Early ovarian cancer: 3-D power Doppler.

Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with "positive" findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.

[Three-dimensional ultrasonographic uterine vascularization and embryo implantation]. / Vascularisation de l'utérus en 3D et implantation.

During the last decade transvaginal color Doppler has played an important role in increasing the understanding of early human development. Although our knowledge of early pregnancy development has recently improved, little is known about the most critical period of human development: implantation. Recent advances in three-dimensional ultrasound have made studies of follicular development, ovulation and uterine receptivity more accurate. Three-dimensional ultrasound facilitates determination of the antral follicle number, ovarian volume calculation and analysis of the intensity of ovarian stromal blood flow in a short time without increasing the patient's discomfort. It is also possible to determine predictors of IVF outcome by three-dimensional ultrasound. Favorable ovarian stromal vascularity is associated with higher number of retrieved oocytes and increased pregnancy rates. The high degree of endometrial perfusion shown by color Doppler ultrasonography and on three-dimensional power Doppler histograms on the day of embryo transfer can indicate a more favorable endometrial milieu for successful in vitro fertilization. Uterine septum is the most common uterine abnormality occurring in infertile women. Three-dimensional ultrasound can be used as a screening method for detection of uterine abnormalities in patients suffering from infertility.

Three-dimensional sonography for assessment of morphology and vascularization of the fetus and placenta.

OBJECTIVE: To analyze the potential of three-dimensional power Doppler sonography in morphologic and functional assessment of the fetus and placenta. METHODS: Review of the recent literature on three-dimensional sonography in early pregnancy and in the second and third trimester. RESULTS: Three-dimensional sonography plays an important role in obstetrics predominantly for assessing fetal anatomy. Multiplanar images and rotation of the object allow systematic review of anatomic structures, such as limb buds, cerebral cavities, cord insertion, stomach, and bladder. Using this modality, volumes of the gestational sac, yolk sac, and fetal organs can be obtained easily. Three-dimensional power Doppler sonography has the potential to study the intervillous and placental circulation and evaluate the development of the embryonic and fetal cardiovascular system. CONCLUSIONS: Three-dimensional ultrasound imaging complements pathologic and histologic evaluation of the developing embryo, giving rise to the new term "three-dimensional sonoembryology." It is evident that three-dimensional ultrasonography improves the visualization of the normal and abnormal fetal anatomy giving a realistic impression of the extent of the defects. These data are useful not only for obstetricians but also for pediatricians and pediatric surgeons.

Predictors of IVF outcome by three-dimensional ultrasound.

BACKGROUND: Our study was designed to evaluate whether ovarian antral follicle number, ovarian volume, stromal area and ovarian stromal blood flow are predictive of ovarian response and IVF outcome. A total of 56 women with normal basal serum FSH concentrations who had no history of ovarian surgery, no ovarian and/or uterine pathology, were non-smokers and undergoing their first IVF cycle using a standard long GnRH agonist protocol were examined. METHODS: Total ovarian antral follicle number, total ovarian volume, total stromal area and mean flow index (FI) of the ovarian stromal blood flow were determined by three-dimensional (3D) and power Doppler ultrasound after pituitary suppression. Pretreatment 3D ultrasound ovarian measurements were compared with subsequent ovulation induction parameters [peak estradiol (E2) on HCG administration day and number of oocytes] and cycle outcome (fertilization and pregnancy rates). RESULTS: The total antral follicle number achieved the best predictive value for favourable IVF outcome, followed by ovarian stromal FI, peak E2 on HCG administration day, total ovarian volume, total ovarian stromal area and age. Using these six parameters, we were able to predict a favourable IVF outcome in 50% (11/22) of patients and poor outcome in 85% (29/34) of patients. CONCLUSIONS: Three-dimensional ultrasound facilitates determination of the antral follicle number, ovarian volume calculation, evaluation of the ovarian stroma and analysis of the intensity of ovarian stromal blood flow in a short time without increasing the patient's discomfort.

Volume and vascularity of the yolk sac assessed by three-dimensional and power doppler ultrasound.

