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Diagnostic Sonography of Blood Flow in Breast Tumors
3
ground noise, since they are the result of the addition
of frequency shifts, and not, as in a conventional Doppler, their mean. For this reason power Doppler can be
used at higher amplification, enabling a more sensitive
and continuous display of the vessels. Sensitivity is increased fortyfold. This procedure makes it possible to
detect flow velocities of 0.4 mm/s (Sohn et al. 1996).
Because angio color is extremely sensitive to low
blood flows in vessels formed by angiogenesis, artifacts formed by patient respiration, pulse, or movements are very frequent. Another drawback of the procedure is also due to its very high sensitivity: some of
the blood vessels detected by power Doppler with extraordinarily low blood flows cannot be quantified by
conventional PW Doppler. Quantification is not
possible in angio mode alone. Work in progress is attempting to relate the number of color pixels in a ROI
to the total sample volume, using computerized systems, but this model does not provide absolute figures.
Fig. 22.5 Color Doppler sonographic display of a breast tumor
without administration of contrast medium.
Introduction of Ultrasound Contrast Media
In many cases the color signals and the quality of the
Doppler flow curves obtained by the usual instrumentation are not adequate for reaching a satisfactory conclusion for the staging of a breast tumor. The introduction of ultrasound contrast media to amplify the echo
signal can improve the evaluation of the degree of
vascularization.
For this procedure 2.5 g of granular galactose are
shaken with 7.5mL H
tion to form a fluid with a concentration of 300 mg/mL.
The microbubbles formed at the surface of the
granules by the agitation are stabilized by adding 1 mg
of palmitic acid, which keeps them in the hepatic and
pulmonary circulations. About 20−25 seconds after the
bolus of contrast medium is injected intravenously
into the peripheral circulation, the intensity of the
Doppler signal increases by 10−20dB (Schlief 1991).
The microbubbles increase the echogenicity of the
blood by forming a boundary with increased acoustic
impedance on their surface.
Side effects due to the contrast medium are rare.
They include transient sensations of pain, heat, or cold
at the injection site (Schlief 1993, Madjar 1997/8).
Hereditary galactosemia is an absolute contraindication to the use of ultrasound contrast medium. Studies
published in the literature to date report a subjective
impression of improved display, primarily of small
tumor vessels (
al. 1993, Madjar et al. 1993).
Considered from a fundamental point of view the
use of sonographic contrast media, by displaying the
dynamics of the circulation in a tumor, can serve as a
diagnostic aid for staging. In this way it resembles
magnetic resonance imaging (MRI), and such studies
are being undertaken. However, a drawback to be considered is that administering a contrast medium represents an additional diagnostic step for both patient and
examiner, and that this can be quite time-consuming.
Finally, more evidence is required to confirm that this
procedure truly provides additional information that
broadens the diagnostic base for staging and so justifies the additional effort in clinical practice.
Figs.
O shortly before the examina-
2
22.5, 22.6) (Cosgrove 1992, Duda et
204
컅 Fig. 22.6 Color Doppler sonographic display of a breast tumor
with administration of contrast medium. Especially the small
tumor vessels can be identified more easily.
Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
The first studies addressing the differential diagnosis
of breast tumors by color-coded Doppler ultrasound
described a purely qualitative display of blood vessels
around the primary lesion. When blood vessels were
then demonstrated in a sonographically equivocal
tumor, the tumor was likely to be malignant, while it
was considered to be benign in the absence of such
vessels (Britton and Coulden 1990).
In contrast to this finding, Adler et al. (1990) could
not demonstrate any blood vessels in 18% of patients
with breast cancer, while they detected bloods vessels
in 97% of all patients they examined who had no suspicious lesions. These results indicate that a purely qualitative description of blood flow is not sufficient for
differential diagnosis.
Based on this finding, increased attention was
devoted to quantitative analysis of Doppler flow curves
derived from tumor vessels (Dock 1993, Konishi 1992).
A further attempt to differentiate benign from malignant findings in the female mammary gland was based
on the detection of a difference in the RIs of the breasts
on the healthy and affected sides (Sohn et al. 1992b,
1993). Current opinions differ considerably regarding
the conclusions that can be drawn from measurements
of perfusion (Jellins 1988, Madjar et al. 1989, 1991a,
1991b, Sohn et al. 1992b, 1993).
The following markers can be examined and
assessed:
왘 Number of vessels in the tumor and its immediate
surroundings,
왘 Calculated Doppler parameters (quotient, RI, PI),
왘 Shape and characteristics of the Doppler flow curve,
왘 Comparison of perfusion in the healthy and affected
breasts in the same patient,
왘 Size and number of individual color pixels or color
surfaces in a tumor.
The differential diagnosis of breast tumors using the
number of blood vessels detected seems problematic.
As noted above, CW Doppler requires a systematic and
time-consuming examination of the whole breast, and
the results depend very much on the examiner’s experience. With color-coded ultrasound the vessels are
detected by using the number of color pixels and surfaces displayed. Often the course of a tumor vessel cannot be determined with confidence, because only
single pixels or small color surfaces are displayed.
Therefore, if the loops of a single vessel appear several
times in one ultrasonic cut, the possibility that it will
be counted several times in the total number of vessels
cannot be excluded with confidence.
The most reproducible constants are the conventional Doppler parameters. Hence in recent years
quantitativeanalysis of blood flow in tumor vessels has
increasingly been using calculated Doppler parameters
(Blohmer and Guski 1995, Dock 1993, Konishi 1992,
Madjar et al. 1991a, Sohn et al. 1992a, 1993). However,
the velocities calculated from the Doppler flow curve
depend on the angle of the incident sound waves (Sohn
et al. 1993). In routine clinical practice it is difficult,
especially for very small tumor vessels, to assure an
optimal angle. The profile of the Doppler curve can of
course be defined objectively to some extent by the RI
and the PI, both almost independent of the angle.
Therefore, the RI is most often used in daily clinical
practice. The vascular resistance is then expressed as a
number between 0 and 1 or as a percentage. The
lowest measured RI values of a tumor and its immediate surrounding tissue are always used for evaluation.
The differences between the vascular supply of
benign and malignant tumors are found in the capillary bed. As noted before, tumor vessels formed by angiogenesis have no muscular layer. Moreover, the total
vascular diameter increases as the number of new
capillaries increases, reducing the resistance.
Variousworking groups havesuggested a cutoff level
in the RI of 쏝0.7 or 70% to distinguish between benign
and malignant tumors. By this measure Doppler ultrasound of the breast has a sensitivity of 84 % and specificity is 80 %. The positive predictive value is given as
71% and the negative predictive value as 90% (PetersEngl et. al. 1995).
However, determining an absolute value for a cutoff
level for blood flow does not appear promising, given
just the physiological changes in the glandular tissue of
the breast and the very varied histological changes in
breast tumors that may show varying degrees of differentiation and often very different patterns of vascularization. Moreover,blood flow depends on the size of the
lesion. In the evaluation of conventional Doppler findings, a drawback we have previously described several
times is that, because of their slow flow rates, it is difficult or impossible to detect the small vessels formed
by neovascularization (Sohn and Meyberg 1995).
The characteristics and shape of the Doppler curve
provide important criteria for the evaluation of tumor
perfusion. Mostly, when the changes in the breast are
benign, systole is relatively high, and by comparison
diastole is low. Systole can clearly be distinguished
from diastole. Whether the resistance is high or low
can be concluded from the shape of the curve. An early
diastolic notch in the Doppler flow curve suggests high
vascular resistance. This characteristic blood flow
curve defines vessels with a flexible muscular layer,
such as run through normal glandular tissue and
benign lesions (Fig. 22.7).
In the case of malignant breast tumors the height of
systole is relatively low and that of diastole by com-
Advanced Topics
205
Diagnostic Sonography of Blood Flow in Breast Tumors
3
Fig. 22.7 Characteristic Doppler flow curve of a benign breast
lesion.
parison relatively high. Often it is impossible to distinguish between systole and diastole. The curve declines
from systole continuously to the end of diastole. The
low resistance generated by the formation of vessels
without a muscular layer in malignant changes of the
breast can often be demonstrated by the absence of a
Fig. 22.8).
notch (
However, the fact that very small capillaries without
a muscular layer also occur in normal organs and
benign tissue changes must be taken into account.
