Three‐dimensional Doppler evaluation of single spherical samples from the placenta: intra‐ and interobserver reliability

Martins, Wellington P.; Lima, Jailson Costa; Welsh, Alec; Araújo, E.; Miyague, A. H.; Filho, Francisco Mauad; Raine‐Fenning, Nick

doi:10.1002/uog.11076

Cited by 42 publications

(36 citation statements)

References 35 publications

(57 reference statements)

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“…Both Guiot et al and Lai et al showed poor inter-acquisition reliability when measuring VOCAL TM indices in samples when multiple areas of the placenta were compared, indicating regional variation in vascularity. 36,41 Another limitation is the use of a single acquirer for each patient and repeated sample acquisitions over the same VOI. Our findings support a study which demonstrated that within the placenta, distinct maternal vascular 'jets' arising from the basal plate project into the intervillous space, 24 leading to areas of mixed maternal and fetal pulsatility, reflected in lower absolute values for impedance indices.…”

Section: Discussionmentioning

confidence: 99%

Novel spatial–temporal image correlation derived indices of tissue vascular impedance: A variability study

Ferreira

Stevenson

et al. 2017

Australas J Ultrason Med

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Objectives: 4D (3D + time) indices of tissue impedance using power Doppler (PD) ultrasound (US) can be measured with spatialtemporal image correlation (STIC) imaging. We wished to evaluate their repeatability and their influence under changes to US machine settings and regional differences within the placenta. Methods: A total of 46 healthy women were recruited at 20-34 weeks of gestation. A total of 9940 3D frames from 644 4D data sets were analysed providing both 3D and 4D indices of vascularity. 4D vs. 3D indices were compared with different machine settings, across the cardiac cycle and in the different placenta regions to assess regional variability. Results: 3D and 4D indices significantly decreased as wall motion filter (WMF) was increased (P < 0.001). Repeatability decreased as WMF increased (ICC; low1 = 0.80; high1 = 0.60). Indices were significantly lower at the maternal aspect (P = 0.002-0.009) of the placenta and showed less repeatability (ICC; 0.42-0.79) than the fetal aspect (ICC 0.49-0.88). 4D repeatability was good in the central region (ICC 0.80-0.81) but poor in the periphery (ICC 0.45-0.59), while 3D indices were good and comparable between regions (ICC; 0.80 central; 0.81 peripheral). Conclusions: This study supports the future use of WMF 'low1' and PD to generate more reliable 4D indices values. For 3D indices, HD Flow may improve Doppler signal sensitivity. Regarding placental regional variability, the fetal plate and the central region demonstrated more repeatable 4D indices. 4D PD indices have potential to overcome the limitations of VOCAL TM indices and provide an internally standardised measure of localised impedance in vascular beds.

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Section: Discussionmentioning

confidence: 99%

Novel spatial–temporal image correlation derived indices of tissue vascular impedance: A variability study

Ferreira

Stevenson

et al. 2017

Australas J Ultrason Med

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“…a 95% confidence interval (CI) of width = 0.20, if the observed area under receiver operating characteristic (ROC) curve was greater than 0.60. 16 For an the area under the ROC curve of 0.713, we would need to assess 160 subjects to have a 95% CI width ≤ 0.20.…”

Section: Methodsmentioning

confidence: 99%

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

et al. 2015

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CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

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“…Even worse, these indices are highly dependent on attenuation (Jones et al 2009;Miyague et al 2014;Raine-Fenning et al 2008a), which limits comparison between patients. Additionally, there are important concerns about reproducibility, particularly when the entire organ cannot be assessed and only a sample can be examined (i.e., the placenta from a third-trimester pregnancy) Martins et al , 2012; such variability could be explained by several factors including variability in movement, sampling region and even the phase in the cardiac cycle during 3-D-PD acquisition (Miyague et al 2013b). This approach is undergoing refinement with respect to 3-D-PD, particularly in the volumetric pulsatility index (Alcazar and Kudla 2012;Martins et al 2013;Welsh et al 2012b) and in fractional moving blood volume (Soares et al 2013;Welsh et al 2012a).…”

Section: Three-dimensional Power Doppler Ultrasoundmentioning

confidence: 99%

Role of 3-D Ultrasound in Clinical Obstetric Practice: Evolution Over 20 Years

Tonni

Martins

Filho³

et al. 2015

Ultrasound in Medicine & Biology

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Three‐dimensional Doppler evaluation of single spherical samples from the placenta: intra‐ and interobserver reliability

Cited by 42 publications

References 35 publications

Novel spatial–temporal image correlation derived indices of tissue vascular impedance: A variability study

Novel spatial–temporal image correlation derived indices of tissue vascular impedance: A variability study

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

Role of 3-D Ultrasound in Clinical Obstetric Practice: Evolution Over 20 Years

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