The yolk sac is an organ of increasingly recognized importance in the initial mechanisms of pregnancy maintenance and the early growth and welfare of the embryo. The aim of our study was to assess the vascularity of the yolk sac and vitelline duct in 150 patients between the 6th and 10th weeks of normal, and uncomplicated pregnancies who were scheduled for termination of pregnancy for psychosocial reasons and 130 complicated pregnancies. In same patients volume of the yolk sac was assessed using Combison 530 3D Voluson, Medison-Kretz Company. Overall visualization rate for yolk sac vessels was 80,38%. The highest visualization rates were obtained in the 7th and 8th weeks of gestation reaching values of 90,71 %. In the same period the visualization rates of the vitelline duct arteries were 87,71% and 91,28% respectively. A characteristic waveform profile included low velocity (5,8+/-1,7 cm/s) and absence of diastolic flow which was obtained from all examined yolk sacs. The PI showed the mean value of 3,24+/-0,94 without significant changes between subgroups (p>0,05). Vitelline vessels showed similar PSV (5,4+/-1,8 cm/s) and PI values (3,14+/0,91) (p>0,05) to that obtained from the yolk sac. Three types of abnormal vascular signals were derived from the yolk sac in patients with missed abortion (n=32): irregular blood flow (n=6), permanent diastolic flow (n=2) and venous blood flow signals (n=5). However, in the most of the patients (n=19) blood flow signals could not have been extracted from these early embryonic structures. Using three-dimensional ultrasound we found a positive correlation between gestational age and volumes of the gestational and yolk sac until 10 weeks gestation. At the end of the first trimester yolk sac volume remained constant, while gestational sac volume continued to grow. It seems that changes in both yolk sac appearance (size, shape, volume and echogenicity) and vascularization are probably a consequence of poor embryonic development or even embryonic death, rather than being a primary cause of an early pregnancy failure.

Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography.

OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. METHODS: Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two- and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. RESULTS: Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 +/- 0.02 cm3) from that in those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02 cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic and three-dimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. CONCLUSIONS: Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors.

Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures.

The objective of this study was to investigate the usefulness of transvaginal color Doppler and three-dimensional power Doppler ultrasonography for the assessment of endometrial receptivity. A total of 89 patients undergoing in vitro fertilization procedures were evaluated for endometrial thickness and volume, endometrial morphology, and subendometrial perfusion on the day of embryo transfer. Neither the volume nor the thickness of the endometrium on the day of embryo transfer had a predictive value for conception during in vitro fertilization cycles (P > .05). Patients who became pregnant were characterized by a significantly lower resistance index, obtained from subendometrial vessels by transvaginal color Doppler ultrasonography (resistance index = 0.53 +/- 0.04 versus 0.64 +/- 0.04, pregnant versus not pregnant, respectively; P < .05), and a significantly higher flow index (13.2 +/- 2.2 versus 11.9 +/- 2.4; P < .05), as measured by a three-dimensional power Doppler histogram. No difference was found in the predictive value of scoring systems analyzing endometrial thickness and volume, endometrial morphology, and subendometrial perfusion by color Doppler and three-dimensional power Doppler ultrasonography. The high degree of endometrial perfusion shown by color Doppler ultrasonography and on three-dimensional power Doppler histograms on the day of embryo transfer can indicate a more favorable endometrial milieu for successful in vitro fertilization.

Histologic architecture and vascularization of hysteroscopically excised intrauterine septa.

STUDY OBJECTIVE: To investigate histologic structures of intrauterine septa resected hysteroscopically. DESIGN: Prospective, consecutive study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Seventy-six women evaluated for uterine septa and infertility. INTERVENTIONS: All patients with diagnosis of uterine septum detected by transvaginal color Doppler (TVCD) underwent operative hysteroscopy in which the most prominent part of the septum was encircled with a hysteroscopic loop electrode and removed. Specimens were sent for histopathologic evaluation. The rest of the septum was divided by monopolar needle electrode until the uterine cavity assumed a globular shape. MEASUREMENTS AND MAIN RESULTS: In 63 women (82.8%) preoperative TVCD revealed septal vascularity typical for radial arteries with mean resistance flow of 0.64 +/- 0.06, and enlarged sunusoidal and capillary spaces. Histopathologic results revealed fibromuscular tissue with moderately more connective tissue in 55 cases (72.3%) and myometrial tissue in 21 (27.6%). There was no statistically significant difference (p >0.05) in frequency of septa between patients with primary and secondary infertility. CONCLUSION: Intrauterine septa consisted of the same type of tissue as normal myometrium, with many muscular fibers. We suspect that muscular tissue within the uterine septum is a potential cause of irregular contractility and consequently increased abortion rate in these patients. (J Am Assoc Gynecol Laparosc 8(1):111-116, 2001)

Clinical implications of sonographic detection of uterine anomalies for reproductive outcome.

