Three‐Dimensional Power Doppler Vascular Sonographic Sampling for Predicting Ovarian Cancer in Cystic‐Solid and Solid Vascularized Masses

Objective. The purpose of this study was to explore the role of 3‐dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic‐solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. Methods. A total of 143 consecutive women (mean age, 50.4 years; range, 17–82 years) with diagnoses of cystic‐solid or solid vascularized adnexal masses on B‐mode and 2‐dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three‐dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer‐aided analysis program. Three‐dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularization‐flow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. Results. A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P < .001), FI (34.318 versus 28.794; P < .001), and VFI (3.233 versus 1.15; P < 0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69–0.85), 0.71 (0.60–0.81), and 0.75 (0.66–0.83) for the VI, FI and VFI, respectively. For reducing the false‐positive rate by almost one‐third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. Conclusions. Three‐dimensional PD vascular indices could be helpful for reducing the false‐positive rate in cystic‐solid and solid vascularized adnexal masses.     

Three‐Dimensional Color‐Coded Duplex Sonography for Assessment of the Vertebral Artery Origin and Vertebral Artery Stenoses

Objective . The aim of the study was to assess the potential of 3‐dimensional (3D) color‐coded duplex sonography (CDS) for evaluation of the vertebral artery origin and stenoses in this location. Methods. To compare 2‐dimensional (2D) and 3D CDS, both techniques were performed in 25 healthy volunteers and in 18 patients with 21 stenoses of the vertebral artery origin. Stenoses were graded in line with hemodynamic criteria on 2D CDS and according to North American Symptomatic Carotid Endarterectomy Trial criteria on 3D CDS. In 6 patients, digital subtraction angiography (DSA) was performed additionally. Stenoses were graded according to North American Symptomatic Carotid Endarterectomy Trial criteria and compared with 2D and 3D sonographic data. Results. Overall correlation of both sonographic techniques concerning the grading of the stenoses was good (r = 0.69; P < .01). The interobserver correlation for assessment of stenoses by means of 3D CDS was high (r = 0.94; P < .01). Three‐dimensional CDS correlated excellently with DSA in 3 of 6 patients but showed only intermediate or no correlation in the remaining 3 patients. In contrast, spatial information on the stenotic morphologic characteristics was always very comparable with the results obtained by DSA. Conclusions. Three‐dimensional CDS represents a valuable tool for assessment of the origin of the vertebral artery, allowing important morphologic information on stenoses in this location. For grading of stenoses of the vertebral artery origin, 3D information should be combined with hemodynamic criteria obtained by spectral Doppler imaging in 2D CDS. Three‐dimensional CDS could be a valuable tool before interventional procedures of the proximal vertebral artery, saving time and avoiding iodinated contrast agents.     

Advantages of 3‐Dimensional Sonography in Embryo Transfer

Objective. The purpose of this study was to investigate the advantages of 3‐dimensional (3D) sonography in embryo transfer. Methods. With the use of 2‐dimensional (2D) and 3D sonography to measure the transfer distance from the fundus (TDF), 319 patients were allocated into 4 groups according to the disparity between 2D and 3D images: group 1 showed disparity of less than 3 mm; group 2 showed disparity of 3 to 5 mm; group 3 showed disparity of 6 to 9 mm; and group 4 showed disparity of 10 mm or greater. The general characteristics and pregnancy outcomes were compared among the 4 groups. Results. For 140 patients, the TDF measured by 2D sonography was different from that measured by 3D sonography, with a positive to negative range of 3 to 13 mm. Compared with the first 3 groups, the clinical pregnancy and implantation rates were lowest in group 4 (7.7% versus 34.1%, 38.1%, and 40%; 3.6% versus 18.2%, 21.2%, and 22.2%; P < .05). Conclusions. Compared with 2D sonography, uterine cavity and catheter placement may be better achieved with 3D sonography, which would improve the embryo transfer technique.     

