ovulation induction (clomiphene + human chorionic gonadotropin [hCG] therapy or follicle-stimulating hormone + hCG therapy). G-CSF (lenograstim, 100 μg) was administered subcutaneously. Onsets of LUF syndrome were compared between the cycle during which G-CSF was given in combination with the ovulation inducer (ie, the G-CSF treatment cycle) and the subsequent cycle during which only the ovulation inducer was given (ie, the G-CSF nontreatment control cycle). The results showed that LUF syndrome recurred in only 3 cycles during the G-CSF treatment cycle (4.4% [3/68 cycles]), whereas LUF syndrome recurred in 13 cycles during the subsequent G-CSF nontreatment control cycle (19.1% [13/68 cycles]). The additional use of G-CSF significantly prevented the onset of LUF syndrome during ovulation induction (P = 0.013, McNemar test). No serious adverse reactions because of the administration of G-CSF were observed. In conclusion, our findings indicate that G-CSF may become a useful therapy for LUF syndrome.

OC11.04: The usefulness of MRI in the diagnosis of fetal lung maturity

n = 18), healthy placenta (+20%, n = 74), pathological placenta (+6.5%, n = 36), healthy fetuses (+13%, n = 53) and hypotrophic fetuses (+6.5%, n = 34). Importantly, the increase was significantly lower in pathological than healthy foeto-placental units (+6.5 vs. +20%, P < 0.001 and +6.5 vs. +13%, P < 0.001 for placenta and fetuses respectively). Conclusions: BOLD contrast MRI allowed assessing non-invasively placental and fetal oxygenation. This method provided to distinguish healthy from pathological foeto-placental units in a rat model of IUGR.

OP37.02: Prenatal diagnosis of fetal respiratory function: evaluation of fetal lung maturity using lung‐to‐liver signal intensity ratio at magnetic resonance imaging

Objective The purpose of this retrospective study is to determine the fetal lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images for the prediction of neonatal respiratory outcome. Methods One hundred ten fetuses who underwent magnetic resonance imaging (MRI) examination for various indications after 22weeks of gestation participated in this study. LLSIR was measured as the ratio of signal intensities of the fetal lung and liver on T2-weighted images at MRI. We examined the changes of the ratio with advancing gestation and the relations between LLSIR and the presence of the severe respiratory disorder (SRD) after birth. The best cut-off value of the LLSIR to predict respiratory outcome after birth was calculated using receiver operating characteristic (ROC) curve analysis. Results Lung-to-liver signal intensity ratio correlated significantly with advancing gestational age (R=0.35, p<0.001). The non-SRD group had higher LLSIR compared with the SRD group (2.15±0.30 vs. 1.53±0.40, p<0.001). ROC curve analysis showed that fetuses with an LLSIR<2.00 were more likely to develop SRD [sensitivity: 100%, 95% confidence interval (CI): 52–100%; specificity: 73%, 95% CI 54–88%]. Conclusion The fetal LLSIR on T2-weighted images is an accurate marker to diagnose the fetal lung maturity.

P02.02: Evaluation of the transcatheter arterial infusion of CDDP as neoadjuvant chemotherapy for cervical cancer by MRI and its prognosis

(P = 0.000). The proportion of breast cancer (4.26%, 23/540 breast) in fatty type was higher than that in fibroglandular-2 type (2.06%, 59/2865 breast) and in fibroglandular-1 (0.88%, 15/1705 breast) which was significant difference (P = 0.000). There was no breast cancer in glandular type. Pathology examination: the involution of the breast was most obviously in the in fatty type which showed severe atrophy of the breast terminal duct lobular unit (TDLU), and the involution wasn’t too severe in the fibroglandular-2 and was lighter in the fibroglandular-1 which displayed the hyperplasia and the involution of the TDLU coinstantaneous, but it was the most light in the glandular which revealed hyperplasia of the TDLU. Conclusions: These results demonstrated correlation between the mammary involution and ultrasound types which show the mammary age, it was important in screening programme of breast lesion.

P20.06: Myometrial blood flow analysis in pregnant women with IUGR: Poster abstracts

and abnormal S/D ratio group(n = 11). All cases were delivered at 37 + 0–41 + 6 weeks of gestational age from January 2001 to December 2008 at Ajou University Medical Center. The criteria for S/D ratio of umbilical artery was 3.0 and the neonatal weight < 10percentile compared to gestational age was used for definition of IUGR. Gas analysis and blood tests, including nRBC count in umbilical artery, were done during delivery. Results: The abnormal S/D ratio group showed significantly higher numbers of nRBC compared to the other groups (2.25 vs 4.67 vs 8.91/WBC100, p < 0.05). Also there was a significant decrease of neonatal weight in the abnormal S/D ratio group compared to the other groups (2130gm vs 2420gm vs 3211gm, p < 0.005). Conclusions: The number of nRBC of the umbilical artery showed an increase in the group of abnormal S/D ratio and associated with decreased neonatal weight.