The purpose of this review article was to analyze the literature on the prevalence, diagnosis and treatment of the congenital uterine anomalies and to discuss current dilemmas on their influence on reproductive outcome. Congenital uterine anomalies are commonly associated with repeated pregnancy failure, in particular an increased risk of first- and second-trimester miscarriages and preterm delivery. Recent reports on two-dimensional and three-dimensional transvaginal ultrasound and saline contrast sonohysterography appear promising for diagnosis and classification of congenital uterine anomalies. The ability to visualize both the uterine cavity and the fundal uterine contour on a three-dimensional scan facilitates the diagnosis of uterine anomalies and enables differentiation between septate and bicornuate uteri. Color Doppler ultrasound allows visualization of intraseptal vascularity and may help in distinguishing the avascular from the vascular septum. Less connective tissue in the septum may result in poor decidualization and placentation, while an increased amount of muscle tissue in the septum can cause miscarriage by the production of local uncoordinated myometrial contractility. Hysteroscopic septum excision is an effective procedure which improves live-birth rates. Because of its simplicity, minimal invasiveness, low morbidity and low cost, a more liberal approach to the treatment of uterine anomalies is being advocated.

Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses.

OBJECTIVE: To investigate the potential usefulness of contrast-enhanced, three-dimensional power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: A total of 45 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy. All the results were compared with histopathology. RESULTS: There were 12 cases of ovarian malignancy and 33 benign adnexal lesions. Of the 12 ovarian cancers, seven (58. 3%) showed vascular distribution suggestive of malignancy at nonenhanced three-dimensional power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy. One cystadenofibroma demonstrated penetrating vessels at initial scan, whereas two benign lesions (fibroma and cystadenofibroma) were misdiagnosed as malignant at contrast-enhanced, three-dimensional power Doppler sonography. The use of a contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency (95.6%) that was superior to that of nonenhanced three-dimensional power Doppler sonography (86. 7%). CONCLUSION: Contrast-enhanced, three-dimensional power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with three-dimensional morphologic ultrasound assessment, enhanced three-dimensional power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.

Vascular impedance of uterine, inferior vesicle, and ophthalmic arteries in postmenopausal women receiving hormonal replacement therapy: comparative Doppler study.

AIM: To investigate the effects of combined hormone replacement therapy (HRT) on vascular impedance of the uterine, the inferior vesicle, and the ophthalmic arteries. METHODS: Thirty-five postmenopausal patients were divided in two groups: 21 patients with 1-5 years of menopause and 14 patients with =6 years of menopause. Each group was examined in basal condition and after 1, 3, and 6 months of HRT. Blood flow impedances of the uterine, the inferior vesicle, and the ophthalmic arteries were analyzed by color Doppler. Estradiol plasma concentrations were assayed on the day of Doppler examination. RESULTS: Analysis of the uterine and inferior vesicle arteries flow velocities showed a significant positive correlation between the resistance index (RI) and years of menopause. Higher impedance values were found in patients with longer menopause duration (p<0.05). In patients with =6 years of menopause, impedances of the uterine and the inferior vesicle arteries were 0. 94+/-0.03 and 0.91+/-0.04, respectively, whereas in patients with 1-5 years of menopause impedances were 0.89+/-0.04 and 0.98+/-0.02, respectively. We noticed no significant correlation between baseline RI and duration of menopause at the level of the ophthalmic artery in either group (0.72 vs. 0.73, respectively; p<0.05). After six months of HRT, plasma estradiol concentrations inversely correlated with RI of the uterine (r=0.2556; p=0.021), the inferior vesicle (r=0.2653; p=0.023), and the ophthalmic (r=-0.2211; p=0.017) arteries. CONCLUSION: Doppler studies of the uterine, the inferior vesicle, and the ophthalmic arteries can provide specific and precise pathophysiological information to assess blood flow variations in correlation with combined HRT.

What do contrast media add to three-dimensional power Doppler evaluation of adnexal masses?

AIM: To investigate the potential usefulness of contrast-enhanced three-dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: Thirty one patients with complex adnexal lesions of uncertain malignancy at transvaginal B-mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of a contrast agent. Presence of a penetrating pattern and a mixed penetrating and/or peripheral pattern suggested adnexal malignancy. The results were compared with histopathologic findings. RESULTS: There were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of 10 ovarian cancers, 6 showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy as well as in 2 benign lesions (fibroma and cystadenofibroma), which were misdiagnosed as malignant. The use of contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency of 96.7%, superior to that of nonenhanced 3D power Doppler sonography (93.5%). CONCLUSION: Contrast-enhanced 3D power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging may precisely discriminate benign from malignant adnexal lesions.