Comparison of 3‐ and 2‐Dimensional Sonographic Techniques for Counting Ovarian Follicles

Objective. The purpose of this study was to compare 3‐dimensional (3D) and 2‐dimensional (2D) ovarian follicle counts and 3D counts using stored volumes between experienced and inexperienced operators. Methods. Follicles larger than 5 mm were counted on 1 randomly selected ovary. Two‐dimensional follicle counts were compared with stored 3D volumes by the same experienced operator (registered diagnostic medical sonographer [RDMS]). Counts using 3D stored data were compared between the experienced operator and inexperienced operator (principal investigator [PI]). The mean difference in follicle counts was computed, and a 1‐sample Student t test was performed to test the hypothesis that the mean of the differences was 0. Comparison of the 2 methods and observers by Bland‐Altman plots was used to determine any systematic differences based on the total number of follicles per selected ovary. Results. Mean differences differed from 0 (P < .005) for all 3 comparisons: 2D RDMS versus 3D RDMS, 2D RDMS versus 3D PI, and 3D RDMS versus 3D PI. For the comparison of 2D versus 3D counts done by the RDMS, 5 ovaries (10%) had a difference of more than 5 follicles counted; for the 2D RDMS versus 3D PI, 11 ovaries (22%) had a difference of more than 5 follicles; for the 3D RDMS versus 3D PI, 8 ovaries (16%) had a difference of more than 5 follicles. Mean differences in counts ranged 0.29 to 1.04 for ovaries with 10 or fewer follicles compared with 3.94 to 9.00 for ovaries with more than 10 follicles. Conclusions. Follicle counts using 3D volumes were similar to 2D counts, and 3D follicle counts done by an inexperienced operator were similar to counts done by an experienced sonographer.     

Comparing Image Processing Techniques for Improved 3‐Dimensional Ultrasound Imaging

Objective. The purpose of this study was to compare volumetric image processing techniques for reducing noise and speckle while retaining tissue structures in 3‐dimensional (3D) gray scale ultrasound imaging. Methods. Eighty subjects underwent a clinically indicated abdominal or obstetric 3D ultrasound examination (20 hepatic, 20 renal, and 40 obstetric cases). Volume data were processed on a pixel (“2‐dimensional [2D] processing”) or a voxel (“3D processing”) basis using commercially available image enhancement software (ContextVision AB, Linköping, Sweden). Randomized, side‐by‐side comparisons of the image processing techniques were performed for each subject. An independent and blinded reader scored the volumes for image quality on a 3‐point scale from 1 (worst) to 3 (best) and compared the results using a nonparametric Wilcoxson signed rank test. Results. The 40 subjects with abdominal 3D imaging received a mean score (± 1 SD) of 1.52 ± 0.51, 2.45 ± 0.60, and 2.75 ± 0.44 for the original, the 2D processed, and the 3D processed volumes, respectively. The differences between the unprocessed and the processed volumes were highly statistically significant (P < .0001), as was the difference between the 2D and 3D processing methods (P = .002). Similar results were obtained for the obstetric data sets (n = 39 due to an acquisition problem) with a mean score of 1.03 ± 0.16 for the original, 2.33 ± 0.48 for the 2D processed, and 2.79 ± 0.47 for the 3D processed volumes (P < .003). Conclusions. A new volumetric ultrasound image enhancement technique has been assessed in abdominal and obstetric applications. Compared to unprocessed volumes and volumes processed with 2D image enhancement software, the new 3D processing technique performed best.     

Three‐Dimensional Sonographic Characteristics of Deep Endometriosis

Objective. The purpose of this presentation is to investigate the potential role of 3‐dimensional (3D) sonography in the assessment of deep endometriosis. Methods. Cases of deep endometriosis are presented to illustrate the spectrum of appearances obtained with 3D sonography. In addition, we evaluate the possible role of other functions included in 3D equipment, such as the niche mode and tomographic ultrasound imaging (TUI). Results. Three‐dimensional image rendering could allow a good analysis of the endometriotic nodule; in fact, in all presented cases, this reconstruction seems to clearly show the irregular shapes and borders of the lesions. This technique allows unrestricted access to an infinite number of viewing planes, which can be very useful for correctly locating lesions within the pelvis and evaluating the relationship with other organs. The stored 3D volumes can be reassessed and compared by the same or different examiners over time. This characteristic may be relevant for monitoring the effect of medical therapies over time. In the niche mode, sonographic imaging is represented as a “cut‐open” view of the internal aspect of the nodule and its surrounding tissue. This additional function, which is associated with TUI, could be particularly useful for evaluation of the extension of a nodule in the rectovaginal septum, the depth of infiltration, and the relationship with the rectosigmoid junction or ureter. Conclusions. In the near future, 3D sonography in deep infiltrating endometriosis could be an interesting mode of research with positive effects in everyday clinical practice.     

