bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective cross‐validation of Doppler ultrasound examination and gray‐scale ultrasound imaging for discrimination of benign and malignant pelvic masses
Authors: Valentin L 
Published: March 2003

AbstractObjectiveTo cross‐validate, prospectively, the diagnostic performance of established ultrasound methods for discrimination of benign and malignant pelvic masses.MethodsA total of 173 consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. A total of 149 tumors were benign, and 24 were malignant. The sensitivity and false‐positive rate with regard to malignancy were calculated for the following methods, using cut‐off values recommended in previous publications: Lerner score; ultrasound morphology, i.e. tumors without solid components being classified as benign and tumors with solid components as malignant; tumor color score; pulsatility index; resistance index; time‐averaged maximum velocity; peak systolic velocity; the combined use of ultrasound morphology and tumor color score and the combined use of ultrasound morphology and peak systolic velocity. Sensitivity and false‐positive rate were also calculated for subjective evaluation of the gray‐scale ultrasound image and for subjective evaluation of the gray‐scale ultrasound image supplemented with subjective evaluation of color Doppler ultrasound examination. The confidence with which the diagnosis was made, based on subjective evaluation, was rated on a visual analog scale.ResultsSubjective evaluation of the gray‐scale ultrasound image was by far the best method for distinguishing benign from malignant tumors (sensitivity 88%, false‐positive rate 4%), followed in descending order by subjective evaluation of the gray‐scale ultrasound image supplemented with color Doppler examination, the Lerner score and the time‐averaged maximum velocity. Adding Doppler examination to subjective evaluation of the gray‐scale image did not increase the number of correct diagnoses, but it increased the confidence with which a correct diagnosis was made in 14% of tumors. In 11 tumors (6% of the series as a whole), the addition of Doppler examination changed the diagnosis based on subjective evaluation of the gray‐scale ultrasound image from an incorrect (n = 1) or uncertain (n = 10) diagnosis to a correct and confident diagnosis.ConclusionIn experienced hands, subjective evaluation of the gray‐scale ultrasound image is the best ultrasound method for discriminating between benign and malignant adnexal masses. The main advantage of adding Doppler examination to subjective evaluation of the gray‐scale image is an increase in the confidence with which a correct diagnosis is made. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10–14 weeks
Authors: Matias A. , Huggon I. , Areias J. C. , Montenegro N. , Nicolaides K. H. 
Published: March 2003

AbstractObjectiveTo assess a possible relationship between ductus venosus blood flow abnormalities and cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation.MethodsDuctus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10–14 weeks' gestation immediately before fetal karyotyping in 200 consecutive singleton pregnancies with increased nuchal translucency. Fetal echocardiography was subsequently carried out in those with normal fetal karyotype.ResultsReverse or absent flow during atrial contraction was observed in 11 of the 142 chromosomally normal fetuses with increased nuchal translucency. Major defects of the heart and/or great arteries were present in seven of the 11 with abnormal ductal flow and increased nuchal translucency, but in none of the 131 with normal flow.ConclusionThese preliminary results suggest that abnormal ductus venosus blood flow in chromosomally normal fetuses with increased nuchal translucency identifies those with an underlying major cardiac defect. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prediction of discordant twins by real‐time ultrasonography combined with umbilical artery velocimetry
Authors: Chittacharoen A. , Leelapattana P. , Rangsiprakarn R. 
Published: March 2003

