- Email: [email protected]
1077
P26
Ultrasound in Medicine and Biology
vascular pedicle itself. The twisted pedicle corresponds to the uteroovarian ligament, suspensory ligament and meso-ovariaum containing ovarian vessel and ovarian branch of uterine vessel. If tubal torsion is combined, fallopian tube, broad ligament and adnexal branch of uterine vessel are also involved. The twisted vascular pedicle is seen as a round structure with multiple concentric stripes (coiling or target appearance), usually located in the inferior aspect of the mass, between the adnexal mass and uterine cornus. Flow signal within the twisted vascular pedicle may be identified as a characteristic “whirlpool sign” on color Doppler US. When a preexisting adnexal mass is twisted, the mass may show eccentric wall thickening and septal thickening in the cystic mass, or hemorrhage within the mass. Occasionally, edematous ovarian stroma surrounding the ovarian mass may be demonstrable. When a normal ovary is twisted, it is enlarged with multiple peripheral cysts. If the fallopian tube is involved, accompanying tubal thickening may be recognized as a tubular mass abutting or surrounding the adnexal mass. Doppler US is helpful for diagnosis of torsion. In the earliest phase of torsion, venous flow is decreased and arterial flow shows a spiky, high-resistance pattern. In later stage, both arterial and venous flows within the ovary are absent. This presentation will discuss sonographic findings of ovarian torsion with focus on the twisted vascular pedicle. Correlative CT and MR features will be presented as well.
3D/4D ULTRASOUND IN OBSTETRICS 1077 3D/4D ultrasound: Role in malformation detection Platt LD, David Geffen, School of Medicine at UCLA, United States of America The purpose of this lecture is to demonstrate how the technological improvements in ultrasound technology have improved over the past several years and thus, leading to improving the clinician’s ability to diagnose fetal structural abnormalities or conditions prenatally. Improvements in resolution and in the equipment’s performance have provided three-dimensional ultrasound imaging additional value over two-dimensional imaging. For example, three-dimensional imaging has the potential to offer clearer visualization of the fetal facial anatomy over two-dimensional ultrasound methods. Improvements in the image rendering technology allows the sonologist to capture multiple images creating a volume dataset that can be rotated into a different plane and the images further analyzed for fetal malformations. The ability to consult with colleagues through the internet while providing all the ultrasound information has improved dramatically over previous ultrasound methods. These issues will be discussed. 1078 Examination of fetal organs using 3D multiplanar mode Kalache K, Princess Anne Hospital, University of Southampton, United Kingdom of Great Britain and Northern Ireland This presentation describes how computer tomography (CT)- and magnetic resonance (MR)-like display modalities are now incorporated into modern ultrasound systems. These new technologies are available as Three-Dimensional eXtended Imaging (3D XI)TM and includes MultiSlice ViewTM, Oblique ViewTM and DynamicMRTM. Multi-Slice ViewTM permit among others to show the three-dimensional ultrasound volumes as multiple sequential parallel planes. By means of Oblique ViewTM it is possible to slice the three-dimensional ultrasound volumes in various ways using intuitive interfaces. Data can be extracted either along a linear plane or along a curved plane. By means of DynamicMRTM, several images are taken with different frequencies and from different angles and composed into a compound image. Artifacts cre-
Volume 32, Number 5S, 2006 ating shadowing or noise are reduced to a minimum, leading to sharper depiction of the tissue margins. The presentation will be based on real-life case studies illustrating the benefit of visualizing abnormal fetal structures by means of 3D eXtended ImagingTM. Topics covered will include: (1) how to use advanced multiplanar mode imaging modalities in prenatal diagnosis; (2) application to difficult fetal brain anomalies; (3) visualization of subtle fetal facial malformations; (4) potential advantage as compared to standard fetal echocardiography. 1079 The role of 3D/4D ultrasound in complications of pregnancy Mazor M, Smolin A, Soroka University Medical Center, Ben Gurion University, Israel Three-dimensional (3D) and four-dimensional (4D) ultrasound diagnostics are based on modern techniques of image acquisition and data processing. The role of 3D/4D ultrasound in complications of pregnancy is increasing during the last years. In this lecture will be presented some of the aspects of the role of 3D/4D ultrasound in the diagnosis and management of complications of pregnancy such as preterm labor, preterm PROM, altered fetal growth in IUGR and macrosomia and twins gestations. 