Umbilical Cord Cysts

Objective. The purpose of this series was to determine whether the use of different 3‐dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2‐dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer‐aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three‐dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. Conclusions. Three‐dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.     

Correlation of Quantified Contrast‐Enhanced Sonography With In Vivo Tumor Response

Objective.. The purpose of our study was to establish in vivo criteria for monitoring tumor treatment response using 3‐dimensional (3D) volumetric gray scale, power Doppler, and contrast‐enhanced sonography. Methods.. Twelve mice were implanted with Lewis lung carcinoma cells on their hind limbs and categorized to 4 groups: control, chemotherapy, radiation therapy, and chemoradiation. A high‐frequency ultrasound system with a 40‐MHz probe was used to image the tumors. Follow‐up contrast‐enhanced sonography was performed on days 7 and 14 of treatment with two 50‐μL boluses of a perflutren microbubble contrast agent injected into the tail vein. The following contrast‐enhanced sonographic criteria were quantified: time to peak, peak intensity, α (microvessel cross‐sectional area), and β (microbubble velocity). Three‐dimensional power Doppler images were also obtained after the acquisition of contrast data. On day 15, the tumors were excised for immunohistochemical analysis with CD31 fluorescent staining. Results.. The tumor size and 3D power Doppler vascular index showed no statistically significant correlation with microvascular density in all examined groups. Among all of the analyzed contrast‐enhanced sonographic parameters, relative α showed the strongest correlation with the histologic microvessel density (Pearson r = 0.93; P < .01) and an independent association with the histologic data in a multiple regression model (beta = .93; R² = 0.86; P < .01). Conclusions.. Of the various examined sonographic parameters, α has the strongest correlation with histologic microvessel density and may be the parameter of choice for the noninvasive monitoring of tumor angiogenic response in vivo.     

Structural Anomalies in Early Embryonic Death

Objective. The purpose of this pictorial essay was to determine whether 3‐dimensional (3D) surface rendering of a dead first‐trimester embryo can provide any information for the loss. Methods. Three‐dimensional surface rendering was performed on a collection of dead first‐trimester embryos with crown‐rump lengths between 12 and 27 mm. These were compared with 2‐dimensional (2D) images of the same embryos and with 2D images and 3D surface renderings of normally developing embryos. Results. Surface rendering of dead embryos showed a variety of abnormalities in the contour and limb formation. Conclusions. The use of 3D sonography may provide insight into the etiology of first‐trimester embryonic death.     

Comparison of Estimated Fetal Weights Using Volume and 2‐Dimensional Sonography and Their Relationship to Neonatal Markers of Fat

Objective. The purpose of this study was to compare the accuracy of traditional 2‐dimensional sonographically estimated fetal weight (EW2D) with 3‐dimensional volume‐based estimated fetal weight (EW3D) and to evaluate the relationship between fetal limb volume, birth weight, and markers of neonatal adiposity. Methods. Fifty singleton pregnancies at 32 to 42 weeks' gestation underwent sonographic evaluation within 48 hours of delivery. We compared the accuracy of the EW2D and EW3D in the prediction of birth weight. The Ponderal index, sum of all skin fold measurements, estimated neonatal fat mass, and percent body fat were calculated. Paired t tests, simple regression analyses, a χ² test, and the Steiger z test were used where appropriate. P < .05 was considered significant. Results. The mean birth weight ± SD was 3130 ± 589 g at 38.8 ± 2.1 weeks. The EW2D (r² = 0.66) and EW3D (r² = 0.76) estimates were both correlated with birth weight. The birth weight and neonatal fat mass were more highly correlated with the sonographically based thigh volume (r² = 0.67 and 0.61) than femur length (r² = 0.41 and 0.37). The mean percent error between EW2D and birth weight was larger (?3.3% ± 11.6%) than the mean percent error of EW3D (0.7% ± 9.2%; P = .0004). Conclusions. Sonographically based fetal limb volumes, especially the fractional thigh volume, reflect neonatal fat mass and are better correlated with birth weight.     

