3D doppler ultrasound can do better than 2D version in checking fetal growth restriction

 

A new study published in the January issue of the Journal of Ultrasound in Medicine showed that three-dimensional Doppler ultrasound can be more accurate than standard two-dimensional Doppler ultrasound to identify abnormal fetal cerebrovascular blood flow patterns of fetal growth Limit (FGR).

 

According to Katherine R. Goetzinger, MD, MSCI, MD, from the University of Maryland Medical School, lead author of the study, this finding may help to more accurately determine the difference between fetal FGR and fetal "constitutional exuberance" in pregnant women.

 

Goetzinger said: "The clinical criteria currently used to assess fetal brain circulation are two-dimensional pulsed Doppler assessment of the middle cerebral artery." This technique has both technical and practical issues, including the inability to accurately detect subtle changes in small blood vessel flow , And the assumption that blood flow redistributes to all areas of the brain is symmetrical.

 

According to this study, FGR affects 4% to 8% of pregnancies, resulting in fetal assessment of fetal morbidity and mortality by ultrasonography of fetuses weighing less than 10%. Goetzinger said: "With the advent of 3D energy Doppler technology, blood flow to fetal organs, including the kidneys, liver and placenta, can be quantified by assessing angiogenesis and blood flow index.

 

This prospective cohort study recruited women from 24-36 weeks of gestation to clinically determine FGR and matched with controls from the appropriate gestational age (AGA) fetus from Washington University during 2011-2013. A total of 306 female patients were enrolled in the study, and standardized 3D Doppler ultrasound was performed on the fetal middle cerebral artery region by a qualified obstetric sonographer. The researchers calculated vascularization index (VI), blood flow index (FI), and angiogenesis index (VFI) using virtual organ computer-assisted analysis based on the study method. In addition, a randomized study of 20 patients in the cohort was followed up to ensure the authenticity and accuracy of the measurements.

 

Of the 306 patients, 151 were indicated as FGR. According to the study, FI was significantly higher in FGR fetuses as compared with AGA controls, and FI was significantly negatively correlated with pulsatile brain-placental ratio. FGR fetuses are also significantly younger, have lower BMI, and have a lower body weight at birth than AGA.

 

Goetzinger concludes: "The novel use of this technology in FGR assessment may help identify the fetus with a preserved brain pathophysiology early in gestation, which may affect fetal monitoring strategies and the timing of childbirth.

 

 

The advantages of 3D energy Doppler ultrasound in two-dimensional pulsed Doppler ultrasound are significant because the study can assess the entire perfusion area rather than a single blood vessel, Goetzinger explains. The intricacies of its low-velocity blood flow and the need for a particular degree of independence are also strengths of research.

 

However, Goetzinger and colleagues cite a number of research limitations that include the lack of continuous ultrasound data, inability to analyze rare neonatal outcomes, and short and long term neurodevelopmental dysfunction, as well as a small proportion of the study population.