Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2018 | July-September | Volume 12 | Issue 3

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Hirokazu Tanaka, Megumi Ishibashi, Aya Tanaka, Ryuichi Shimono, Masashiro Sugino, Shinji Nakamura

HDlive Flow with HDlive Silhouette Mode for Diagnosis of Fetal Diaphragmatic Eventration

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:4] [Pages No:149 - 152]

Keywords: Diaphragmatic eventration, Fetus, HDlive flow, HDlive silhouette mode, Twin pregnancy

   DOI: 10.5005/jp-journals-10009-1565  |  Open Access |  How to cite  | 


We present our initial experience of using HDlive Flow with the HDlive silhouette mode for diagnosing fetal diaphragmatic eventration in one of a pair of monochorionic diamniotic twin fetuses at 21 weeks and 4 days of gestation. Two-dimensional (2D) sonography suggested abnormal elevation of the right hemidiaphragm. Power Doppler ultrasound revealed upward-deviated right pulmonary and hepatic vessels, which were demarcated by the right hemidiaphragm. HDlive Flow with the HDlive silhouette mode clearly depicted the upward-deviated right pulmonary and hepatic vessels, which were separated by the high position of the right hemidiaphragm. The spatial relationships among the fetal liver, diaphragm, lung, and heart could be clearly recognized using HDlive Flow with the HDlive silhouette mode. MRI also strongly suggested right diaphragmatic eventration at 30 weeks and 4 days of gestation. HDlive Flow with the HDlive silhouette mode might be beneficial as an additional diagnostic tool along with conventional 2D sonography, and it facilitates early differentiation between fetal diaphragmatic eventration and diaphragmatic hernia.



Ivica Zalud, Holly Olson

Is OB/GYN Ultrasound a Science of Uncertainty and an Art of Probability? USA Perspective and Hawaii Experience

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:3] [Pages No:153 - 155]

Keywords: Accreditation, ACGME, Education, Hawaii, Ultrasound

   DOI: 10.5005/jp-journals-10009-1566  |  Open Access |  How to cite  | 


At every level of medical education and training, accrediting bodies have the ability to drive curricular change through the establishment of standards and the accreditation process. This review demonstrates one aspect of documentation of ultrasound training via the evolution of minimum procedures required over the years and documentation of case logs to establish national norms. The utility of the Ian Donald Interuniversity Schools of Medical Ultrasound as one means to assist educators by providing access to hands on simulation is highlighted as an efficient mechanism for providers to demonstrate lifelong learning outside of a residency-training program.



Coordination of Fetal Facial Expressions after 36 weeks of Gestation

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:6] [Pages No:156 - 161]

Keywords: Brain maturation, Coordination of fetal facial expressions, Reproducibility assessment, Third trimester of pregnancy, 4D ultrasound.

   DOI: 10.5005/jp-journals-10009-1567  |  Open Access |  How to cite  | 


Aim: To assess the coordination in the frequency of fetal facial expressions and reproducibility of fetal facial expression counting in normal singleton pregnancies in the third trimester of pregnancy using four-dimensional (4D) ultrasound. Methods: One hundred and eleven healthy fetuses between 30 and 40 weeks of gestation were examined using 4D ultrasound. The frequencies of 7 facial expressions during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30-31 weeks, 43 at 32-35 weeks, and 43 at ≥36 weeks). Correlation analysis between each frequency and other fetal facial expressions in each gestational age group was performed to determine the change in the number of significant correlations with advancing gestation. Results: Only two significant correlations were identified among 21 combinations of facial expressions at 30-31 and 32-35 weeks of gestation, whereas more frequent correlations (nine significant correlations) were noted at 36 to 40 weeks (p = 0.009). All fetal facial expressions showed intra- and inter-class correlation coefficients greater than 0.72, with good intra- and inter-observer agreements. Conclusion: Our results suggest that the coordination of different parts of the fetal brain controlling facial expressions become apparent after 36 weeks of gestation because of the mature development of the fetal brain and central nervous system. To the best of our knowledge, this is the first study on the reproducibility assessment of fetal facial expression counting using 4D ultrasound.