Spatiotemporal Image Correlation Using High‐Definition Flow

Objective. The purpose of this study was to describe a new method for assessing ovarian vascularization using spatiotemporal image correlation (STIC)–high‐definition flow (HDF). Methods. Thirty healthy premenopausal fertile women were assessed in the follicular part of the menstrual cycle by transvaginal sonography. A 4‐dimensional STIC‐HDF volume was obtained from the nondominant ovary to assess 3‐dimensional (3D) vascular indices (vascularization index [VI] and flow index [FI]) during one cardiac cycle in each women. Using 1‐cm³ spherical sampling, we calculated the VI and FI from the most vascularized part of the ovarian stroma at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all of the patients (pulse repetition frequency, 0.9 kHz; gain, 0.8; and depth, 40 mm). We calculated the VI and FI ratios between systole and diastole. Results. The mean VI during systole (11.485%; SD, 6.7%) was significantly higher than during diastole (8.653%; SD, 5.6%; P < .0001). The mean FI values during systole (47.799 [unitless]; SD, 5.8) and diastole (47.791; SD, 6.0) were nearly identical (P = .993). The VI ratio was 1.35 (95% confidence interval, 1.28–1.42), which means that the mean VI was 35% higher during systole compared to diastole, whereas the FI during systole and diastole remained constant (FI ratio, 1.00; 95% confidence interval, 0.96–1.04). There was a high correlation between VI values during systole and diastole (r² = 0.94), whereas this correlation was weaker for the FI (r² = 0.45). Conclusions. The STIC‐HDF method allows assessment of 3D vascular indices throughout the cardiac cycle. Vascularization index calculation is affected by the moment of the cardiac cycle during which the measurement is taken. However, it seems that FI calculation is not affected by the cardiac cycle in the normal nondominant ovary.     

Three‐Dimensional Vascular Indices Calculated Using Conventional Power Doppler and High‐Definition Flow Imaging

Objective. The purpose of this study was to determine whether there are differences in 3‐dimensional (3D) vascular indices when calculated using high‐definition flow imaging (HDF) and power Doppler imaging (PD). Methods. Twenty‐five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28–33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization‐flow index [VFI]) from the endometrium. Results. The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Conclusions. Three‐dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.     

Methodology for Using 3‐Dimensional Sonography to Measure Fetal Adrenal Gland Volumes in Pregnant Women With and Without Early Life Stress

Fetal adrenal gland volumes on 3‐dimensional sonography have been studied as potential predictors of preterm birth. However, no consistent methodology has been published. This article describes the methodology used in a study that is evaluating the effects of maternal early life stress on fetal adrenal growth to allow other researchers to compare methodologies across studies. Fetal volumetric data were obtained in 36 women at 20 to 22 and 28 to 30 weeks' gestation. Two independent examiners measured multiple images of a single fetal adrenal gland from each sonogram. Intra‐ and inter‐rater consistency was examined. In addition, fetal adrenal volumes between male and female fetuses were reported. The intra‐ and inter‐rater reliability was satisfactory when the mean of 3 measurements from each rater was used. At 20 weeks' gestation, male fetuses had larger average adjusted adrenal volumes than female fetuses (mean, 0.897 versus 0.638; P = .004). At 28 weeks' gestation, the fetal weight was more influential in determining values for adjusted fetal adrenal volume (0.672 for male fetuses versus 0.526 for female fetuses; P = .034). This article presents a methodology for assessing fetal adrenal volume using 3‐dimensional sonography that can be used by other researchers to provide more consistency across studies.     