Objective To evaluate the role of umbilical Doppler velocimetry combined with ultrasonographic intertwin differences derived from estimated fetal weight, biparietal diameter, abdominal circumference and femur length as a comprehensive test for the prediction of discordancy.
Methods The sets of twins were studied with real‐time ultrasonography for morphometric measurements and with duplex Doppler velocimetry for the S/D ratio of the umbilical artery in third trimester. The following cutoff values were used to indicate abnormal test results: Δ biparietal diameter > 6 mm, Δ abdominal circumference > 20 mm, Δ femur length > 5 mm, Δ estimated fetal weight > 15% and Δ systolic/diastolic ratio > 15%. Discordancy was identified when the birth weight difference exceeded 15%.
Results Among the 52 sets of twin pregnancies studied, 40 sets of twins fulfilled the study criteria. Thirteen sets of twins were discordant (32.5%) The mean gestational age at delivery was 37.15 ± 2.24 weeks (range 28–41 weeks). The diagnostic accuracy provided by ultrasonographic morphometries was not significantly different from that provided by umbilical Doppler velocimetry. Overall the best predictors appeared to be the presence of either Δ systolic/diastolic ratio > 15% or Δ estimated fetal weights > 15% with sensitivity and specificity values of 92% and 70%, respectively.
Conclusion Real‐time ultrasonography combined with umbilical artery velocimetry is useful in predicting discordant twins.
Prenatal diagnosis of single umbilical artery: determination of the absent side, associated anomalies, Doppler findings and perinatal outcome
Authors: Geipel A. , Germer U. , Welp T. , Schwinger E. , Gembruch U. 
Published: March 2003

Objective To determine the absent side of a single umbilical artery and its association with malformations and abnormal karyotypes. Methods We prospectively studied 102 fetuses from 13 to 39 weeks of gestational age with a prenatally identified single umbilical artery. The absent side, pregnancy data, Doppler findings and the perinatal outcome were reviewed. Results (1) The left umbilical artery was absent in 71 (69.6%) and the right in 31 (30.4%) fetuses; (2) Single umbilical artery as an isolated finding occurred in 59 (57.8%) pregnancies and was not associated with aneuploidy. The mean gestational age at delivery in this group was 38.4 weeks and the mean birth weight was 3047 g. Six (10.2%) fetuses were small for gestational age, all of them with normal umbilical and uterine Doppler findings; and (3) Chromosomal abnormalities were diagnosed in 10 of 43 fetuses with single umbilical artery and congenital malformations. In nine of 10 fetuses with aneuploidy the left umbilical artery was not developed. Absence of the left artery occurred in 21 of 33 fetuses with sonographic anomalies and normal karyotype. Pathologic Doppler measurements of the umbilical artery were found in only one case of nonchromosomal abnormality. Conclusion Our data suggest that in fetuses with single umbilical artery the absence of the left artery is more frequent than the absence of the right artery. The association with additional malformations seems to be equal on each side.
Reference ranges for two‐dimensional echocardiographic examination of the fetal ductus arteriosus
Authors: Mielke G. , Benda N. 
Published: March 2003

Objectives To establish reference ranges for 2D‐echocardiographic examination of the fetal ductus arteriosus and its relationship to the main pulmonary artery and the aorta.Methods A prospective cross‐sectional echocardiographic study was performed in 222 normal fetuses from 13 to 41 weeks of gestation using high resolution/color Doppler ultrasound equipment.Results Gestational age‐specific reference ranges are given for the diameter of the pulmonary valve anulus, diameter of the ductus arteriosus at its beginning, middle, and end, ductal length, ductal diameter‐to‐pulmonary valve anulus diameter ratio, and the spatial relationship of the ductus arteriosus to the main pulmonary artery and to the aorta.Conclusions The presented data derived from a study group of 222 normal fetuses provide in‐vivo insights into the morphology of the ductus arteriosus and its relationship to the adjacent vessels. The reference ranges may be helpful in prenatal diagnosis of cardiac malformations and abnormalities of the ductus arteriosus, such as obstruction or aneurysm from 13 to 41 weeks of gestation.
Doppler obstetric ultrasound: a graphical display of temporal changes in safety indices
Authors: Deane C. , Lees C. 
Published: March 2003