3D ultrasound imaging of uterine cervix can provide additional information to 2D ultrasound in describing the cervical canal, the shape and size of the funnel, and other uterine abnormalities. In addition, 3D/4D ultrasound may help in the follow up and management of women with a short cervix and cerclage. This new application of 3D/4D can provide a more complete assessment of the uterine cervix in pregnant women at high risk for premature delivery. Another potential obstetric application of 3D/4D ultrasonography is in the examination of the developmental stage of the placenta and detailed visualization of placental abnormalities. Recently, 3D/4D Doppler ultrasound system has been suggested to have the advantage over conventional 2D sonography in determining abnormalities of the umbilical cord and in placental vascularity. Maldevelopment of the placental villous tree and their blood vessels results in impaired fetal growth. Amplification of a new technique of imaging colour power angiography with 3D reconstruction provides a tool to examine the villous development during pregnancy in vivo. This approach should help us to differentiate between pregnancies complicated by fetal growth restriction due to placental factors (that will be associated with abnormal vascular fetal growth patterns) from those caused by fetal factors. Recent studies have used 3D ultrasound for a better estimation of fetal weight since this technology can better measure volumes of fetal structures such as thigh, arm and intraabdominal structures for the prediction of fetal weight. These 3D findings were reported to be superior to 2D biometry system in the accurate assessment of fetal weight and prediction of macrosomia. It has a potential that 3D ultrasonography may improve our knowledge in the management of diabetes in pregnancy. An additional possible application of 3D ultrasound and power Doppler imaging techniques is the diagnosis and management of twin gestations and in particular in those complicated with twin to twin transfusion syndrome. There are reports of using the real time 3D/4D ultrasonography in prenatal invasive procedures such as amniocentesis and cordocentesis. It may be useful in determining whether or not the needle is correctly placed during ultrasound-guided procedures. The images obtained are likely to reduce the number of complications associated with difficult cases such as those with severe oligohydramnios with or without PROM. Another important advantage of 4D sonography is the information obtained in changes in fetal behavior in the context of complications of pregnancy that were unavailable until now to obstetricians. Further accumulation of experience with these new techniques in the near future will increase the importance of 3D/4D in the diagnosis and management of complications of pregnancy.
Ultrasound in Medicine and Biology
vascular pedicle itself. The twisted pedicle corresponds to the uteroovarian ligament, suspensory ligament and meso-ovariaum containing ovarian vessel and ovarian branch of uterine vessel. If tubal torsion is combined, fallopian tube, broad ligament and adnexal branch of uterine vessel are also involved. The twisted vascular pedicle is seen as a round structure with multiple concentric stripes (coiling or target appearance), usually located in the inferior aspect of the mass, between the adnexal mass and uterine cornus. Flow signal within the twisted vascular pedicle may be identified as a characteristic “whirlpool sign” on color Doppler US. When a preexisting adnexal mass is twisted, the mass may show eccentric wall thickening and septal thickening in the cystic mass, or hemorrhage within the mass. Occasionally, edematous ovarian stroma surrounding the ovarian mass may be demonstrable. When a normal ovary is twisted, it is enlarged with multiple peripheral cysts. If the fallopian tube is involved, accompanying tubal thickening may be recognized as a tubular mass abutting or surrounding the adnexal mass. Doppler US is helpful for diagnosis of torsion. In the earliest phase of torsion, venous flow is decreased and arterial flow shows a spiky, high-resistance pattern. In later stage, both arterial and venous flows within the ovary are absent. This presentation will discuss sonographic findings of ovarian torsion with focus on the twisted vascular pedicle. Correlative CT and MR features will be presented as well.