Follicular Thyroid Carcinoma With an Eggshell Calcification

Objective. The purpose of this series is to report 3 cases of follicular thyroid carcinoma with an eggshell calcification along with their imaging findings. Methods. Imaging findings on gray scale and power Doppler (PD) sonography (n = 3), computed tomography (CT; n = 3), and integrated fluorodeoxyglucose F 18 (¹⁸F‐FDG) whole‐body positron emission tomography (PET)/CT (n = 1) were assessed. Results. Of the 3 cases, two 75‐year‐old women had bone metastasis, and one 54‐year‐old woman had a thyroid incidentaloma on sonography. All 3 cases had a spherical mass with an interrupted eggshell calcification on gray scale sonography and CT; 2 revealed intranodular vascularity on PD sonography, and 1 showed intense hypermetabolism (maximum standardized uptake value, 7.9 g/mL) on integrated ¹⁸F‐FDG whole‐body PET/CT. Conclusions. Follicular carcinoma should be considered in the differential diagnosis of a thyroid nodule with an eggshell calcification.     

Reproducibility of Placental Volume and Vasculature Indices Obtained by 3‐Dimensional Power Doppler Sonography

Objective. The purpose of this study was to evaluate the reproducibility of 3‐dimensional (3D) power Doppler assessment of placental volumes and vascularization before adopting these in routine evaluation of normal and complicated pregnancies. Methods. A prospective study was performed on 30 normal singleton pregnancies from 11 to 14 weeks. To evaluate placental vascularization, 3D power Doppler sonography was applied to obtain a placental volume, and the volume acquired was analyzed using virtual organ computer‐aided analysis. Two consecutive measurements were taken from each patient by two observers blinded to each other's and the individual's previous measurement. This yielded a total of 60 data set pairs. The placental volume, vascularization index, flow index, and vascularization‐flow index (VFI) were calculated. Normal distribution of the data was confirmed with the Kolmogorov‐Smirnov test. Intraobserver and interobserver correlations were evaluated. Bland‐Altman plots and statistics were used to compare the 95% limits of agreement between measurements. Results. All 3D power Doppler placental volumes and vascular indices showed intraobserver correlations of 0.80 or higher. Similar excellent interobserver correlations were seen for all indices with the exception of the VFI, which showed a lower but acceptable correlation. The Bland‐Altman analyses indicated good reproducibility of the evaluated placental indices. Conclusions. Our findings provide validation of the technique, showing good reproducibility of the 3D power Doppler parameters when applied to studies of the placental volume and vascular tree.     

High‐Frequency Sonographic Measurements of True and False Vocal Cords

Objective. The purpose of this study was to prospectively identify the normal sonographic values of human true and false vocal cords. Methods. In total, 229 healthy volunteers were divided into 8 groups according to their age and sex. High‐frequency sonography was used to measure the length, width, and thickness of both true and false vocal cords. Measurements were compared between groups, and correlations with age were analyzed. Forty of the 229 volunteers also participated in reliability and reproducibility studies. Results. The sonographic measurements had good reproducibility, with intraclass correlation coefficient ranges of 0.736 to 0.903 for interobserver reliability and 0.723 to 0.943 for intraobserver reliability. Measurements for the 3 parameters of both true and false vocal cords in male adults were greater than those in female adults (P < .001). The length, width, and thickness of true and false vocal cords in participants younger than 18 years were obviously correlated with age (r = 0.835–0.957; P < .001), but no significant correlation was found in the adult groups. The rates of visualization in male groups were significantly lower than those in female groups (P < .001) and gradually decreased with increasing age. Conclusions. Both true and false vocal cords can be shown by high‐frequency sonography, which can quantitatively measure both true and false vocal cords with good reliability and reproducibility.     

First-Trimester Placental Volume and Vascularization Measured by 3-Dimensional Power Doppler Sonography in Pregnancies With Low Serum Pregnancy-Associated Plasma Protein A Levels