Therefore, in the eyes of an experienced examiner, low
resistance is only suggestive. The relative height of systole and diastole can also be unremarkable, and an
early diastolic notch only poorly developed. Moreover,
the evaluation of the shape of the Doppler flow curve
depends solely on the subjective impression of the examiner. The curve cannot be reproduced objectively
and its assessment depends greatly on the examiner’s
experience. The results of one study suggest that a
comparison of the blood flow in the affected and the
normal breast of the same patient can be used for the
differential diagnosis between benign and malignant
lesions (Blohmer et al. 1984). In this study the Doppler
flow parameters in the lesion were compared to those
in an artery in the corresponding quadrant of the contralateral breast. There was a distinct difference between the maximal systolic, end-diastolic, and mean
velocities in the vessels of the malignant and the comparison breast. In the case of the malignant tumor the
velocities in the vessels are typically higher. Attempts
to explain these findings suggest that afferent vessels
Fig. 22.8 Characteristic Doppler flow curve of a malignant
breast lesion.
are usually located in the biologically active periphery
of the tumor. The vessels in the tumor itself grow into
irregular shapes and arrangements. The arteries are
twisted into corkscrews and their caliber manifests
considerable variations. Flow inside such arteries is
turbulent with high flow rates (Kurjack et al. 1992). In
addition, arteriovenous shunts form, in which flow
rates are high (Bouck 1994).
No significant differences in the Doppler flow parameters RI and PI havebeen determined between tumor
vessels and the corresponding vessels in the contralateral breast (Konishi 1992, Madjar et al. 1992). By
using new, very sensitive color techniques it may be
possible in the future to display more clearly the flow
in the terminal vascular bed that characterizes the
tumor more precisely. To date it has only been possible
to use these newer techniques, such as angio mode, for
the analysis of single color pixels or color surfaces.
These are evaluated subjectively according to their intensity, size, and number. Currently computer programs are being developed to quantify blood flow displayed by color Doppler. Here the colored area is compared to the whole B-mode image. Additionally, the intensity of the color surfaces will be taken into account.
In conclusion, we should say that sonographic tumor
staging develops from the sum of a number of separate
pieces of information. When a lesion shows signs of
malignancy on the B-mode image or cannot be clearly
shown to be benign, and if in a color Doppler examination blood flow can be demonstrated, safety demands
that the lesion must be identified histologically.
206
Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
Advanced Topics in Obstetrics and Gynecological Doppler Ultrasound: References
Doppler Ultrasound and the Cardiotocogram
Jouppila P., Kirkinen P. Blood velocity waveforms of the fetal aorta in
normal and hypertensive pregnancies. Obstet. Gynecol. 67 (1986)
856−860.
Krebs MB, Petres, RE. Clinical application of a scoring system for an-
tepartum fetal heart rate monitoring. Am. J. Obstet. Gynecol. 130
(1978) 765−772.
Laurin J., Marsal K., Persson PM., Lingman G., Ultrasound measure-
ment of fetal blood flow in predicting fetal outcome. Br. J. Obstet.
Gynecol. 94 (1987) 940−948.
Schneider KTM., Loos W. 10 Jahre geburtshilfliche Dopplersonogra-
phie − Entwicklungen und Perspektiven. Geburtsh. u. Frauenheilk.
49 (1989) 407−415
Voigt HJ. Diagnostic and clinical significance of Doppler ultrasound
in obstetrics Thesis, University of Erlangen, Germany 1991.
Doppler Ultrasound Findings Near Term
Adamsons K, Myers RE. Circulation in the intervillous space; obste-
trical considerations in fetal deprivation. In: Grünwald P, ed. The
placenta and its maternal supply line, Lancaster: MT Press; 1975:
158−77.
Arduini D, Rizzo G, Romanini S, Mancuso S. Doppler assessment of
fetal blood flow velocity waveforms during acute maternal oxygen
administration as predictor of fetal outcome in post-term pregnancy. Am J Perinat. 1990; 7: 258−62.
Battaglia C, Artini PG, Ballestrie M et al. Hemodynamic, hematologi-
cal and hemorheological evaluation of post-term pregnancy. Acta
Obstet Gynecol Scand. 1995; 74: 336−40.
Battaglia C, Larocca E, Lanzani G, Coukos G, Genazzani AR. Doppler
velocimetry in prolonged pregnancy. Obstet Gynecol 1991; 77:
213−5.
Benirschke K, Kaufmann P. Pathology of the human placenta. 3rd ed.
New York: Springer; 1995.
Bilardo CM, Campbell S, and Nicolaides KH (1988). Mean blood velo-
cities and flow impedance in the fetal descending thoracic aorta
and common carotid artery in normal pregnancy. Early Hum Dev,
18: 2−3.
Bonnin P, Fouron JC, Teyssier G, Sonesson SE, Skoll A. Quantitative as-
sessment of circulatory changes in the fetal aortic isthmus during
progressive increase of resistance to umbilical blood flow. Circulation. 1993; 88: 216−22.
Campbell S, Diaz-Recasens J, Griffin DR et al. New Doppler technique
for assessing uteroplacental blood flow. Lancet. 1993; i: 675−7.
Eik-Nes, SH., Maršál K, Brubakk AO, Kristofferson K, Ulstein M. Ultra-
sonic measurement of human fetal blood flow. J Biomed Engng.
1982; 4: 28−36.
Eik-Nes SH, Maršál K, Kristofferson K, Vernersson E. Noninvasive
Messung des fetalen Blutstromes mittels Ultraschall. Ultraschall.
1981; 2: 226−31.
Eldridge M, Berman Jr. W, Greene ER. Serial echo-Doppler measure-
ments for human fetal abdominal aortic blood flow. Ultrasound
Med. 1985; 4: 453−8.
Erskine RL, Ritchie JW. Umbilical artery blood flow characteristics in
normal and growth-retarded fetuses. Br J Obstet Gynaecol. 1985;
92: 605−10.
Fairlie FM, Lang GD, Sheldon CD. Umbilical artery flow velocity wa-
veforms in labour. Br J Obstet Gynaecol. 1989; 96: 151−7.
Fendel H, Fendel M, Warnking R. Fehlermöglichkeiten der gepulsten
Dopplermethode zur Blutflußmessung am Feten. Z Geburtshilfe
Perinatol. 1983; 187: 83−7.
Fouron JC, Zarelli M, Drblik SPO, Lessard M. Flow velocity profile of
the fetal aortic isthmus through normal gestation. Am J Cardiol.
1994; 74: 483−6.
Gill RW,Trudinger BJ, Garrett WJ, Kossoff G, Warren PS: Fetal umbili-
cal venous flow measured in utero by pulse d Doppler and B-mode
ultrasound. I. Normal pregnancies. Am J Obstet Gynecol. 1981;
139: 720−5.
Gosling RG, Dunbar G, King DH. The quantitativeanalysis of occlusive
peripheral arterial disease by a non-intrusive ultrasonic technique.
Angiology. 1971; 22: 52−5.
Griffin D, Cohen-Overbeek T, Campbell S. Fetal and uteroplacental
blood flow. Clin Obstet Gynaecol. 1983; 10: 565−602.
Jörn H, Funk A, Fendel H. Doppler-Ultraschalldiagnostik bei Termin-
überschreitung. Geburtshilfe Frauenheilkd. 1993; 53: 603−8.
Jouppila P, Kirkinen P. Blood velocity waveforms of the fetal aorta in
normal and hypertensive pregnancies. Obstet Gynecol. 1986; 67:
856−60.
Kaesemann H, Trenkel K. Kombinierte B-Bild-Doppler-Sonographie−
Messungen am In-vitro-Modell und in fetalen Gefäßen. Z Geburtshilfe Perinatol. 1986; 190: 43−8.
Kirkinen P, Müller R, Huch R, Huch A. Blood flow velocity waveforms
in human fetal intracranial arteries. Obstet Gynecol. 1987;70: 617−
21.
Lingman G, Gennser G, Maršál K. Ultrasonic measurements of the
blood velocity and pulsatile diameter changes in the fetal descending aorta. In: Rolfe, P.,ed. Fetal physiological measurements, London: Butterworths; 1986: 206−10.
Lingman G, Maršál K. Fetal central blood circulation in the third tri-
mester of normal pregnancy − A longitudinal study. I. Aortic and
umbilical blood flow. Early Hum Dev. 1986; 13: 137−50.
