Significant advances have been made in recent years in clinical application of 3D sonography in both obstetrics and gynecology. Since the author pioneered the use of 3D sonography many new clinical useful techniques have been used for better visualization of early human development and for the diagnostics of many gynecological problems as well as the use of 3D in management of female infertility. In this review we are describing further development in 3D ultrasound, which should be of general interest of readers of this journal.

Three-dimensional, multiplanar sonography, using a volume data set acquired with a 3D probe, has revolutionized ultrasonographic imaging and takes sonographers to a new perception of the fetus in 3 dimensions. Real time scanning, until the late nineties only possible in B-mode, can now be performed in 3D with up to 40 frames/sec. Fetal neurology emerged as a new perinatal research field with the 4D visualization of fetal behavior. Doppler ultrasound, diversified and refined from continuous wave and pulsed Doppler to Color – and Power Doppler, when added to 3D sonography, creates fascinating options of noninvasive fetal vascular mapping (sonoangiography) and vascular assessment of placenta. The diagnostic and demonstrative potential of an acquired 3D volume data set can be maxed with the help of postprocessing and rendering software. After storage, the evaluation of fetal 3D data sets can happen without the patient, with the option of specialist consultation, using telemedicine. In the article, the new 3D “modes” like surface rendering, maximum mode, 3D Color and Power Doppler, STIC, volume rendering, and glass body rendering, are described and illustrated in their display of normal fetal anatomy.

The introduction of four-dimensional (4D) ultrasound techniques would facilitate fetal behavioral assessment in three-dimensions in realtime during pregnancy. We describe the latest 4D sonographic studies on fetal behavior, especially fetal whole-body movements and facial expressions in all three trimesters of pregnancy and the continuation of behavior from the fetal to neonatal period. Moreover, we introduce a new scoring system (KANET, Kurjak Antenatal Neurological Test) for assessment of the fetal neurological status using 4D ultrasound. 4D ultrasound also facilitated the evaluation of inter-human contact in twin pregnancies in utero. This novel technique may assist in the evaluation of fetal behavior and inter-twin contact, and offer potential advantages relative to conventional two-dimensional ultrasound. 4D ultrasound should become an important modality in future research on fetal neurobehavioral development and the prenatal identification of severely brain-damaged infants. Further studies involving a larger sample size are needed to ascertain the role of 4D ultrasound in the evaluation of fetal neurobehavioral development.

Significant advances have been made in accurate and reliable visualization of the cerebral circulation in normal and abnormal pregnancies. They provided the non-invasive studies of fetal cerebral angiogenesis and further development that filled some of the gaps made by neuroanatomical studies alone. The first breakthrough in the assessment of fetal circulation was development of Doppler system with purpose to obtain velocity waveforms. Continuing technical advances in Doppler ultrasound equipment, especially highly sensitive color flow imagining techniques have made it possible to study smaller anatomical parts of fetal circulation system including cerebral vascularization. Before examination of brain vascularity, anatomical vascular structure and development on the different appearance at each gestational age should be remembered as the basic knowledge. Since the development of the embryo is rapid and significant changes occur during even one week it is important to specify the stage of the embryo or fetus both by age (postmenstrual weeks and days) and by size (crownrump length (CRL) and biparietal diameter (BPD).

Introduction of three-dimensional (3D) sonography and 3D power Doppler techniques have enabled visualization of intracranial vessels. 3D power Doppler assessment particularly adds useful information in the prenatal evaluation of normal brain development, vascular malformation and tumoral vascularity.

Review of present knowledge about fetal growth, and clinical and ultrasonography diagnosis of Intrauterine growth restriction by means of 2D and 3D. The review included the diagnosis of type of IUGR and the study of fetal deterioration (Chronic Tests and Acute Markers). Also the obstetrics management.

Adnexal masses have an etiological spectrum ranging from gynecologic to non-gynecologic causes. Because they can be benign or malignant, their evaluation has to include a careful analysis of the patients history, a physical examination, and laboratory and imaging tests. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component or intracystic proliferations, thick septations (greater than 2 to 3 mm), bilateral occurrence, blood flow within the solid component of the mass, and presence of ascites. Tumor-neoangiogenesis has typical features of flow pattern and vascular architecture, indicative of malignancy, which can be visualized by Doppler ultrasound. Power Doppler with its increased sensitivity for slow flow and small vessels is ideal for this purpose and, in combination with acquisition of a volume data set of the region of interest (RoI), gives new insights in tumor angiology and appears to be an additional diagnostic tool. An important predictor of malignancy is a resistance index (RI) below 0.42 in arterial tumor vessels. 3D rendering modes like magic cut, NICHE mode, power Doppler glass body rendering, can make valuable contributions to differential diagnose of adnexal masses. A variety of adnexal masses is illustrated in their specific sonographic appearance, with special regard to ovarian carcinoma.

In developed countries more women die annually from ovarian cancer than from all other gynecologic malignancies combined. The fact that the ovaries are deep within the pelvic cavity and difficult to palpate is an obstacle to early diagnosis, especially in peri-post menopausal women, the group with the highest incidence of the disease. Seventy percent of patients are not diagnosed with the disease until the cancer has metastasized beyond the ovaries and is at stage 3 or 4. Patients with stage 3 or 4 have a 5-year survival rate of only 20-30%. Given the burden of suffering associated with ovarian cancer and the clear survival gradient related to the stage of disease at diagnosis, there is great need for development of effective screening methods for early detection of epithelial ovarian cancer. Better understanding of ovarian cancer etiology and increasing knowledge of tumor biology have both contributed to identify efficient Serum Tumor Markers, to screen high-risk populations. Technical advances in the field of ultrasound made transvaginal sonography (TVS) become the most important diagnostic tool, and multimodal (Serum markers plus TVS) screening appears to be a diagnostic break-through in fighting ovarian cancer. Five case reports illustrate that new ultrasound technologies such as 3D volume acquisition and 3D power Doppler imaging promise more reliable identification of an abnormal ovarian tumor vascularity and tumor-typical vascular architecture, thus facilitating early stage 1 – detection of the disease.