AbstractObjectiveTo investigate ultrasound use and exposure in pregnant women undergoing Doppler ultrasound investigation of the maternal and fetal circulation using Doppler ultrasound techniques.MethodsSample graphical displays were generated showing duration of each mode, thermal and mechanical index levels and overall elapsed time of scan and modes.ResultsThe displays revealed combinations of scanner settings which delivered higher output intensity levels and which we subsequently altered in our practice to reduce ultrasound exposure.ConclusionA display of this type would enable monitoring of output levels and exposures, especially for operators undergoing training in Doppler applications. It would also identify poor practice where there is prolonged exposure at high output levels. Such a display, in combination with accurate output measurement from manufacturers and independent laboratories, would help to ensure the safe use of ultrasound in fetal assessment. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal arterial and venous Doppler parameters in the interpretation of oligohydramnios in postterm pregnancies
Authors: Selam B. , Koksal R. , Ozcan T. 
Published: March 2003

AbstractObjectiveThe objective of the current study was to evaluate fetal arterial and venous Doppler parameters in postterm pregnancies with oligohydramnios and those with normal amniotic fluid.Study DesignA cross‐sectional study was performed in 38 pregnancies beyond 41 weeks' gestation. Pulsed Doppler imaging was used to determine the pulsatility index (PI) for the fetal middle cerebral artery (MCA), renal artery, umbilical artery, inferior vena cava (IVC) and ductus venosus. The amniotic fluid index (AFI) was used for semiquantitive assessment of amniotic fluid volume. Oligohydramnios was defined as an AFI < 5 cm.ResultsOligohydramnios was detected in 10 cases, and a normal AFI was present in 28 cases. In the presence of oligohydramnios the PI of the MCA was decreased, while the renal artery PI and the MCA PI/UA PI ratio were found to be elevated. In cases of oligohydramnios the PI in the IVC was increased but was unchanged in the ductus venosus.ConclusionOligohydramnios in post‐term pregnancies is associated with arterial redistribution of fetal blood flow typifying the brain sparing effect and with decreased resistance in the MCA and increased resistance in the fetal IVC. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Virilizing tumors of the ovary: imaging features
Authors: Outwater E. K. , Marchetto B. , Wagner B. J. 
Published: March 2003

AbstractAimVirilizing tumors of the ovary are an uncommon cause of a common clinical problem. The reported imaging features of these tumors are based on case reports. The purpose of this study was to determine the spectrum of imaging characteristics of these tumors based on a larger referral population.Patients and MethodsCase records from the Armed Forces Institute of Pathology were searched for clinical evidence of virilization as a presentation of an excised sex cord‐stromal and steroid cell ovarian tumor. Records and imaging studies on 14 patients with virilizing tumors were found. All available imaging studies (ultrasound studies of the pelvis (11 patients), CT scans of the pelvis (five patients), MRI examinations of the pelvis (two patients), and plain films of the pelvis (four patients) were reviewed by three radiologists independently for ascites, calcification, percent solid portion, echogenicity and attenuation.ResultsOn CT and/or ultrasound most (69%) of the tumors appeared to be solid or mostly solid. The amount of solid tissue varied with the tumor type, granulosa cell tumors were predominantly cystic. The masses were isoechoic (82%) or hypoechoic (18%). Ascites was an infrequent (23%) finding. Only a minority of these tumors (14%) were calcified on imaging studies. Six tumors were 5.0 cm or less in mean size, and two less than 3.0 cm in size. All cases were stage I tumors at presentation.ConclusionThe majority of virilizing tumors of the ovary are typically solid, noncalcified, confined to the ovary at presentation, and not associated with ascites. Variability in appearance depends in part on tumor type. Many are small and may be difficult to recognize as a mass morphologically. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Non‐invasive assessment of endothelial function in normal pregnancy
Authors: Savvidou M. D. , Kametas N. A. , Donald A. E. , Nicolaides K. H. 
Published: March 2003