Khushali Gandhi, Sugandha Goel

Role of Three-dimensional Power Doppler Angiography in Assessment of Perifollicular Ovarian Vascularity in Patients Undergoing In Vitro Fertilization: A Single Center Experience

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:6] [Pages No:162 - 167]

Keywords: IVF outcome, Number of follicles, Power doppler angiography, Three dimensional

   DOI: 10.5005/jp-journals-10009-1568  |  Open Access |  How to cite  | 


Introduction: Ovarian blood flow plays a vital role in ovarian follicular development in In Vitro fertilization (IVF) cycle. Perifollicular color mapping with three-dimensional (3D) power Doppler angiography (PDA) is a reliable technique for predicting IVF success. Objective: Single-center prospective study, with an aim to investigate correlation between 3D PDA parameters and success of IVF cycles. Methods: Ovulation induction was done using a long protocol with gonadotrophins and GnRH agonist in 94 infertile women. With the help of 3D PDA, on the day of HCG administration, ovarian volume (OV), number of follicles (NF), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated. The success of IVF outcome in these patients was noted. Results: The OV, VI, FI, VFI, and NF were significantly higher in women who conceived following IVF. IVF outcome can be presumed by NF and VI. NF was the only independent parameter predicting a number of retrieved oocytes, mature oocytes, fertilized oocytes and number of grade 4 embryos. Conclusion: Three-dimensional USG and PDA is an easy and quick modality for ovarian blood flow assessment and prediction of success of IVF cycle. Positive correlation was identified between 3D PDA parameters and IVF laboratory parameters along with subsequent IVF success.



Gabriella Minneci, Giuseppe Cali

Placenta–From Basic Facts to Highly Sophisticated Placenta Accreta Story

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:18] [Pages No:168 - 185]

Keywords: Early diagnosis of pathological entities, Placenta, Placental diseases

   DOI: 10.5005/jp-journals-10009-1569  |  Open Access |  How to cite  | 


The study of the placenta is a fundamental aspect of pregnancy management from the first to the third trimester. In the last years, the increased ultrasound technology has given us new possibilities of diagnosis, often with great importance in the clinical practice. This paper discusses the most know placental diseases but highlights the importance of some emerging pathological entities, whose early diagnosis or suspect may significantly improve maternofetal outcomes.



Matija Prka, Asim Kurjak

Screening for Ovarian Cancer by Different Modes of Transvaginal Sonography

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:11] [Pages No:186 - 196]

Keywords: 3D power Doppler, Early detection, Malignant ovarian masses, Screening

   DOI: 10.5005/jp-journals-10009-1570  |  Open Access |  How to cite  | 


Studies indicate that 3D power Doppler imaging can improve the ability to differentiate benign from malignant ovarian masses, increasing significantly specificity and positive predictive value (PPV) in ovarian cancer detection. Therefore, the problem of low PPV in ultrasound-only strategies may be solved by introducing new 3D ultrasound technologies, used together in a secondary screening procedure. The possible role of 3D ultrasound and 3D power Doppler imaging in the early and accurate detection of ovarian cancer is under evaluation through Zagreb Ovarian Cancer Screening Trial.



Lucia Rosignoli, Giovanni Centini

Three-dimensional Ultrasound in the Visualization of Fetal Anatomy in the Three Trimesters of Pregnancy

[Year:2018] [Month:July-September] [Volume:12] [Number:3] [Pages:52] [Pages No:197 - 248]

Keywords: HDlive, Silhouette, Three-dimensional ultrasound, Visualization of fetal anatomy,

   DOI: 10.5005/jp-journals-10009-1571  |  Open Access |  How to cite  | 


It is now widely considered that three- and four-dimensional (3-4D), namely 3D with a fourth dimension, time, offer too many possibilities to be ignored. Acquisition of a volume or region of interest is the great novelty of 3D technique. And just as exciting is the possibility of studying it in movement during ultrasound examination or afterward; also by other operators in an infinite number of section planes that can all be perfectly reproduced. This paper aims to provide pictorial documentation of pregnancy monitoring with 3D images, sometimes with the corresponding 2D image, so readers can begin to habituate themselves and hopefully acquire a different and personal key to the 3D image.


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