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10.5005/jp-journals-10009-1270
REVIEW ARTICLE
ABSTRACT
Since, ultrasound was introduced as diagnostic tool in obstetrics
and gynecology by Professor Ian Donald 6 decades ago, realtime imaging has become the most common sonographic
technique used in obstetrics and gynecology. When uncertain
findings on real-time gray scale during two-dimensional
sonography require further evaluation, advanced techniques are
often necessary. Such advanced techniques include color and
power Doppler, three- and four-dimensional ultrasound and
techniques of volume manipulation (rendering), such as surface
and maximum mode, magic cut, volume calculation (VOCAL),
NICHE mode, and -as latest innovation, HD flow (Doppler) and
HD life surface rendering. The authors would like to illustrate by
means of a series of images and case presentations, how these
new diagnostic tools find their clinical application in the daily
routine of care in obstetrics and gynecology.
Keywords: 3D ultrasound, 4D ultrasound, Volume rendering,
HD flow, HD life.
How to cite this article: Honemeyer U, Kurjak A. Advanced
Obstetrical and Gynecological Ultrasound: Imaging with New
Technologies. Donald School J Ultrasound Obstet Gynecol
2013;7(1):51-65.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Three-dimensional (3D) sonography functions as twodimensional (2D) static display of a 3D data set. To acquire
and render images, special probes and software are
necessary. 3D technology can reduce scanning time since,
the acquired volume data set of the fetus in obstetrical
ultrasound, and the pelvis in gynecologic ultrasound, can
be explored and evaluated without the patient. 3D surface
rendering with 3D sonography demonstrates much clearer
those abnormalities of the fetus which had been detected
with 2D sonography. Splendid examples for remote
evaluation of 3D volumes are facial abnormalities, neural
tube defects, and fetal central nervous system (CNS)
anomalies.
Four-dimensional (4D) sonography, also known as
dynamic 3D sonography, stands for visualization of 3D
images in real-time. 4D ultrasound is used to study fetal
movement, behavioral states and the fetal heart.
Color Doppler, power Doppler and HD flow represent
sonographic techniques to visualize (blood) flow. While
color Doppler allows differentiation of flow direction, power
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Tumor vasculature resulting from malignant neoangiogenesis with low resistance to flow (RI < 0.42) represents
another important diagnostic criterion and is accessible by
color-, power- and HD flow Doppler.3
Images of Benign and
Malignant Ovarian Tumors (Figs 1 to 14)
Uterine pathology often presents as the cause of menstrual
irregularities, lower abdominal pain and infertility. 4
Advanced ultrasound as a noninvasive method contributes
to early diagnosis of such causes and enables appropriate
decisions for clinical management. Minimal invasive
diagnostic ultrasound in the form of SISH can produce
almost hysteroscopy-like images and gives clear directions
to the surgeon regarding options of operative hysteroscopy.
Images of Uterine Anomalies and
SISH (Figs 15 to 44)
Application of Advanced Ultrasound in Obstetrics
Sonographic assessment during first trimester targets
ovulation, early and advanced embryonic stage, and early
fetus. It is obvious that diagnosis of abnormal early
pregnancy, pregnancy failure and fetal abnormalities should
be established as early as possible to enable timely decisions
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Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies
Fig. 11: Malignant ovarian tumor low resistance index (RI) to flow
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Fig. 18: Niche in the anterior lower uterine segment after LSCS
Fig. 14: Right ovarian mass, magnified intracystic proliferation,
power Doppler
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Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies
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Fetal face: Around the 13th week, after the puzzle of the
human facewith the philtrum as center point of the
Fig. 50: Nuchal translucency (NT) 7.4 mm, coronal view with
nuchal edema
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Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies
Fig. 54: NT 7.4 mm, massive turbulent regurgitation over mitral valve
Fig. 58: Body stalk 11w6d color Doppler short umbilical cord
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Fig. 60: Body stalk 11w6d fetus magic cut, limb defect (lower leg)
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Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies
Fig. 67: Sinus tachycardia heart rate 231 beats per min
(29w1d PW Doppler)
Fig. 71: Vasa previa at 31w, pulsed Doppler with fetal heart rate
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Fig. 94: Absent baseline variability in CTG as sign of severe neurological damage
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Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies
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Asim Kurjak
Professor, Department of Obstetrics and Gynecology; Dean, School
of Medicine, Dubrovnik International University, Croatia
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