Ultrasound for evaluation of adnexal malignancy: From 2D to 3D ultrasound

Abstract

Conventional two-dimensional (2D) ultrasound has been widely used for the evaluation of adnexal malignancy in gynecologic fields. This 2D ultrasound evaluation includes a morphological assessment, color/power and pulsed Doppler sonographic assessment, scoring system, and contrast agent assessment of adnexal masses. The introduction of three-dimensional (3D) ultrasound would facilitate the novel assessment of adnexal masses. With the recent advance in 3D power Doppler (3DPD) ultrasound as well as quantitative 3DPD histogram analysis, quantitative and qualitative assessments of the vascularization and blood flow of adnexal masses have become feasible. These novel techniques may assist in the evaluation of adnexal malignancy, and offer potential advantages relative to conventional 2D sonographic assessments. 3D ultrasound may be an important modality in future gynecologic oncology research and in the evaluation of adnexal malignancy in clinical practice, although some limitations regarding the assessment of adnexal malignancy employing 3D ultrasound remain unresolved.

Four-dimensional Ultrasound Evaluation of Fetal Neurobehavioral Development

“…"The question raised here is whether or not facial expressions represent a reliable behavior or emotional state, or constitute reflexive behavior on the part of the fetus". 31 Kurjak et al 49 observed that an increase in facial movement is simultaneously associated with a decrease in the number of general movements. This observation is considered to reflect the normal neurological development of the fetus.…”

“…Subsequent to approximately thirty weeks of gestation, there is an increase in long-duration fetal movements, referred to as epochs and episodes". 31 There have been no studies on the comparison of 2D and 4D techniques to assess fetal facial expression or behavior in the late second and third trimesters of pregnancy, in which the neurobehavioral regulations of fetal movement are the most important.…”

“…However, 4D ultrasound provides consecutive sculpture-like 3D images of the fetal face in real time". 31 Kurjak et al 52 were the first to employ 4D ultrasound to study 10 healthy fetuses aged from 30 to 33 weeks, and they found that facial activities and different forms of expression could be easily recognized, and eyelid and mouthing movements dominated this gestational age. In the recent study by these authors, 100 women with normal singleton pregnancies were recruited for longitudinal 4D ultrasonographic examinations to evaluate fetal neurodevelopmental parameters from the 15th to 40th week.…”

“…However, whole-body movements are actually a composite of the isolated body movements". 31 Only one study determined the accuracy of 4D ultrasound in the assessment of embryonic and early fetal motor activity, in comparison with conventional 2D ultrasound. 53 General body, head, and limb movements recorded by 2D ultrasound were notable by 4D ultrasound between 6-14 weeks of gestation, and there were significant correlations in the frequencies of all observed movement patterns assessed by the two different techniques.…”

“…20 With the appearance and development of four-dimensional (4D) ultrasound, fetal behavioral movements and the full range of facial expressions can be observed. 15,[21][22][23][24][25][26][27][28][29][30][31] The ease with which 4D ultrasound can be used to evaluate fetal movements might well promote a resurgence of interest in fetal behavior and responsiveness. 32 "Fetal behavior, defined as any observable action or reaction to an external stimulus by the fetus, reflects the activity of the fetal central nervous system".…”