AbstractObjectiveTo assess endothelial function in normal pregnancy by non‐invasive methods.MethodsFlow‐mediated dilatation of the brachial artery was measured by ultrasonography in 157 women with normal singleton pregnancies between 10 and 40 weeks' gestation and 19 non‐pregnant controls.ResultsFlow‐mediated dilatation in the non‐pregnant controls was 6.42 ± 2.45%. In pregnant women, between 10 and 30 weeks, the mean flow‐mediated dilatation (8.84 ± 3.18%) was significantly higher than the non‐pregnant controls (P = 0.002), but after 30 weeks of gestation there was a decrease to prepregnancy levels. Resting vessel diameter and blood flow were significantly increased in pregnancy, mainly after 30 weeks' gestation (P < 0.001, P < 0.001, respectively). Flow‐mediated dilatation was significantly correlated to resting vessel diameter and reactive hyperemia.ConclusionNormal pregnancy is associated with enhanced endothelial function which is apparent from at least 10 weeks' gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound evaluation of the fetal brain: the three horn view
Authors: Timor‐Tritsch I. E. , Monteagudo A. , Mayberry P. 
Published: March 2003

AbstractObjectiveTo describe an easy technique for obtaining one of the most important views of the fetal brain and image. Tthe entire lateral ventricle including the anterior, posterior and inferior horns is demonstrated on one image. We propose to call this view, obtained in an oblique plane ‘the three horn view’.MethodsDepending upon the scanning technique employed there are two ways to obtain the three horn view: (1) by two‐dimensional (2D) transvaginal transfontanelle sonography obtained by using the left and right Oblique‐1 sections, and (2) by three‐dimensional (3D) imaging of the fetal brain, is obtained by acquiring a volume scan of the brain orienting the fetal head in the three main orthogonal planes and by rotating or tilting the midcoronal section to the left and right.ResultsTo illustrate the technique of obtaining the three horn view four normal fetal brains were scanned. Two scans utilized the 2D transvaginal transfontanelle approach and two scans utilized the 3D scanning technique. The same technique was then applied to six fetuses with various brain malformations with inflicted changes in the shape of the proposed three horn view.ConclusionThe three horn view, depicting the anterior, posterior, and inferior horns on the same image, was easy to obtain using both the 2D and the 3D ultrasound techniques. It provided diagnostic and clinically useful information much like neonatal transfontanelle ultrasound imaging after which it was emulated. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound in the evaluation of fetal anomalies
Authors: Dyson R. L. , Pretorius D. H. , Budorick N. E. , Johnson D. D. , Sklansky M. S. , Cantrell C. J. , Lai S. , Nelson T. R. 
Published: March 2003

AbstractObjectivesTo determine the additional information and clinical impact provided by three‐dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2‐dimensional ultrasound (2D US).Materials and methodsSixty‐three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images. Clinical impact and pathologic or clinical outcome were determined in all cases.ResultsThe 3D US images provided additional information in 53 anomalies (51%), were equivalent to 2D US images in 46 anomalies (45%), and were disadvantageous in four anomalies (4%). The 3D US was most helpful in evaluating fetuses with facial anomalies, hand and foot abnormalities and axial spine and neural tube defects. Planar images derived from 3D US volume data sets generally were more helpful for diagnostic purposes, whereas rendered 3D US images were more useful as a point of reference and were better appreciated by patients in understanding fetal abnormalities. Additional information provided by 3D US images impacted clinical management in 5% of patients. The 3D US images were disadvantageous in two fetuses with multiple anomalies and two with cardiac anomalies.ConclusionThe 3D US offered diagnostic advantages in about one‐half of the selected cases studied and had effect on patient management in 5% of cases. This modality can be a powerful adjunctive tool to 2D US in providing a more comprehensible, 3D US impression of congenital anomalies. Thus, 3D US is currently most helpful as a targeted study complementing 2D US. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal adrenal and middle cerebral artery Doppler velocimetry in high‐risk pregnancy
Authors: Dubiel M. , Breborowicz G. H. , Marsal K. , Gudmundsson S. 
Published: March 2003

AbstractObjectivesAnimal studies have shown that hypoxic fetuses redistribute their blood flow, giving preferential supply to the brain, heart and adrenal glands. The aim of this study was to establish whether blood velocity waveforms in the human fetal adrenal artery and middle cerebral artery showed signs of redistribution of fetal circulation in high‐risk pregnancy, and to analyze the relationship between signs of such redistribution and the outcome of pregnancy.MethodsFetal middle adrenal artery and middle cerebral artery waveforms were recorded between 27 and 41 weeks of gestation in 102 pregnancies complicated by pregnancy‐induced hypertension. Signs of fetal adrenal‐sparing were deemed present when the pulsatility index (PI) fell below the fifth percentile of the normal range. Signs of fetal brain‐sparing were deemed present when the cerebral artery PI was below the mean −2 SD of the normal range and the cerebroplacental PI ratio was < 1.08.ResultsSigns of adrenal sparing were found in 64 cases and brain sparing in 32 cases. Fetal adrenal sparing was strongly associated with adverse perinatal outcome; all perinatal mortality cases showed signs of adrenal sparing. There was a significant positive correlation between the fetal adrenal artery PI and umbilical arterial and venous pH.ConclusionsSigns of adrenal sparing are frequent in high‐risk pregnancies. Adrenal artery velocimetry may be a useful procedure for fetuses at risk for hypoxemia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction
Authors: Baschat A. A. , Gembruch U. , Reiss I. , Gortner L. , Weiner C. P. , Harman C. R. 
Published: March 2003

AbstractObjectiveThe aim of this investigation was to assess the relationship between abnormal arterial and venous Doppler findings and perinatal outcome in fetuses with intrauterine growth restriction (IUGR).MethodsDoppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), inferior vena cava (IVC), ductus venosus (DV) and free umbilical vein was performed in 121 IUGR fetuses with a UA pulsatility index (PI) > 2SD above the gestational age mean and subsequent birth weight < 10th centile for gestational age. Groups based on the last Doppler exam were: 1 = abnormal UA‐PI only (n = 42, 34.7%), 2 = MCA‐PI > 2SD below the gestational age mean (= ‘brain sparing’) in addition to abnormal UA‐PI (n = 29, 24.0%), 3 = DV or IVC peak velocity index (PVIV) > 2SD above the gestational age mean and/or pulsatile UV flow (n = 50, 41.3%). Z‐scores (delta indices) were calculated for Doppler indices. Perinatal mortality, respiratory distress (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), circulatory failure and umbilical artery blood gases were recorded.ResultsAbsence or reversal of umbilical artery end‐diastolic flow was observed in 4 (9.5%) of fetuses in group 1, 10 (34.5%) fetuses in group 2 and 41 (82%) fetuses in group 3. A low middle cerebral artery pulsatility index was found in 39 (78%) fetuses in group 3. Multiple regression analysis with gestational age at delivery, delta indices and cord artery blood gas as independent parameters and individual perinatal outcomes as dependent variables was performed. In this analysis the association was strongest with gestational age for each complication. There were no significant differences in Apgar scores between groups. At delivery, ‘brain sparing’ was associated with hypoxemia and abnormal venous flows with acidemia. Perinatal mortality was highest in group 3 and stillbirth was only observed when venous flow was abnormal. All postpartum complications were more frequent in fetuses with abnormal venous flows. The only statistically significant relation between Doppler indices and outcome was the association between abnormal ductus venosus flow and fetal death (r2 = 0.24, P < 0.05).ConclusionGrowth restricted fetuses with abnormal venous flow have worse perinatal outcome compared to those where flow abnormality is confined to the umbilical or middle cerebral artery. In fetuses with low middle cerebral artery pulsatility, venous Doppler allows detection of further deterioration. While abnormal venous flows can be significantly associated with fetal demise, gestational age at delivery significantly impacts on all short‐term outcomes. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology