"Assessment of Fetal Brain Vascularization using Three-Dimensional Power Doppler Ultrasound Angiography in Pregnancies Affected by Late-Onset Fetal Growth

Authors

  • Alberto Rossi

  • Irene Romanello

Keywords:

Abstract

28 fetuses affected by late onset (34-36 weeks of gestation) growth restriction and 77 appropriate for gestational age fetuses (AGA) have been enrolled . Objectives: Aim of this study is to explore the possible use of 3D power Doppler ultrasound angiography (3D-PDA) in the assessment of cerebral blood flow distribution in growth restricted fetuses (FGR) compared to normal fetuses. Methods: 28 fetuses affected by late-onset FGR (34-36 weeks) and 77 appropriate for gestational age fetuses (AGA) were enrolled. Two regions of interest (ROI) of the fetal brain were scanned. The first ROI (named Frontal Zone), sprinkled mainly by anterior cerebral artery (ACA) and the second ROI, (named Temporal Zone), sprinkled by middle cerebral artery (MCA). We analysed 3D-Power Doppler Angiography (PDA) indexes: VI (vascularization index), FI (flow index), VFI (vascularization-flow index). Results: All the fetuses included in the late-onset FGR group had normal UA PI and normal MCA PI. Instead, VI and VFI values were increased in the Frontal Zone and decreased in the Temporal Zone comparing with the control group. Conclusions: 3D-PDA of fetal brain could recognize regional variations of brain perfusion in late-onset FGR without any pathological 2D Doppler. The phenomenon of preferential increment in blood supply to the frontal region ("frontal brain sparing effect") may protect general cognitive functions, occurring while MCA PI has not demonstrated signs of deterioration yet.

How to Cite

"Assessment of Fetal Brain Vascularization using Three-Dimensional Power Doppler Ultrasound Angiography in Pregnancies Affected by Late-Onset Fetal Growth. (2014). Global Journal of Medical Research, 14(5), 15-20. https://medicalresearchjournal.org/index.php/GJMR/article/view/

References

Yu Chang CH, Chen Ko HC (2003) Three-dimensional power Doppler ultrasound for the assessment of the fetal brain blood flow in normal gestation. 29(9), 1273-1279.

(2000) ACOG Practice Bulletin: Clinical Management Guidelines of Obstetrician-Gynecologists. 95(1). http://www.acog.org/publications/educational_bulletins/pb012.cfm

H. Figueroa‐diesel, E. Hernandez‐andrade, R. Acosta‐rojas, L. Cabero, E. Gratacos (2007) Doppler changes in the main fetal brain arteries at different stages of hemodynamic adaptation in severe intrauterine growth restriction. 30(3), 297-302. https://doi.org/10.1002/uog.4084

Ronny Geva, Rina Eshel, Yael Leitner, Aviva Valevski, Shaul Harel (2006) Neuropsychological Outcome of Children With Intrauterine Growth Restriction: A 9-Year Prospective Study. 118(1), 91-100. https://doi.org/10.1542/peds.2005-2343

A. Baschat, U. Gembruch, I. Reiss, L. Gortner, C. Weiner, C. Harman (2000) Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. 16, 407-413.

C. Harman (2001) Antenatal assessment of the growth restricted fetus. 13, 161-168.

J. Wladimiroff, H. Tonge, P. Stewart (1986) Doppler ultrasound assessment of cerebral blood flow in the human fetus. 93, 471-475.

Vyas S, Nicolaides KH (1990) Middle cerebral artery flow velocity waveforms in fetal hypoxaemia. 97, 797-803.

A. Baschat (2011) Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction. 37, 501-514.

Hadlock FP, Harrist RB, Sharman RS (1985) Estimation of fetal weight whit the use of head, body and femur measurements: a prospective study. 151(3), 333-337.

Gosling RG, Dunbar G, King DH (1971) The Quantitative Analysis of Occlusive Peripheral Arterial Disease By a Non-Intrusive Ultrasonic Technique. 22(1), 52-55. https://doi.org/10.1177/000331977102200109

Mari G, Deter RI (1992) Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses. 166, 1262-1270.

Gudmundsson S, Marsal K (1988) Umbilical and uteroplacental blood flow velocity waveform in normal pregnancy: a crossectional study. 67, 347-354.

Hernandez-Andrade E, Brodski J (2002) Uterine artery score and perinatal outcome. 19(5), 438-442.

Chen-Hsiang Yu, Chiung-Hsing Chang, Huei-Chen Ko, Wen-Chu Chen, Fong-Ming Chang (2003) Assessment of placental fractional moving blood volume using quantitative three-dimensional power doppler ultrasound. 29(1), 19-23. https://doi.org/10.1016/s0301-5629(02)00695-6

N. Jones, E. Hutchinson, P. Brownbill, I. Crocker, D. Eccles, G. Bugg, N. Raine-Fenning (2009) In Vitro Dual Perfusion of Human Placental Lobules as a Flow Phantom to Investigate the Relationship between Fetoplacental Flow and Quantitative 3D Power Doppler Angiography. 30, 130-135.

Severi FM, Bocchi C, Visentin A (2002) Uterine and fetal cerebral Doppler predict the outcome of third‐trimester small‐for‐gestational age fetuses with normal umbilical artery Doppler. 19, 225-228.

M. Dubiel, G. Gunnarsson, S. Gudmundsson (2002) Blood redistribution in the fetal brain during chronic hypoxia. 20, 117-121.

Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Puerto B, Gratacos E (2010) Longitudinal brain perfusion changes in near-term small-for-gestational-age fetuses as measured by spectral Doppler indices or by fractional moving blood volume. 203(42), e1-e6.

E. Hernandez‐andrade, H. Figueroa‐diesel, T. Jansson, H. Rangel‐nava, E. Gratacos (2008) Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth‐restricted fetuses. 32(1), 71-76. https://doi.org/10.1002/uog.5377

Guimaraes Filho, H. da Costa, L. (2008) Placenta: angiogenesis and vascular assessment through three-dimensionale power Doppler ultrasonography. 277, 195-200.

N. Raine‐fenning, N. Nordin, K. Ramnarine, B. Campbell, J. Clewes, A. Perkins, I. Johnson (2008) Determining the relationship between three‐dimensional power Doppler data and true blood flow characteristics: an in‐vitro flow phantom experiment. 32, 540-550.

Fuster JM (2002) Frontal lobe and cognitive development. 31, 373-385.

Sladkevivius Rovas L, Strobel E, Vsalentin Intraobserver, interobserver gray-scale (2005) Intraobserver and interobserver reproducibility of three‐dimensional gray‐scale and power Doppler ultrasound examinations of the cervix in pregnant women. 26, 132-137.

Assessment of Fetal Brain Vascularization using Three-Dimensional Power Doppler Ultrasound Angiography in Pregnancies Affected by Late-Onset Fetal Growth Restriction

Published

2014-02-07

How to Cite

"Assessment of Fetal Brain Vascularization using Three-Dimensional Power Doppler Ultrasound Angiography in Pregnancies Affected by Late-Onset Fetal Growth. (2014). Global Journal of Medical Research, 14(5), 15-20. https://medicalresearchjournal.org/index.php/GJMR/article/view/