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Review
. 2021 Aug 21;11(8):1511.
doi: 10.3390/diagnostics11081511.

A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography

Tuangsit Wataganara  1 , Thanapa Rekhawasin  1 , Nalat Sompagdee  1 , Sommai Viboonchart  1 , Nisarat Phithakwatchara  1 , Katika Nawapun  1
Affiliations
Review

A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography

Tuangsit Wataganara et al. Diagnostics (Basel). .

Abstract

Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors' 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.

Keywords: cervix; fetus; flow-volume index; placenta; prenatal; three-dimensional power Doppler; three-dimensional sonoangiography; three-dimensional ultrasound; twins; umbilical cord.

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Conflict of interest statement

The authors declare that there are no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Fetal assessment with three-dimensional sonoangiography. (a) Vein of Galen aneurysmal malformation of a fetus at 30 weeks of gestation; thick-slice, three-dimensional, high-definition flow (3D HDF). (b) Deep medullary veins of a fetus at 29 weeks of gestation; thick-slice 3D HDF. (c) Diminished vasculatures (arrow) of right lung with primary dysplasia, compared with the left normal lung, in left and right lung of a fetus at 29 weeks of gestation; thick-slice 3D HDF. (d) Primitive hepatic vasculature of a fetus at 22 weeks of gestation; HDLive Silhouette (GE, Milwaukee, WI, USA), thick-slice 3D HDF. (e) Mature hepatic vasculatures of a fetus at 38 weeks of gestation; thick-slice 3D HDF. (f) Confluent vasculatures of hepatic hemangioma of a fetus at 30 weeks of gestation; thick-slice 3D HDF. (g) Complex visceral vasculatures of a fetus at 20 weeks of gestation; thick-slice 3D HDF. (h) Primitive visceral vasculatures of an acardia at 26 weeks of gestation; HDLive Silhouette (GE, Milwaukee, WI, USA), thick-slice, 3D HDF.
Figure 2
Figure 2
Extra-fetal assessment with three-dimensional sonoangiography. (a) Histogram flow-volume indices of the placenta at 26 weeks of gestation; three-dimensional (3D) power Doppler (PD) with a spherical representation of the entire placental vascular tree. (b) Normal parenchymal vasculatures of the placenta at 24 weeks of gestation; SlowflowHD (GE GmbH, Vienna, Austria). Note the virtual absence of flow in the lake (circle). (c) Confluent parenchymal vasculatures of placenta percreta at 29 weeks of gestation; HDLive Silhouette (GE, Milwaukee, WI, USA), thick-slice, monochrome 3D high-definition flow (HDF). (d) Complicated vasculatures involving the entire thickness of the placenta, with extension to the myometrial–bladder interface of placenta percreta, at 29 weeks of gestation; orthogonal multiplanar 3D HDF. (e) Velamentous umbilical cord insertion at 25 weeks of gestation; thick-slice 3D HDF. Note the transition from coiled umbilical vessels to chorionic vessels with the artery (blue) crossing over the vein (red). (f) Marginal placenta previa at 28 weeks of gestation; HDLive Silhouette (GE, Milwaukee, WI, USA), thick-slice 3D HDF. Note the proximity of the velamentous umbilical cord insertion to the internal cervical os (arrow). (g) Feeding vessels of chorioangioma at 29 weeks of gestation; thick-slice 3D HDF. (h) Parenchymal vasculatures of a normal cervix at 32 weeks of gestation; two-dimensional HDF.
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