Objective. The purpose of this study was to investigate the first-trimester placental volume and 3-dimensional (3D) power Doppler vascularization of pregnancies with low serum pregnancy-associated plasma protein A (PAPP-A) levels and to relate these findings to pregnancy outcomes. Methods. Three-dimensional power Doppler sonography of the placenta was performed at gestational ages of 11 weeks to 13 weeks 6 days in 84 pregnancies with PAPP-A concentrations of less than 0.4 multiple of the median (MoM). With a standardized setting, the placental volume and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated and related to pregnancy outcomes. Results. Pregnancy outcomes were as follows: 57 pregnancies with birth weights at or above the 10th percentile (group A), 16 pregnancies with birth weights below the 10th percentile and normal Doppler findings in the umbilical artery throughout gestation (group B), and 11 pregnancies with birth weights below the 10th percentile and abnormal umbilical Doppler findings later in gestation (group C). No differences were found in PAPP-A levels among groups. Placental volume values were significantly lower than reference limits, but no differences were found between groups. In groups A and B, there were no significant differences in 3D Doppler indices. However, these indices were significantly lower in group C (VI mean difference, −1.904; P < .001; FI mean difference, −1.939; P < .001; VFI mean difference, −1.944; P < .001). Placental vascular indices were significantly related to the severity of intrauterine growth restriction (IUGR; VI, r = 0.438; P < .001; FI, r = 0.482; P < .001; VFI, r = 0.497; P < .001) but not to the PAPP-A MoM and placental volume values. Conclusions. Low serum maternal PAPP-A levels are associated with altered 3D placental Doppler indices, and these changes are related to subsequent development of IUGR and adverse pregnancy outcomes.     

Blood Flow in the Internal Carotid Artery With Common Carotid Artery–Occluding Lesions in Takayasu Arteritis

Objective. The purpose of this study was to investigate carotid artery hemodynamics and blood flow involving external carotid artery (ECA) and internal carotid artery (ICA) patency in patients with Takayasu arteritis (TA). Methods. The common carotid artery (CCA), ECA, ICA, and vertebral artery (VA) were examined in 19 patients with TA involving ECA and ICA patency and in 19 healthy control participants. Bilateral carotid sonographic studies were performed with the use of 5‐ to 8‐MHz linear transducers. Results. Patency of the ECA and ICA was noted in 14 bilateral, 2 right‐sided, and 3 left‐sided CCA lesions. Flow in the ECA was retrograde, whereas flow in the ICA was directed cephalad and showed a low‐frequency, damped waveform or even a veinlike waveform. The peak systolic velocity (PSV) of the ICA in the patients was significantly lower than that in the control participants (P < .001). A good correlation was observed in the PSV between the ECA and ICA (r = 0.77). The VA displayed normally directed flow, a significantly larger diameter, and a higher flow velocity (P < .001). Conclusions. Color duplex sonography can identify special features of TA with CCA‐occluding lesions and permit quantification of carotid artery flow velocities and VA diameters both efficiently and practically.     

Feasibility of Automated 3‐Dimensional Fetal Cardiac Screening in Routine Ultrasound Practice

Objective. The purpose of this study was to prospectively assess the clinical feasibility of an automated 3‐dimensional (3D) software tool for extended basic cardiac screening in routine ultrasound practice. Methods. During the 2‐month study period, all gravidas fitting our inclusion criteria were consecutively included. Cardiac 3D volumes were acquired within the time slot allocated for the usual 2‐dimensional fetal examination. All volumes were assessed on their quality, based on display of the 4‐chamber view, and on the ability to sufficiently display diagnostic cardiac planes (left ventricular outflow tract [LVOT], right ventricle outflow tract [RVOT], and stomach location) with Sonography‐Based Volume Computer‐Aided Diagnosis software (SonoVCAD; GE Healthcare, Milwaukee, WI). Results. Volume acquisition was successful in 107 of 126 cases (85%). For each sonographer, more than 70% of the acquired cardiac volumes were of high or sufficient quality. Separately analyzed, diagnostic planes of the LVOT, RVOT, and stomach location were visible in 62.1%, 81.6%, and 92.2%, respectively. An extended basic fetal cardiac examination based on retrieval of all diagnostic cardiac planes from a single volume using SonoVCAD could be performed in 46.6% of the cases. Conclusions. This study shows that cardiac volume acquisition can be incorporated in a routine ultrasound screening program without much difficulty. However, currently, SonoVCAD software still lacks the consistency to be clinically feasible for cardiac screening purposes. Further advances in ultrasound technology and familiarization with 3D ultrasound might improve its performance.     

Fine‐tuning the Diagnosis of Fetal Scalp Cysts

Objective. The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence. Methods. Transabdominal and transvaginal 2‐ and 3‐dimensional sonography with color and power Doppler imaging as well as 3‐dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed. Results. In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst. Conclusions. These 2 cases show the value of going the distance with the newly available high‐frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality.