PICTURE OF THE MONTH | https://doi.org/10.5005/jp-journals-10009-1603 |
SlowflowHD for Detection of Small Fetal Peripheral Vasculature
1,5Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan; Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
2–4,6Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan
Corresponding Author: Toshiyuki Hata, Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan; Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan, Phone: +81-(0)87-891-2174, e-mail: toshi28@med.kagawa-u.ac.jp
How to cite this article Hata T, Mori N, Yamamoto K, et al. SlowflowHD for Detection of Small Fetal Peripheral Vasculature. Donald School J Ultrasound Obstet Gynecol 2019;13(4):155–158.
Source of support: Nil
Conflict of interest: None
ABSTRACT
SlowflowHD (GE Voluson E10, BT 19) is a new Doppler technology, which can visualize blood flow of smaller vessels in the branching vascular bed of the fetus and placenta. Its main characteristics are a high-display frame-rate, high-line density (high-resolution), and good sensitivity. In this article, we present our first experience of using SlowflowHD for the detection of small fetal peripheral vasculature.
Keywords: Color Doppler, Fetus, SlowflowHD, Small peripheral vessels.
INTRODUCTION
SlowflowHD (GE Voluson E10, BT 19, GE Healthcare Japan, Tokyo, Japan) is a new Doppler technology, which can visualize slow flow of smaller vessels in the branching vascular bed of the fetus and placenta. Its unique characteristics are a high-display frame-rate, high-line density (high-resolution), and good sensitivity. On applying it, we can detect slow-velocity flow of fetal peripheral small vessels. In this article, we present our first experience of using SlowflowHD for the detection of small fetal peripheral vessels in various organs.
FETAL HEAD
Small intracranial vessels can be clearly identified using SlowflowHD during pregnancy (Figs 1 to 3). The orbital vasculature can also be clearly visualized using this technique (Fig. 4).
FETAL BODY
Small fetal thoracic and intra-abdominal vessels can be clearly identified using SlowflowHD (Figs 5 to 14). Especially, the adrenal artery can be visualized using this technique (Figs 9 and 13).
FETAL EXTREMITIES
Arm and leg arteries can be clearly noted using SlowflowHD (Figs 15 and 16).
DISCUSSION
Superb microvascular imaging (SMI) is a new color Doppler technology which can detect slow-velocity blood flow in the fetus and placenta.1–8 Superb microvascular imaging with Doppler luminance is the latest Doppler technology. It generates a gray-scale image (two-dimensional) to show SMI data (three-dimensional) utilizing shading to represent amplitudes of signals.9 SlowflowHD is almost the same technology as SMI with Doppler luminance. In the present study, we had the first experience of using SlowflowHD for the detection of fetal peripheral small vessels. As a result, very small intracranial, intrathoracic, and intraabdominal vessels could be clearly depicted in fetuses using this technology. Moreover, small vessels of the extremities could also be noted. Further studies involving a larger sample size are needed to ascertain the actual usefulness of SlowflowHD for the detection of small peripheral vessels of fetuses. Moreover, quantitative assessments of SlowflowHD signals are indispensable to assess the relevance of this technology for future clinical use and research.
Fig. 1: Circle of Willis depicted by SlowflowHD at 30 weeks and 1 day of gestation. ACA, anterior cerebral artery; Achor, anterior choroidal artery; Acomm, anterior communicating artery; MCA, middle cerebral artery; OA, ophthalmic artery; PCA, posterior cerebral artery; Pcomm, posterior communicating artery
Fig. 2: Circle of Willis depicted by SlowflowHD at 36 weeks of gestation. ACA, anterior cerebral artery; Acomm, anterior communicating artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; Pcomm, posterior communicating artery
Fig. 3: Intracranial vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. LSA, lenticulostriate artery; MCA, middle cerebral artery
Fig. 4: Fetal orbital vasculature depicted by SlowflowHD at 30 weeks and 1 day of gestation. EB, eyeball; LA, lacrimal artery; PCA, posterior ciliary artery
Fig. 5: Fetal pulmonary vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. RL, right lung
Fig. 6: Fetal pulmonary vessels depicted by SlowflowHD at 33 weeks and 4 days of gestation. RL, right lung
Fig. 7: Fetal pulmonary vessels depicted by SlowflowHD at 36 weeks of gestation. RL, right lung
Fig. 8: Fetal splenic vessels depicted by SlowflowHD at 28 weeks and 5 days of gestation. AG, adrenal gland; L, liver; S, spleen; SA, splenic artery; Sp, spine; St, stomach
Fig. 9: Fetal intra-abdominal vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. DAo, descending aorta; L, liver; RAG, right adrenal gland; RK, right kidney
Fig. 10: Fetal hepatic vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. L, liver
Fig. 11: Fetal hepatic vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. GB, gallbladder; L, liver; RL, right lung
Figs 12A to C: Fetal renal vessels depicted by SlowflowHD at 33 weeks and 4 days of gestation. RA, renal artery. (A) Longitudinal view; (B) Transverse view; (C) Transverse view
Fig. 13: Fetal intra-abdominal vessels depicted by SlowflowHD at 30 weeks and 1 day of gestation. AA, adrenal artery; AG, adrenal gland; DAo, descending aorta; RA, renal artery; RK, right kidney
Fig. 14: Fetal intercostal arteries (LA) depicted by SlowflowHD at 30 weeks and 1 day of gestation. Sp, spine
Fig. 15: Fetal arm arteries depicted by SlowflowHD at 30 weeks and 1 day of gestation. AA, axillary artery; BA, brachial artery; RSA, right subclavian artery
Fig. 16: Fetal leg arteries depicted by SlowflowHD at 28 weeks and 5 days of gestation. FA, femoral artery; PFA, profundal femoris artery
REFERENCES
1. Hasegawa J, Suzuki N. SMI for imaging of placental infarction. Placenta 2016;47:96–98. DOI: 10.1016/j.placenta.2016.08.092.
2. Hasegawa J, Yamada H, Kawasaki E, et al. Application of superb micro-vascular imaging (SMI) in obstetrics. J Matern Fetal Neonatal Med 2018;31(2):261–263. DOI: 10.1080/14767058.2016.1278206.
3. Ganjiguur TO, AboEllail MAM, Mori N, et al. HDliveFlow with HDlive silhouette mode for diagnosis of persistent right umbilical vein and single umbilical artery. Donald Sch J Ultrasound Obstet Gynecol 2018;12(1):1–3. DOI: 10.5005/jp-journals-10009-1545.
4. Hata T, Kanenishi K, Ishibashi M, et al. HDliveFlow with HDlive silhouette mode for diagnosis of fetal diaphragmatic eventration. Donald Sch J Ultrasound Obstet Gynecol 2018;12(3):149–152. DOI: 10.5005/jp-journals-10009-1565.
5. Hata T, Kanenishi K, Yamamoto K, et al. Microvascular imaging of thick placenta with fetal growth restriction. Ultrasound Obstet Gynecol 2018;51(6):837–839. DOI: 10.1002/uog.18837.
6. Hasegawa J, Kurasaki A, Hata T, et al. Sono-histological findings of the placenta accrete spectrum. Ultrasound Obstet Gynecol 2019;54(5):705–707. DOI: 10.1002/uog.20207.
7. Hata T, Mori N, AboEllail MAM, et al. Advances in color Doppler in obstetrics. J South Asian Feder Obst Gynae 2019;11(1):1–12. DOI: 10.5005/jp-journals-10006-1641.
8. Hata T, Hanaoka U, Mori A, et al. Superb microvascular imaging of retained placenta with placenta accrete spectrum. Donald Sch J Ultrasound Obstet Gynecol 2019;13(3):85–87.
9. Hata T, Mori N, AboEllail MAM, et al. SMI with Doppler luminance in obstetrics. Donald Sch J Ultrasound Obstet Gynecol 2019;13(2):69–77.
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