3D/4D ULTRASOUND IN OBSTETRICS 1077 3D/4D ultrasound: Role in malformation detection Platt LD, David Geffen, School of Medicine at UCLA, United States of America The purpose of this lecture is to demonstrate how the technological improvements in ultrasound technology have improved over the past several years and thus, leading to improving the clinician’s ability to diagnose fetal structural abnormalities or conditions prenatally. Improvements in resolution and in the equipment’s performance have provided three-dimensional ultrasound imaging additional value over two-dimensional imaging. For example, three-dimensional imaging has the potential to offer clearer visualization of the fetal facial anatomy over two-dimensional ultrasound methods. Improvements in the image rendering technology allows the sonologist to capture multiple images creating a volume dataset that can be rotated into a different plane and the images further analyzed for fetal malformations. The ability to consult with colleagues through the internet while providing all the ultrasound information has improved dramatically over previous ultrasound methods. These issues will be discussed. 1078 Examination of fetal organs using 3D multiplanar mode Kalache K, Princess Anne Hospital, University of Southampton, United Kingdom of Great Britain and Northern Ireland This presentation describes how computer tomography (CT)- and magnetic resonance (MR)-like display modalities are now incorporated into modern ultrasound systems. These new technologies are available as Three-Dimensional eXtended Imaging (3D XI)TM and includes MultiSlice ViewTM, Oblique ViewTM and DynamicMRTM. Multi-Slice ViewTM permit among others to show the three-dimensional ultrasound volumes as multiple sequential parallel planes. By means of Oblique ViewTM it is possible to slice the three-dimensional ultrasound volumes in various ways using intuitive interfaces. Data can be extracted either along a linear plane or along a curved plane. By means of DynamicMRTM, several images are taken with different frequencies and from different angles and composed into a compound image. Artifacts cre-
Volume 32, Number 5S, 2006 ating shadowing or noise are reduced to a minimum, leading to sharper depiction of the tissue margins. The presentation will be based on real-life case studies illustrating the benefit of visualizing abnormal fetal structures by means of 3D eXtended ImagingTM. Topics covered will include: (1) how to use advanced multiplanar mode imaging modalities in prenatal diagnosis; (2) application to difficult fetal brain anomalies; (3) visualization of subtle fetal facial malformations; (4) potential advantage as compared to standard fetal echocardiography. 1079 The role of 3D/4D ultrasound in complications of pregnancy Mazor M, Smolin A, Soroka University Medical Center, Ben Gurion University, Israel Three-dimensional (3D) and four-dimensional (4D) ultrasound diagnostics are based on modern techniques of image acquisition and data processing. The role of 3D/4D ultrasound in complications of pregnancy is increasing during the last years. In this lecture will be presented some of the aspects of the role of 3D/4D ultrasound in the diagnosis and management of complications of pregnancy such as preterm labor, preterm PROM, altered fetal growth in IUGR and macrosomia and twins gestations. 3D ultrasound imaging of uterine cervix can provide additional information to 2D ultrasound in describing the cervical canal, the shape and size of the funnel, and other uterine abnormalities. In addition, 3D/4D ultrasound may help in the follow up and management of women with a short cervix and cerclage. This new application of 3D/4D can provide a more complete assessment of the uterine cervix in pregnant women at high risk for premature delivery. Another potential obstetric application of 3D/4D ultrasonography is in the examination of the developmental stage of the placenta and detailed visualization of placental abnormalities. Recently, 3D/4D Doppler ultrasound system has been suggested to have the advantage over conventional 2D sonography in determining abnormalities of the umbilical cord and in placental vascularity. Maldevelopment of the placental villous tree and their blood vessels results in impaired fetal growth. Amplification of a new technique of imaging colour power angiography with 3D reconstruction provides a tool to examine the villous development during pregnancy in vivo. This approach should help us to differentiate between pregnancies complicated by fetal growth restriction due to placental factors (that will be associated with abnormal vascular fetal growth patterns) from those caused by fetal factors. Recent studies have used 3D ultrasound for a better estimation of fetal weight since this technology can better measure volumes of fetal structures such as thigh, arm and intraabdominal structures for the prediction of fetal weight. These 3D findings were reported to be superior to 2D biometry system in the accurate assessment of fetal weight and prediction of macrosomia. It has a potential that 3D ultrasonography may improve our knowledge in the management of diabetes in pregnancy. An additional possible application of 3D ultrasound and power Doppler imaging techniques is the diagnosis and management of twin gestations and in particular in those complicated with twin to twin transfusion syndrome. There are reports of using the real time 3D/4D ultrasonography in prenatal invasive procedures such as amniocentesis and cordocentesis. It may be useful in determining whether or not the needle is correctly placed during ultrasound-guided procedures. The images obtained are likely to reduce the number of complications associated with difficult cases such as those with severe oligohydramnios with or without PROM. Another important advantage of 4D sonography is the information obtained in changes in fetal behavior in the context of complications of pregnancy that were unavailable until now to obstetricians. Further accumulation of experience with these new techniques in the near future will increase the importance of 3D/4D in the diagnosis and management of complications of pregnancy.