Three-dimensional (3D) power Doppler data is increasingly used to assess and quantify blood flow and tissue perfusion. The objective of this study was to assess the validity of common 3D power Doppler 'vascularity' indices by quantification in well characterised in-vitro flow models. A computer driven gear pump was used to circulate a steady flow of a blood mimicking fluid through various well characterised flow phantoms to investigate the effect of the number of flow channels, flow rate, depth dependent tissue attenuation, blood mimic scatter particle concentration and ultrasound settings. 3D Power Doppler data were acquired with a Voluson 530D scanner and 7.5MHz transvaginal transducer (GE Kretz). Virtual Organ Computer-aided Analysis software (VOCAL) was used to quantify the vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). The vascular indices were affected by many factors, some intuitive and some with more complex or unexpected relationships (e.g. VI increased linearly with an increase in flow rate, blood mimic scatter particle concentration and number of flow channels, and had a complex dependence on pulse repetition frequency). Use of standardised settings and appropriate calibration are required in any attempt at relating 'vascularity indices' with flow.
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