Three-dimensional sonography in prenatal diagnosis: a luxury or a necessity?

Three-dimensional sonography revolutionized ultrasound imaging with its capacity to depict an unlimited number of planes in which the object of interest can be displayed. The addition of numerous modalities of image rendering promotes three-dimensional sonography to the top of the spectrum of diagnostic imaging in obstetrics and gynecology. The aim of this article is to present our experience in 3-D sonography during the second and third trimester of pregnancy and to give a comparative review of literature. 247 patients in gestational age ranging from 12 to 40 weeks of gestation were examined over a three year period. The majority of patients entered the study because fetal anomaly was suspected at two-dimensional sonography. Some patients were sent on to three-dimensional sonography because it was not possible to depict clearly normal fetal anatomy by two dimensional sonography. Out of 170 fetal anomalies three-dimensional sonographic analysis failed in only three cases. In all three anomaly was accompanied with severe oligohydramnios. Main advantages of three-dimensional ultrasound in perinatal medicine and antenatal diagnosis include scanning in the coronal plane, improved assessment of complex anatomic structures, surface analysis of minor defects, volumetric measuring of organs, "plastic" transparent imaging of fetal skeleton, spatial presentation of blood flow arborization and, finally, storage of scanned volumes and images. It is our decided opinion that three-dimensional sonography has gained a valuable place in prenatal diagnosis, becoming a necessity for every modern perinatal unit.

Preoperative diagnosis of the primary fallopian tube carcinoma by three-dimensional static and power Doppler sonography.

OBJECTIVE: To investigate whether three-dimensional static and power Doppler ultrasound improves the diagnosis of primary Fallopian tube carcinoma. METHODS: During a 2-year period five cases of primary Fallopian tube carcinoma were selected from a cohort of 520 patients with a previous scan suggestive of an adnexal tumor. RESULTS: Tubal malignancy occurred in patients between 49 and 64 years, with presenting symptoms such as pain, vaginal bleeding and leukorrhea. CA 125 was elevated in three cases of tubal carcinoma with stages II and III, while in two patients with stage I, CA 125 was within the normal limits. Two-dimensional ultrasound demonstrated sausage shaped cystic masses with papillary projections in two patients and a complex adnexal mass in one patient. Three-dimensional ultrasound revealed sausage shaped cystic and/or complex masses with papillary projections in all five cases of tubal malignancy. In one patient preoperative 3-D ultrasound correctly predicted bilateral tumors, while 2-D transvaginal sonography found only unilateral changes. Additional 3-D power Doppler examination depicted vascular geometry typical for malignant tumor vessels such as arteriovenous shunts, microaneurysms, tumoral lakes, blind ends and dichotomous branching in each of the cases with Fallopian tube carcinoma. CONCLUSIONS: Three-dimensional ultrasound allows precise depiction of tubal wall irregularities such as papillary protrusions and pseudosepta. Improved understanding of anatomical relationships may aid in distinguishing ovarian from tubal pathology. Multiple sections of the tubal sausage like structures enable determination of local tumor spread and capsule infiltration. Study of the vascular architecture in cases of Fallopian tube malignancy is further enhanced using 3-D power Doppler imaging.

Three-dimensional ultrasound and power doppler improve the diagnosis of ovarian lesions.

OBJECTIVE: The aim of this study was to determine whether three-dimensional power Doppler can improve the ability to differentiate benign from malignant ovarian masses. METHODS: Transvaginal color Doppler and three-dimensional power Doppler were performed on 120 patients with ovarian lesions. All patients underwent both ultrasound examinations during the day prior to laparotomy or laparoscopy. Scoring systems combining morphological and Doppler parameters were adopted for two- and three-dimensional ultrasound examinations. RESULTS: In each of 11 ovarian malignancies, preoperative diagnosis by three-dimensional power Doppler was confirmed by histopathology. Transvaginal color Doppler missed 1 case of serous cystadenocarcinoma, while 3 benign lesions were considered false positive. In 1 case of cystadenofibroma both transvaginal color Doppler and three-dimensional power Doppler were falsely positive. Qualitative analysis of the tumor vascularity architecture added to morphological parameters had a sensitivity and specificity of 100 and 99.08%, respectively. CONCLUSIONS: Better results achieved by three-dimensional ultrasound can be explained by improved recognition of the ovarian mass anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three-dimensional power Doppler imaging can detect structural abnormalities of malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Three-dimensional power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian masses.

Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions.

OBJECTIVE: To determine whether three-dimensional ultrasound (3D US) and 3D power Doppler can improve the ability to differentiate benign from malignant ovarian lesions. METHODS: Transvaginal ultrasound, transvaginal color Doppler, 3D US and 3D power Doppler were performed on 90 patients with ovarian lesions during the week prior to surgery. Four independent sonographers were blinded to the results of other ultrasound studies. RESULTS: Color Doppler studies added to transvaginal gray-scale characterization of ovarian lesions resulted in sensitivity of 88.89% and specificity of 97.53% in diagnosing ovarian malignancy. Qualitative analysis of tumor vascularity by 3D power Doppler added to morphological features obtained by 3D US is clinical pertinent and reached sensitivity and specificity of 100 and 98.76%, respectively. CONCLUSION: Three-dimensional ultrasound and power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian lesions. Introduction of the 3D quantitative technique for measurements of blood flow and vascularization may increase clinical relevance of these studies.

The study of morphology and circulation of early embryo by three-dimensional ultrasound and power Doppler.

Three-dimensional (3-D) ultrasound plays an important role in obstetrics predominantly for assessing fetal anatomy. Presenting volume data in a standard anatomic orientation assists both ultrasonographers and pregnant patients to recognize anatomy more readily. Three-dimensional ultrasound is advantageous for the study of normal embryonic and/or fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. This method offers advantages in assessing the embryo in the first trimester as it is able to obtain multiplanar images through endovaginal volume acquisition. Rotation of the embryo and close scrutiny of the volume allow the systematic review of anatomic structures such as cord insertion, limb buds, cerebral cavities, stomach and bladder. Using this modality one can easily obtain the volumes of the gestational sac and yolk sac and can evaluate their relationship to prediction of pregnancy outcome. Three-dimensional power Doppler sonography has the potential to study process of placentation and evaluate the development of the embryonic and fetal cardiovascular systems. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3-D sonoembryology. Rapid technological development will allow real-time 3-D ultrasound to provide improved and expanded patient care on the one side, and increased knowledge of developmental anatomy on the another.

[Study of intervillous blood circulation using color and pulsed doppler ultrasound]. / Istrazivanje interviloznog optoka krvi s pomocu obojenog i pulzirajuceg Doplerskog ultrazvuka.

Studies of the formation and hemodynamics of intervillous circulation aroused great scientific interest in the past few years. The reason for this is development of the technology of color Doppler ultrasound, which can non-invasively in vivo follow-up changes in intervillous circulation during all three trimesters of gestation. The results of Doppler ultrasound measurements have been compared to histological and embryological findings. Different experimental findings and theories induced intensive scientific discussions about the timing of the formation of intervillous circulation, as well as about possible significance of hemodynamic changes in physiological and pathological processes in early and late gestation. In this review article we tried to acquaint the broader professional readership with this interesting subject, and to present our results and viewpoints after several years of the study of intervillous circulation with color Doppler.

Three dimensional ultrasound and power doppler in assessment of uterine and ovarian angiogenesis: a prospective study.

AIM: To determine whether three-dimensional power Doppler can improve the recognition of pelvic tumor morphology and angiogenesis. METHODS: Using this technique we analyzed 180 adnexal masses and 110 uterine lesions. Tumor volume, morphology, and vascularity were evaluated in each patient. Irregular and randomly dispersed vessels with complex branching depicted by comprehensive three dimensional display were suggestive of pelvic malignancy, while linear-like vascular morphology, single vessel arrangement and regular branching were typical for benign structures. RESULTS: Addition of qualitative analysis of vascular architecture of adnexal tumor to morphological parameters reached 96.15% sensitivity and 98.73% specificity. When endometrial lesions were prospectively analyzed, sensitivity and specificity were 91.67% and 98.49%, respectively. Because the lowest positive predictive value of 16.67% was obtained for myometrial lesions, this method should not be advised for their eva luation. CONCLUSION: Good results achieved by three dimensional ultrasound can be explained by improved recognition of the pelvic lesion anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three dimensional power Doppler imaging can detect structural abnormalities of the malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Therefore it enhances and facilitates the morphologic and functional evaluation of both benign and malignant pelvic tumors.