Lingman G, Maršál K. Fetal central blood circulation in the third tri-
mester of normal pregnancy − A longitudinal study. II. Aortic blood
velocity waveform. Early Hum Dev. 1986; 13: 151−9.
Malcus P, Maršál K, Persson P-H. Fetal and uteroplacental blood flow
in prolonged pregnancies. A clinical study. Ultrasound Obstet Gynecol. 1991; 1: 40−5.
Mari G. Arterial blood flow velocity waveforms of the pelvis and lo-
wer extremities in normal and growth-retarded fetuses. Am J Obstet Gynecol. 1991; 165: 143−51.
Maršál K, Lindblad A, Lingman G, Eik-Nes HE. Blood flow in the fetal
descending aorta; intrinsic factors affecting fetal blood flow, i.e. fetal breathing movements and cardiac arrhythmia. Ultrasound Med
Biol. 1984; 10: 339−48.
Maršál K, Lingman G, Giles WB. Evaluation of the carotid, aortic and
umbilical blood velocity waveforms in the human fetus. XIth Annual Conference of the Society for the Study of Fetal Physiology.
Oxford; 1984: C33.
Pal A, Kurjak A. Examination of the blood flow in the umbilical artery
by ultrasound. Zentralbl Gynäkol. 1986; 108: 724−9.
Patton DJ, Fouron JC. Cerebral arteriovenous malformation: Prenatal
and postnatal central blood flow dynamics. Pediatr Cardiol. 1995;
16: 141−4.
Pourcelot, L. Applications cliniques de l’examen Doppler transcu-
tane. INSERM Colloq. 1974; 34: 213−40.
Rightmire DA, Campbell S. Fetal and maternal Doppler blood flow
parameters in postterm pregnancies. Obstet Gynecol. 1987; 69:
891−4.
Rudolph AM. Distribution and regulation of blood flow in the fetal
and neonatal lamb. Circ Res. 1985; 57: 811.
Satoh S, Koyanagi T, Hara K, Shimokawa H, Nakano H. Developmental
characteristics of blood flow in the middle cerebral artery in the
human fetus in utero, assessed using the linear-array pulsed
Doppler method. Early Hum Dev. 1988; 17: 2−3.
Schneider KTM. Die Überwachung der Geburt aus forensischer Sicht.
Gynäkologe. 1994; 27: 212−21.
Schulman H, Fleischer A, Stern W, Farmakides G, Jagani N, Blattner P.
Umbilical velocity wave ratios in human pregnancy. Am J Obstet
Gynecol. 1984; 157: 985−9.
Sohn C, Stolz W: Untersuchung zur Entwicklung der Dopplerpara-
meter in fetalen und mütterlichen Gefäßen 10 Tage vor bis 10 Tage
nach errechnetem Geburtstermin. Geburtshilfe Frauenheilkd.
1994; 54: 102−7.
Ståle H, Gennser G, Maršál K. Blood flow velocity and pulsatile dia-
meter changes in the fetal descending aorta: A longitudinal study.
Am J Obstet Gynecol. 1990; 163: 26−9.
Stuart B, Drumm J, FitzGerald DE, Duignan NM. Fetal blood velocity
waveforms in normal pregnancy. Br J Obstet Gynaecol. 1980; 87:
780−5.
Stuart IP, Lindow SW, van der Elst CW. Fetal acidosis and Doppler ve-
locimetry of the umbilical arteries in labor. Ultrasound Obstet Gynecol. 1993; 3: 256−9.
Teyssier G, Fouron JC, Maroto E, Sonesson S-E, Bonnin P. Blood flow
velocity profile in the fetal aortic isthmus: A sensitive indicator of
changes in systemic peripheral resistances. I. Experimental studies. J Mat Fetal Invest. 1993; 3: 213−8.
Thaler I, Manor D, Itskovitz J et al. Changes in uterine blood flow du-
ring human pregnancy. Am J Obstet Gynecol. 1990; 162: 121−5.
Tonge HM, Stewart PA, Wladimiroff JW. Fetal blood flow measure-
ments during fetal cardiac arrhythmia. Early Hum Dev. 1984; 10:
1−2.
van Lierde M, Oberweis D, Thomas K. Ultrasonic measurement of
aortic and umbilical blood flow in the human fetus. Obstet Gynecol. 1984; 63: 801−5.
Advanced Topics
207
Advanced Topics in Obstetrics and Gynecological Doppler Ultrasound: References
208
3
Vetter K. Dopplersonographie in der Schwangerschaft. VCH; Wein-
heim: 1991.
Vetter K, Favre Y, Suter T, Huch R, Huch A. Dopplersonographisch er-
mittelte spezifisch hämodynamische Veränderungen im Kreislauf
von Feten in den letzten 4 Wochen vor Geburt. Z Geburtsh u Perinat. 1989; 93: 215−8.
Vogel M. Atlas der morphologischen Plazentadiagnostik. Berlin:
Springer; 1992.
Vyas S, Nicolaides KH, Campbell S: Renal artery flow-velocity wave-
forms in normal and hypoxemic fetuses. Am J Obstet Gynecol.
1989; 161: 168−72.
Woo JSK, Liang ST, Lo RLS, Chan FY. Middle cerebral artery Doppler
flow velocity waveforms. Obstet Gynecol. 1987; 70: 613−6.
Diagnostic and Clinical Significance of Doppler Ultrasound in Obstetrics
Adamson SL, Morrow RJ, Bascom PAJ, Mo LYL, Ritchie JWK. Effect of
placental resistance, arterial diameter, and blood pressure on the
uterine aterial velicity waveform: a computer modeling approach.
Ultrasound Med Biol. 1989; 15: 437−42.
Almström H, Axelsson O, Cnattingius S, Ekman G, Maesel A, Ulmsten
U. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet.
1992; 340: 936−40.
Altman DG. Size of clinical trials. Br Med J. 1983; 286: 1842−3.
Altman DG. Practical statistics for medical research. London: Chap-
man and Hall; 1991; 4440−76.
Arabin B, Saling E. Die „Sparschaltung“ des fetalen Kreislaufs,
dargestellt anhand von eigenen quantitativen Doppler-Blutfluß-
parametern. Z Geburtsh Perinat. 1987; 191: 213−8.
Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of
a loss of end-diastolic velocities in the fetal aorta and/or umbilical
artery using Doppler ultrasound. Gynecol Obstet Invest. 1988; 25:
173−80.
Arbeille P, Patat F, Tranquart F et al. Exploration Doppler des circula-
tion artérielles ombilicale et cérébrale du foetus. J Gynecol Obstet
Biol Reprod. 1987a; 16: 45−51.
Arbeille P,Roncin A, Berson M, Patat F, Pourcelot L. Exploration of the
fetal cerebral blood flow by duplex Doppler-linear array system in
normal and pathological pregnancies. Ultrasound Med Biol.
1987b; 13: 329−37.
Arduini D, Rizzo G, Romanini C. Changes of pulsatility index from
fetal vessels preceding the onset of late decelerations in growth-
retarded fetuses. Obstet Gynecol. 1992; 79: 605−10.
Arduini D, Rizzo G, Romanini C. The development of abnormal heart
rate pattern after absent enddiastolic velocity in umbilical artery:
analysis of risk factors. Am J Obstet Gynecol. 1993; 168: 43−50.
Assali NS, Holm LW,Sehgal N. Hemodynamic changes in fetal lamb in
utero in response to asphyxia, hypoxia, and hypercapnia. Circ Res.
1962; 11: 423−30.
Beattie RB, Farine D, Ryan RG, Ritchie JWK. Absent enddiastolic
velocity in the umbilical artery waveform − the case for a comput-
erised registry. J Matern Fetal Invest. 1994; 4.
Beattie RB, Dornan JC. Antenatal screening for intra uterine growth
retardation using umbilical artery Doppler ultrasound. Br Med J.
1989; 298: 631−5.
Bekedam DJ, Visser GHA, van der Zee AGJ, Snijders RJM, Poelmann-
Weesjes G. Abnormal velocity waveforms of the umbilical artery
in growth retarded fetuses: relationship to antepartum late heart
rate decelartions and outcome. Early Hum Dev. 1990; 24: 79−89.
Berkowitz GS, Mehalek KE, Chitkara U, Rosenberg J, Cogswell C,
Berkowitz RL. Doppler velocimetry in the prediction of adverse
outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynecol. 1988; 71: 742−6.
Blair E, Stanley FJ. Intrapartum asphyxia: a rare cause of cerebral
palsy. J Pediatr. 1988; 112: 515−9.
Bocking AD, Gagnon R, White SE, Homan J, Milne KM, Richardson BS.
Circulatory responses to prolonged hypoxia in fetal sheep. Am J
Obstet Gynecol. 1988; 159: 1418−24.
Brar HS, Platt LD. Reverse end-diastolic flow velocity on umbilical
artery velocimetry in high-risk pregnancies: An ominous finding
with adverse pregnancy outcome. Am J Obstet Gynecol. 1988; 159:
559−61.
Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in
the pathogenesis of pre-eclampsie. Obstet Gynecol Ann. 1972:
177−91.
Bruinse HW, Sijmons EA, Reuwer PJHM. Clinical value of screening
for fetal growth retardation by Doppler ultrasound. J Ultrasound
Med. 1989; 8: 207−9.
Buekens P, Kaminski M. Epidemiological evaluation of prenatal
screening procedures. Eur J Obstet Gynecol Reprod Biol. 1988; 28,
Suppl: 53−67.
Burke G, Stuart B, Crowley P, Scanaill SN, Drumm J. Is intrauterine-
growth retardation with normal umbilical blood flow a benign
condition? Br Med J. 1990; 300: 1044−5.
Campbell AFM, Dawes GS, Fishman AP, Hyman AI. Regional redis-
tribution of blood flow in the mature fetal lamb. Circ Res. 1967; 21:
229−35.
Campbell S, Diaz-Recasens J, Griffin DR et al. New Doppler technique
for assessing uteroplacental blood flow. Lancet. 1983; 321: 675−7.
Chalmers I, Hetherington J, Newdick M et al. The Oxford database of
perinatal trials: developing a register of published reports of controlled trials. Controlled Clin Trials. 1986; 7: 306−25.
Chandran R, Serra-Serra V, Sellers SM, Redman CWG. Fetal middles
cerebral artery flow velocity waveforms − a terminal pattern. Case
report. Br J Obstet Gynaecol. 1991; 98: 937−8.
Chandran R, Serra-Serra V, Sellers SM, Redman CWG. Fetal cerebral
Doppler in the recognition of fetal compromise. Br J Obstet Gynaecol. 1993; 100: 139−44.
CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Col-
laborative Group: CLASP: a randomised trial of low-dose aspirin
for the prevention and treatment of pre-eclampsia among 9364
pregnant women. Lancet. 1994; 343: 619−29.
Cohn HE, Sacks EJ, Heymann MA, Rudolph AM. Cardiovascular re-
sponses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol. 1974; 1974; 120: 817−24.
Collins R, Gray R, Godwin J, Peto R. Avoidance of large biases and
large random errors in the assessment of moderate treatment effects: the need for systematic overviews. Stat Med. 1987; 6: 245−
50.
Davies JA, Gallivan S, Spencer JDA. Randomised controlled trial of
doppler ultrasound screening of placental perfusion during pregnancy. Lancet. 1992; 340: 1299−303.
Dawes GS. The umbilical circulation. Am J Obstet Gynecol. 1962; 84:
1634−48..
DeBono M, Fawdry RDS, Lilford RJ. Size of trials for evaluation of an-
tenatal tests of fetal wellbeing in high risk pregnancy. J Perinat
Med. 1990; 18: 77−87.
Dempster J, Mires GJ, Taylor DJ, Patel NB. Fetal umbilical artery flow
velocity waveforms: prediction of small for gestational age infants
and late decelerations in labour. Eur J Obstet Gynecol Reprod Biol.
1988; 29: 21−5.
Dempster J, Mires GJ, Patel NB, Taylor DJ. Umbilical artery velocity
waveforms: poor association with small-for-gestational-age babies. Br J Obstet Gynaecol. 1989; 96: 692−6.
Divon MY, Girz BA, Lieblich R, Langer O. Clinical management of the
fetus with diminished umbilical artery enddiastolic flow. Am J Obstet Gynecol. 1989; 161: 1523−7.
Dornan JC, Harper A. Where are we with Doppler? Br J Obstet Gynae-
col. 1994; 101: 190−1.
Editorial: Cerebral palsy, intrapartum care and a shot in the foot. Lan-
cet. 1989; 334: 1251−2.
Editorial. Doppler ultrasound in obstetics. Lancet 1992;339:1083-4.
EFSUMB (European Federation of Societies for Ultrasound in Medi-
cine and Biology). Report from the ultrasound radiation safety
committee (Watchdogs, Chairman: G. ter Haar). 1992; Newsletter
No. 6: 3−7.
Erz W, Gonser M. Dopplersonographie der fetalen Arteria cerebri
media: präfinale Normalisierung des zerebralen Blutflusses? Geburtshilfe Frauenheilk. 1995; 55: 407−10.
Evans DH, McDicken WN, Skidmore R, Woodcock JP. Doppler ultra-
sound: physics, instrumentation, and clinical applications. Chichester: John Wiley; 1989; 162−87.
Fleischer A, Schulman H, Farmakides G et al. Uterine artery Doppler
velocity in pregnant women with hypertension. Am J Obstet Gynecol. 1986; 154: 806−13.
Giles W,Bisits A. Clinical use of Doppler ultrasound in pregnancy: in-
formation from six randomised trials. Fetal Dign Ther. 1993; 8:
247−55.
Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity
waveforms and placental resistance: pathological correlation. Br J
Obstet Gynaecol. 1985; 92: 31−8.
Giles WB, Trudinger BJ, Cook CN, Connelly A. Umbilical artery flow
velocity waveforms and twin pregnancy outcome. Obstet Gynecol.
1988; 72: 894−7.
Gonser M. Proposal of a unified description of blood flow parame-
ters, based on analogy between acoustic field and velocity field,
with application to fetal blood flow measurement. Echocardiography. 1989; 6: 339−45.
Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
Gonser M. Umbilical venous flow pulsations. Ultrasound Obstet
Gynecol. 1992; 2: 108 (Abstr).
Gonser M, Pfeiffer KH, Dietl J, HofstaetterC, Gross M. Effect of placen-
tal location on uteroplacental Doppler measurements and perinatal risk estimation. J Matern Fetal Invest. 1993a; 3: 9−13.
Gonser M, Pfeiffer KH, Dietl J, Niemann G. Outcome bei dias-
tolischem Block oder Rückstrom in der Nabelarterie. Arch Gynecol
Obstet. 1993b; 254: 1500−1.
Gramellini D, Folli M, Raboni S, Vadora E, Merialdi A. Cerebral-
umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol. 1992; 79: 416−20.
Grant A, Mohide P. Screening and diagnosis in antenatal care. In:
Enkin, M., I. Chalmers, eds.: Effecetiveness and satisfactionin antenatal care. London: Heinemann; 1982: 22−59.
Gudmundsson S, Lindblad A, Marsal K. Cord blood gases and absence
of enddiastolic blood velocities inthe umbilacal artery. Early
Human Dec. 1990; 231−7.
Hadi HA, Malette JQ, Strickland D. The clinical significance of reverse
umbilical artery flow velocity waveforms in preterm growth retarded fetuses. Am J Obstet Gynecol. 1991; 164: 413 (Abstr).
Harrington KF, Campbell S, Bewley S, Bower S. Doppler velcimetry
studies of the uterine artery and the early prediction of pre-eclampsia and intra-uterine growth retardation. Eur J Obstet Gynecol Reprod Biol. 1991; 42, Suppl: 14−20.
Heinomen K, Matilainen R, Koski H, Launila K. Intrauterine growth re-
tardation (IUGR) in preterm infants. J Perinat Med. 1985; 13:171−8.
Hitschold T, Müntefering H, Berle P. Dopplersonographie der A.
umbilicalis zur Beurteilung des fetoplazentaren Gefäßbaumes: ein
prospektiver histologischer Vergleich. Ultraschall in Med. 1992;
13: 162−5.
Hofmeyr GJ, Pattinson R, Buckley D, Jennings J, Redman CWG.
Umbilical artery resistance index as a screening test for fetal wellbeing. II: Randomized feasibility Study. Obstet Gynecol. 1991; 78:
359−62.
Indik JH, Chen V, Reed KL. Association of umbilical venous with infe-
rior vena cava blood flow velocities. Obstet Gynecol. 1991;77:551−
7.
Jensen A. Die Zentralisation des fetalen Kreislaufs. Stuttgart: Thieme;
1989; 123−33.
Jensen A, Hohmann M, Künzel W. Dynamic changes in organ blood
flow and oxygen consumption during acute ashpyxia in fetal
sheep. J Dev Physiol. 1987; 9: 543−59.
Jones RAG, Roberton NRC. Problems of small-for-dates baby. Clin Ob-
stet Gynaecol. 1984; 11: 499−524.
Konfinas AD, Penry M, Swain M, Hatjis CG. Effect of placental lateral-
ity on uterine artery resistance and development of preeclampsia
and intrauterine growth retardation. Am J Obstet Gynecol. 1989;
161: 1536−9.
Lilford RJ. Clinical experimentation in obstetrics. Br Med J. 1987;295:
1298−300.
Lilford RJ. Randomised trials in peri-natal medicine: suggestions to
overcame practical limitations and ethical constraints. J Perinat
Med. 1989; 17: 13−8.
Lingman G, Laurin J, Marsal K. Circulatory changes in fetuses with
imminent asphyxia. Biol Neonate. 1986; 49: 66−73.
Longo LD. Antenatal genesis of developmental disabilities. Ultra-
sound Obstet Gynecol. 1992; 2: 76−8.
Low JA. The current status of maternal and fetal blood flow
velocimetry. Am J Obstet Gynecol. 1991; 164: 1049−63.
Low JA, Pancham SR, Worthington D, Boston RW. The incidence of
fetal asphyxia in six hundred high-risk monitored pregnancies.
Am J Obstet Gynecol. 1975; 121: 456−9.
Lowery C, Henson B, Wan J, Brumfield C. A comparison between
umbilical artery velocimetry and standard antepartum surveillance in hospitalised high-risk patients. Am J Obstet Gynecol.
1990; 162: 710−4.
Malcus P, van Beck E, Marsal K. Umbilical artery velocimetry and
non-stress test in monitoring pregnancies: a comparative longitudinal study. Ultrasound Obstet Gynecol. 1991; 1: 1−7.
Mandruzzato GP,Bogatti P, Fischer L, Gigli C. The clinical significance
of absent or reverse end-diastolic flow in the fetal aorta and
umbilical artery. Ultrasound Obstet Gynecol. 1991; 1: 192−6.
Mari G, Wassersturm N. Flow velocity waveforms of the fetal circula-
tion preceding fetal death in a case of lupus anticoagulant. Am J
Obstet Gynecol. 1991; 165: 876−82.
Marsál K. Doppler ultrasound examination as a clinical diagnostic
test in obstetrics. J Perinat Med. 1991; Suppl 1: 299−306.
Marsál K, Lingman G, Giles W. Evaluatioin of the carotid, aortic and
umbilical blood velocity waveforms in the human fetus. Proc. Soc.
Study of Fetal Physiology. XI Ann. Conf. Oxford: The Nuffield Institute. 1984; p. C 33.
Marsál K, Persson PH. Ultrasonic measurement of fetal blood velocity
waveforms as a secondary diagnostic test in screening for intrauterine growth retardation. J Clin Ultrasound. 1988; 16: 239−44.
Mason GC, Lilford RJ, Porter J, Nelson E, Tyrell S. Randomised com-
parison of routine versus highly selective use of Doppler ultrasound in low risk pregnancies. Br J Obstet Gynaecol. 1993; 111:
130−3.
McCowan LM, Mullen BM, Ritchie K. Umbilical artery flow velocity
waveforms and placental vascular bed. Am J Obstet Gynecol. 1987;
157: 900−2.
McParland P, Pearce JM. Review article: Doppler blood flow in preg-
nancy. Placenta. 1988; 9: 427−50.
McParland P, Pearce JM, Chamberlain GVP. Doppler ultrasound and
aspirin in recognition and prevention of pregnancy induced hypertension. Lancet. 1990; 335: 1548−51.
Melone PJ, Ernest JM, O’Shea MD, Klinepeter KL. Appropriateness of
intrapartum fetal heart rate management and risk of cerebral
palsy. Am J Obstet Gynecol. 1991: 165: 272−7.
Naeye RL, Peters EC, Bartholomew M, Landis JR. Origins of cerebral
palsy. Am J Dis Child. 1989; 143: 1154−61.
Neilson JP. Doppler ultrasound in high risk pregnancies. In: Enkin
MW, Keirse MJNC, Renfrew MJ, Neilson JP, eds. Pregnancy and
childbirth module (computer program). Cochrane Database of Systematic Reviews. Review no 3889. Oxford: Cochrane Updates on
Disk; spring 1993.
Newnham JP, O’Dea MR-A, Reid KP, Diepeveen DA. Doppler flow
velocity waveform analysis in high risk rpegnancies: a randomized
controlled trial. Br J Obstet Gynaecol. 1991; 98: 956−63.
Nicolaides KH, Bilardo CM, Soothill PW, Campbell S. Absence of end
diastolic frequencies in umbilical artery: a sign of fetal hypoxiaand
acidosis. Br Med J. 1988; 297: 1026−7.
Nienhuijs SJ, Ruissen CJ, Hoogland HJ, Gerver JW, Vles J, de Haan J.
Cost effectiveness of a Doppler based policy of intrauterine growth
retardation − a randomized controlled trial. In: Platt, L.D., eds. Abstracts, 3rd Congress, International Perinatal Doppler Society. Los
Angeles; 1990: p35.
Omtzigt AWJ, Reuwer PJHM, Bruinse HW. A randomized controlled
trial on the clinical value of umbilical Doppler velocimetry in antenatal care. Am J Obstet Gynecol. 1994; 170: 625−34.
Pardi G, Cetin I, Marconi AM et al. Diagnostic value of blood sampling
in fetuses with growth retardation. N Engl J Med. 1993; 328: 692−
6.
Peeters LLH, Sheldon RE, Jones MD, Makowski EL, Meschia G. Blood
flow to fetal organs as a function of arterial oxygen content. Am J
Obstet Gynecol. 1979; 135: 637−42.
Redman CWG. Examination of the placental circulation by Doppler
ultrasound. Br Med J. 1989; 298: 621−2.
Reed KL, Appleton CP, Anderson CF, Shenker L, Sahn DJ. Doppler stu-
dies of vena cava flows in the human fetus: insights into normal
and abnormal cardiac physiology. Circulation. 1990; 81: 498−505.
Reuwer PJHM, Sijmons EA, Rietman GW,van Tiel MWM, Bruinse HW.
Intrauterine growth retardation: prediction of perinatal distress
by Doppler ultrasound. Lancet II. 1987: 415−8.
Richardson BS, Rurak D, Patrick JE, Homan G, Carmicha-el L. Cerebral
oxidative metabolism during sustained hypoxaemiain fetal sheep.
J Dev Physiol. 1989; 11: 37−43.
Rizzo G, Arduini D, Romanini C. Doppler echocardiographic assess-
ment of fetal cardiac function. Ultrasound Obstet Gynecol. 1992;2:
434−45.
Rochelson B, Schulman H, Farmakides G et al. The significance of ab-
sent end-diastolic velocity in umbilical artery velocity waveforms.
Am J Obstet Gynecol. 1987a; 156: 1213−8.
Rochelson BL, Schulman H, Fleischer A et al. The clinical significance
of Doppler umbilical artery velocimetry in the small for gestational age fetus. Am J Obstet Gynecol. 1987b; 156: 1223−6.
Roemer VM, Kieback DG, Bühler K. Gestationszeit und Geburts-
gewicht. 1. Mitteilung: Intrauterine Wachstumskurven. Z Geburtsh Perinat. 1990; 194: 241−53.
Saling E. Neue Gesichtspunkte über den Ablauf fetaler Hypoxien. Ge-
burtsh Frauenheilk. 1965; 25: 886−7.
Saling E. Die O
Frauenheilk. 1966; 26: 413−9.
Saling E. Oxygen-conserving adaptation of the foetal circulation.
Mod Trends Paediatr. 1970; 3: 51−68.
Schmidt W, Ballestrem CL, Ertan AK, Rühle W, Gnirs J, Boos R. Pathol-
ogische Doppler-Flow-Befunde und kardiotokographische Ergebnisse. Geburtsh Frauenheilk. 1991a; 51: 523−31.
Schmidt W, Rühle W, Ertan AK, Boos R, Gnirs J. Doppler-Sonographie
− Perinatologische Daten bei Fällen mit enddiastolischem Block
bzw. Reserve Flow. Geburtsh Frauenheilk. 1991b; 51: 288−92.
-Sparschaltung des fetalen Kreislaufs. Geburtsh
2
Advanced Topics
209
Advanced Topics in Obstetrics and Gynecological Doppler Ultrasound: References
210
3
Schmidt W, Rühle W, Ertan AK, Hettenbach A. Doppler sonography
and nonstress-testin cases with absent enddiastolic flow. Am J Obstet Gynecol. 1991c; 164: 414 (Abstr).
Schulman H, Winter D, Farmakides G, Coury A, Schneider E, Penny B.
Doppler examinations of the umbilical and uterine arteries during
pregnancy. Clin Obstet Gynecol. 1989; 32: 738−45.
Soothill PW. Cordoncentesis and fetuses that are small for ge-
stational age. N Engl J Med. 1993a; 328: 728−9.
Soothill PW, Ajayi RA, Campbell S, Nicolaides KH. Prediction of mor-
bidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies. Br J Obstet Gynaecol. 1993b; 11: 742−5.
Steel SA, Pearce JM, McParland P, Chamberlain GVP. Early Doppler ul-
trasound screening in prediction of hypertensive disorders of
pregnancy. Lancet. 1990; 335: 1548−51.
Thaler IZ, Weiner J, Itskovitz. Systolic or diastolic notch in uterine
artery blood flow velocity waveforms in hypertensive pregnant
patients: relationship to outcome. Obstet Gynecol. 1992; 80: 277−
82.
Thompson SG, Pocock SJ. Can meta-analysis be trusted? Lancet 1991;
338: 1127−30.
Thornton JG, Lilford RJ. Do we need randomised trials of antenatal
tests of fetal wellbeing? Br J Obstet Gynaecol. 1993; 100: 197−200.
Trudinger BJ, Cook CM, Jones L, Giles WB et al. A comparison of fetal
heart rate monitoring and umbilical artery waveforms in the recognition of fetal compromise. Br J Obstet Gynaecol. 1986; 93: 171−
5.
Trudinger BJ, Cook CM, Giles WB, Connelly A, Thompson RS. Umbili-
cal artery flow velocity waveform in high risk pregnancy. Randomised controlled trial. Lancet I. 1987: 188−90.
Trudinger BJ, Cook CM, Giles WB. Fetal umbilical artery waveforms
and subsequent neonatal outcome. Br J Obstet Gynaecol. 1991; 98:
378−84.
Tyrrell SN, Lilford RJ, Macdonald HN, Nelson EJ, Porter J, Gupta JK.
Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk
pregnancies. Br J Obstet Gynaecol. 1990; 97: 909−16.
Tyrrell S, Obaid AH, Lilford RJ. Umbilical artery Doppler velocimetry
as a predictor of fetal hypoxia and acidosis at birth. Obstet Gynecol. 1989; 74: 332−7.
Vetter K, Gonser M. Indices zur Beurteilung von Dopplersonogram-
men. Gynäkologe. 1992; 25: 332−40.
Vetter K. Die Dopplersonographie an Gefäßen von Uterus, Plazenta
und Fet. Gynäkol Prax. 1993; 17: 69−78.
Visser GHA, Stigter RH, Bruinse HW. Management of the growth-re-
tarded fetus. Eur J Obstet Gynecol Reprod Biol. 1991; 42, Suppl:
73−8.
Voigt HJ, Becker V. Uteroplacental insufficiency comparison of utero-
placental blood flow velocity and histomorphology of placental
bed. J Matern Fetal Invest. 1992; 2: 251−5.
Vyas S, Nicolaides KH, Bower S, Campbell S. Middle cerebral artery
flow velocity waveforms in fetal hypoxaemia.Br J Obstet Gynaecol.
1990; 97: 797−803.
Weiner CP. The relationship between the umbilical artery systolic/
diastolic ratio and umbilical gas measurements in specimens obtained by cordocentesis. Am J Obstet Gynecol. 1990; 162: 1198−
202.
Weiner CP, Wenstrom KD, Sipes SL, Williamson RA. Risk factors for
cordocentesis and fetal intravascular transfusion. Am J Obstet Gynecol. 1991; 165: 1020−5.
Weiner Z, Farmakides G, Schulman H, Penny B. Central and periph-
eral hemodynamic changes in fetuses with absent enddiastolic
velicity in umbilical artery: correlation with computerized fetal
heart rate pattern. Am J Obstet Gynecol. 1994; 170: 509−15.
WeissE, Hitschold T,Müntefering H, Berle P. Dopplersonographie der
Art. umbilicalis. Differenzierte Diagnostik bei der intrauterinen
Mangelentwicklung. Geburtsh Frauenheilk. 1989; 49: 466−71.
Weiss E, Ulrich S, Berle P. Condition at birth of infants with pre-
viously absent or reverse umbilical artery end-diastolic flow
velocities. Arch Gynecol Obstet. 1992; 252: 37−43.
Whittle MJ, Hanretty KP, Primrose MH, Neilson JP. Screening for the
compromised fetus: a randomized trial of umbilical artery
velocimetry in unselected pregnancies. Am J Obstet Gynecol.
1994; 170: 555−9.
Wladimiroff JW, Tonge HM, Stewart PA. Doppler ultra sound assess-
ment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol. 1986: 93: 471−5.
Yoon BH, Syn HC, Kim SW. The efficacy of Doppler umbilical artery
velocimetry in identifying fetal acidosis. A comparison with Fetal
Biophysical Profile. J Ultrasound Med. 1992; 11: 1−6.
Doppler Ultrasound of the Fetal
Venous Circulation
De Vore GR, Horenstein J. Ductus venosus index: a method for eva-
luation right ventricular preload in the second-trimester fetus. Ultrasound Obstet Gynecol. 1993; 3: 338−342
Eik-Nes SH, Brubakk AO, Ulstein MK. Measurement of human fetal
blood flow. B Med J. 1980; 280: 283−284
Gudmundsson S, Huhta JC, Wood DC, Tulzer G, Cohen AW, Weiner S.
VenousDoppler ultra-sonography in the fetus with nonimmun hy-
Gudmundsson S, Tulzer G, Huhta JC, Marsal K: Venous Doppler in the
fetus with absent end-diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol. 1995; 7: 262−267
Hecher K, Campbell S, Doyle P, Harrington K, Nicolaides K. Assess-
ment of Fetal Compromise by Doppler ultrasound Investigation of
the Fetal Circulation. Arterial, Intracardiac and Venous Blood Flow
Velocity Studies. Circulation. 1995; 91: 129−138
Hecher K, Campbell S, Snijders R, Nicolaides K. Reference ranges for
fetal venous and atrioventricular blood flow parameters. Ultrasound Obstet Gynecol. 1994; 4: 381−390
Hofstaetter C, Gudmundsson S, Dubiel M, Marsal K. Fetal right hepa-
tic venous blood velocimetry in normal and high-risk pregnancies.
European J Ultrasound. 1996; 4: 153−160
Huisman TWA, Gittenberger-de Groot AC, Wladimirroff JW: Recogni-
tion of a fetal subdiarhagmatic venous vestibulum essential for fetal venous Doppler assessment. Pediat Res. 1992a; 32: 338−341
Huisman TWA, Stewart PA, Wladimirroff JW. Flow velocity wave-
forms in the fetal inferior V. cava during the second half of normal
pregnancy. Ultrasound Med Biol. 1991; 7: 679−682
Huisman TWA, Stewart PA, Wladimiroff JW. Ductus venosus blood
flow velocity waveforms in the human fetus − a Doppler study. Ultrasound Med Biol. 1992b; 18: 33−37
Kiserud T, Eik Nes SH, Hellevik LR, Blaas HG. Ductus venosus − A lon-
gitudinal Doppler Velocimetry Study of the Human Fetus. J Matern
fetal Invest. 1992a; 2: 5−11
Kiserud T,Eik Nes SH, Blaas HG, Hellevik LR. Foramen ovale:an ultra-
sonographic study of its relation to the inferior V. cava, ductus venosus and hepatic veins. Ultrasound Obstet Gynecol. 1992b; 4:
389−396
Kiserud T,Eik Nes SH, Hellevik LR, Simensen B. Ductus venosus blood
velocity and the umbilical circulation in the seriously growth-retarded fetus. Ultrasound Obstet Gynecol. 1994; 4: 109−114
Reed KL, Appelton CP, Anderson CF, Shenker L, Sahn DJ. Doppler Stu-
dies of V. CavaFlows in Human Fetuses. Circulation. 1990;81: 498−
505
Rizzo G, Arduini D, Romanini C. Inferior Vena cava flow velocity
waveforms in appropriate and small-for-gestational-age fetuses.
Am J Obstet Gynecol. 1992; 166: 1271−1280
Rizzo G, Capponi A, Arduini D, Romanini C. Ductus venosus velocity
waveforms in appropriate- and small for-gestational-age fetuses.
Early Human Develop. 1994; 39: 15−26
Doppler Ultrasound in Gynecology
Alatas G, Aksoy E, Akarsu C, Yakin K, Bahceci M. The effect of uterine
volume on uterine artery Doppler velocimetry in the myomatous
state. Gynecol obstet Invest. 1997; 43(1): 55−59
Benacerraf BR, Finkler NJ, Wojciechowski C, Knapp RC. Sonographic
accuracy in the diagnosis of ovarian masses. J Reprod Med. 1990;
35: 491−495
Bourne T, Campbell S, Reynolds KM et al. Screening for early familial
ovarian cancer with transvaginal ultrasonography and colour
blood flow imaging. Br Med J. 1993; 306: 1025−1029
Bourne T, Campbell S, Steer C, Royston P, Whitehead MI, Collins WP.
Detection of endometrial cancer by transvaginal ultrasonography
with color flow imaging and blood flow analysis: a preliminary report. Gynecol Oncol. 1991; 40: 253−259
Bourne T, Campbell S, Steer C, Whitehead MJ, Collins WP. Transvagi-
nal colour flow imaging: a possible new screening technique for
ovarian cancer. Br Med J. 1989; 299: 1367−1370
Bourne T, Campbell S, Whitehead MI, Royston P, Steer CV, Collins W.
Detection of endometrial cancer in postmenopausal women by
transvaginal ultrasonography and color flow imaging. Br Med. J.
1990; 310: 369−370
Bourne T, Craxford T, Hampson J, Collins WP, Campbell S. The detec-
tion of endometrial cancer by transvaginal ultrasonography with
colour Doppler. Ultrasound Obstet Gynecol. 1992; 2: 75
Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
Bromley BH, Goodman H, Benacerraf BR. Comparison between sono-
graphic morphologic and Doppler waveform for the diagnosis of
ovarian malignancy. Obstet Gynecol. 1994; 83: 434-437.
Campbell S, Bhan V, Royston P, Whitehead M, Collins WP. Transabdo-
minal ultrasound screening for early ovarian cancer. Br Med J.
1989; 299: 1363−1367
Campbell S, Royston P, Bhan V, Whitehead M, Collins WP. Novel
screening strategies for early ovarian cancer by transabdominal ultrasonography. Br J Obstet Gynecol. 1990; 97: 304−311
Carter J, Lau J, Fowler J, Carlosn J, Carson L, Twiggs L. Blood flow cha-
racteristics of ovarian tumors: Implications for ovarian cancer
screening. Am J Obstet Gynecol. 1995; 172: 901−907
Cullinan J, Fleischer A, Kepple D, Arnold A. Sonohysteropgraphy: a
technique for endometrial evaluation. Radiographics: 1995; 15:
501−514
Deligdisch L. Endometrial response to hormonal therapy. In: Altchek
A, Deligdisch L, eds. The Uterus. Berlin: Springer; 1991: 102−114
Duda V, Rode G, Thein C, Schulz KD. Vaginalsonographie: Pilotstudie
für den Einsatz als Ovarial-Screening-Verfahren. Geburtsh und
Frauenheilk. 1990; 50: 388−391
Exacoustos C, Zupi E. Endometrial evaluation in postmenopausal
breast cancer patients receiving tamoxifen; an ultrasound, colour
flow Doppler, hysteroscopicand histological study. Ultrasound Obstet Gynecol. 1995; 6: 435−442
Fleischer AC, Rodgers WH, Ra WK et al. Assessment of ovarian tumor
vascularity with transvaginal colour Doppler sonography. J Ultrasound Med. 1991; 10: 563−568
Fleischer A, Appplebaum M, Parsons A. Transvaginal sonography of
the normal endometrium. In: Fleischer A, Kurjak A, Granberg S,
eds. Ultrasound and the Endometrium. Parthenon Publishing
Group LTD; 1997: pp 1−17
Folkman J, Melrel E, Abernethy C, Williams G. Isolation of a tumor
factor responsible for angiogenesis. J Exp Med. 1971;133: 275−288
Folkman J. Tumor angiogenesis, Adv Cancer Res. 1974; 19: 331
Goswamy R, Williams G, Steptoe P. Decreased uterine perfusion − a
cause of infertility. Hum Reprod. 1988; 5: 391−395
Granberg S, Norstrom A, Wikland M. Tumors in the lower pelvis as
imaged by vaginal sonography. Gynecol. 1990
Granberg S, Bourne TH. Transvaginal sonography of endometrial dis-
orders in postmenopausal woman. In: Fleischer, A., A. Kurjak, S.
Granberg, eds. Ultrasound and the Endometrium. Parthenon Pu-
blishing Group LTD; 1997: pp 29−47
Grimes D. Dilatation and curretage: A reappraisal. Am J Obstet Gyne-
col. 1982; 142: 1−6
Hata K, Hata T, Manabe A, Fujimura K, Kitao M. A critical evaluation
of transvaginal Doppler studies, transvaginal sonography, magne-
tic resonance imaging and CA 125 in detecting ovarian cancer. Ob-
stet Gynecol. 1992; 80: 922−926
Hata K, Makihara K, Hata T. Transvaginal color Doppler imaging for
hemodynamic assessment of reproductive tract tumors. Jpn Int J
Gynecol Obstet. 1991; 36: 301−308
Herrmann HJ, Dreher C, Goldhirsch A, Locker GW, Jann EX. Sonogra-
phic patterns of ovarian tumors: prediction of malignancy. Obstet
Gynecol. 1987; 69: 777−781
Higgins RV, van Nagell JR, Donaldson ES et al. Transvaginal sonogra-
phy as a screening method for ovarian cancer. Gynecol Oncol.
1989; 34: 402−406
Huang SC, Yu CH, Huang RT, Hsu KF, Tsai YC, Chou CY. Intratumoral
blood flow in uterine myoma correlated with a lower tumor size
and volume, but not correlated with cell proliferation or angiogen-
sis. Obstetrics and Gynecology. 1996; 87(6): 1019−24
Kawai M, Kano T, Kikkawa F, Maeda O, Oguchi H, Tomoda Y. Transva-
ginal Doppler ultrasound with colour flow imaging in the diagno-
sis of ovarian cancer. Obstet Gynecol. 1992; 79: 163−167
Koonings P, Moyer D, Grimes D. A randomized clinical trial compa-
ring Pipelle and Tis-U-Trap for endometrial biopsy. Obstet Gyne-
col. 1990; 75: 293−295
Kurjak A, Kupesic S, Shalan H, Jukic S, Kosuta D, Ilijas M. Uterine sar-
coma: a report of 10 cases studied by transvaginal color and pulsed
Doppler sonography. Gynecologic Oncology. 1995; 59(3): 342−6
Kurjac A, Predanic M. New scoring system for prediction of ovarian
malignancy based on transvaginal color Doppler. J Ultrasound
Med. 1992; 11: 631−638
Kurjak A, Schulman H, Sosic A, Zalud Shalan H. Transvaginal ultra-
sound, colour flow and Doppler waveform of the postmenopausal
adnexal mass. Obstet Gynecol. 1992; 80: 917−921
Kurjak A, Shalom H, Kupesic S. Attempt to screen asymptomatic wo-
men for ovarian and endometrial cancer with transvaginal colour
and pulsed Doppler sonography. J Ultrasound Med. 1994; 13 (4):
295−297
Kurjak A , Zalud J, Alfirevic A. Evaluation of adnexal masses with
transvaginal colour ultrasound. (1991) J. Ultrasound Med. 1991;
10: 295−297
Lerner JP, Timor-Tritsch IE, Federmann A, Abramovich G. Transvagi-
nal ultrasonographic characterization of ovarian masses with an
improved weighted scoring system, Am J Obstet Gynecol. 1994;
170: 170−181
Lerner JP, Timor-Tritsch IE, Monteagudo A. Use of transvaginal sono-
graphy in the evaluation of endometrial hyperplasia and carcinoma. Obstet Gynecol Survey. 1996; 51: 718−725
Prömpeler HJ, Madjar H, Sauerbrei W. et al. Transvaginale Farbdopp-
lersonographie bei Ovarialtumoren. Geburtshilfe Frauenheilk.
1994; 54: 216−221
Prömpeler HJ, Madjar H, Sauerbrei W, Lattermann U. Kombinierte
Beurteilung von Ovarialtumoren mit transvaginaler B-Bild- und
Farbdopplersonographie. Geburtsh. u. Frauenheilk. 1996; 56: 345−
350
Sassone MA, Timor-Tritsch JE, Artner A, Westhoff C, Warren WB.
Transvaginal sonographic characterisation of ovarian disease; evaluation of a new scoring system to predict ovarianmalignancy. Obstet Gynecol. 1991; 78: 70−76
Schillinger H, Kliem M, Klosa W, Pohl J, Wilhelm C, Madjar H, Zalasa J.
Dignitätsbeurteilung gynäkologischer Tumore durch einen sonographischen Tumor-Score unter besonderer Berücksichtigung des
Ovarialkarzinoms. Archives of Gynecology + Obstetrics, 1989
Schneider VL, Schneider A, Reed L, Hatch HD. Comparison of Doppler
with two-dimensional sonography and CA 125 for prediction of
malignancy of pelvic masses. Obstet Gynecol. 1993; 81: 983−988
Scholtes MCW, Wladimiroff JW,van Rinen HJM, Hop WC. Uterine and
ovarian velocity waveforms in the normal menstrual cycle: a
transvaginal Doppler study. Fertil Steril. 1989; 52: 981−985
Schulman H, Conway C, Zalud I, Farmakides G, Haley J, Cassata M.
Prevalence in a volunteer population of pelvic cancer detected
with transvaginal ultrasound and color flow Doppler. Ultrasound
Obstet Gynecol. 1994; 4: 414−420
Sheth S, Hamper U. Endometrial blood flow analysis in postmeno-
pausal women: can it help differentiate benign from malignant
causes of endometrial thickening? Radiology. 1995; 195: 661−665
Sohn C, Meyberg G, von Fournier D, Bastert G. Geburtsh. u. Frauen-
heilk. 1993; 53: 395−399
Steer CV, Campbell S, Pampiglione JS, Kingsland CR, Mason BR, Col-
lins WP. Transvaginal colour flow imaging of the uterine arteries
during the ovarian and menstrual cycles. Hum Reprod. 1990; 5:
391−395
Tekay A, Jouppila P. Validity of pulsatily and resistance indices in
classification of adnexal tumors with transvaginal colour Doppler
ultrasound. Ultrasound Obstet Gynecol. 1992; 2: 338−344.
Timor-Tritsch JE, Lerner JP, Monteagudo A, Santos R. Transvaginal ul-
trasonographic characterisation of ovarian masses by means of colour flow-directed Doppler measurements and a morphologic scoring system. Am J Obstet Gynecol. 1993; 168: 909−913
Valentin L, Sladkevicius K, Marsal K. Limited contribution of Doppler
velocimetry to the differential diagnosis of extrauterine pelvic tumors. Obstet Gynecol. 1994; 83: 425−433
Voigt HJ. Transvaginaler Doppler/Farbdoppler in der gynäkologi-
schen Diagnostik. Gynäkologe. 1995; 28: 254−261
Voigt HJ. Colour flow Doppler use in ectopic pregnany in Schmidt W.
Kurjak A. editors. Color Duplex Ultrasound in Gynecology and Obstetrics. Thieme International Stuttgart, New York 2004.
Weiner Z, Thaler J, Beck D, Rottem S, Deutsh M, Brandes JM. Differen-
tiating malignant from benign ovarian tumors with transvaginal
colour flow imaging. Obstet Gynecol. 1992; 79: 159−162
YoshiokaN. Usefulness of Doppler ultrasound in predicting the effect
of gonadotropin-releasing hormone agonist (GnRHa) an myoma
uteri. Acta obstetrica et Gynaecologica Japonica. 1995; 47(11):
1255−60
Diagnosis of the Uterine Tube by Transvaginal Ultrasound
Degenhardt F. Kontrastmittelsonographie in der Gynäkologie. Stutt-
gart: Thieme; 1995; 1−63.
Deichert U, van de Sandt M, Lauth G, Daume E. Die transvaginale Hy-
sterokontrastsonographie (HKSG). Geburtsh. u. Frauenheilk. 1988;
48: 835−844.
Rimbach S, Sohn C, Wallwiener D. Vaginalsonographische Beurtei-
lung der Eileiter mittels Ultraschallkontrastmittel. In: Sohn, C., W.
Holzgreve, eds. Ultraschall in Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 1995: 779−782.
Advanced Topics
211
Advanced Topics in Obstetrics and Gynecological Doppler Ultrasound: References
212
3
Runnebaum B, Rabe T, eds. Gynäkologische Endokrinologie und Fort-
pflanzungsmedizin; Bd. 2. Berlin Heidelberg: Springer; 1994: 117−
182.
Steck T, Becker W, Albert P, Börner W, Würfel W. Erste Erfahrungen
mit der Hysterosalpingoszintigraphie (HSS) bei normaler und pathologischer Tubenpassage. Geburtsh. u. Frauenheilk. 1989; 49:
889−893.
Diagnostic Ultrasound of Blood Flow in Breast
Tumors
Adler DD, Carson PL, Rubin JM, Quinn-Reid D. Doppler ultrasound co-
lor flow imaging in the study of breast cancer. Preliminary findings. Ultrasound Med Biol. 1990; 16: 553−559.
Algire GH, Chalkley W. Vascular reactions of normal and malignant
tissues in vivo. I. Vascular reactions of mice to wounds and to normal and neoplastic implants N Natl Cancer Inst. 1945; 6: 73−85.
Bell DS, Bamber JC, Eckersley RJ. Segmentation and analysis of colour
Doppler images of breast tumor vasculature. Bildgebung Imaging
60. 1993; 2, Suppl.: 51.
Blohmer JU, Lau HU. Erste Erfahrungen mit der Farb-Doppler-Sono-
graphie der Mamma. Gesellschaft für Geburtshilfe und Gynäkologie in Berlin, Sitzungsbericht. Geburtsh. u. Frauenheilk. 1993; 53:
730.
Blohmer JU, Chaoui R, Bollmann R, Lau HU. Die gepulste und farbko-
dierte Dopplermammasonographie: Stellenwert in der Differentialdiagnose von Mammatumoren. 13. Wissenschaftliche Tagung
der Deutschen Gesellschaft für Senologie, Berlin; 1993a.
Blohmer JU, Bollmann R, Chaoui R, Lau HU. The assessment of breast
vascularity using pulsed wave and color Doppler sonography. Bildgebung Imaging 60. 1993b; 2, Suppl.: 46.
Blohmer JU, Bollmann R, Schmalisch A, Chaoui R, Lau HU. Die Diffe-
rentialdiagnose von Mammatumoren durch den Vergleich der
Durchblutung des Tumors mit der kontralateralen Brust mittels
farbkodierter, gepulster Dopplersonographie. Geburtsh. u. Frauenheilk. 1994; 54.
Blohmer JU, Guski H. Sonographische Kriterien zur Differentialdia-
gnose von Mammatumoren. In: Sohn C, Holzgreve W. Ultraschall
in Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 1995: 671−
718.
Bouck N. Understanding tumor angiogenesis. Contemp Oncol. 1994;
24−29.
Britton PD, Coulden RA. The use of Doppler ultrasound in the diagno-
sis of breast cancer. Clin Radiol. 1990; 42: 399−401.
Burns PN, Halliwell M, Wells PN, Webb AJ. Ultrasonic Doppler studies
of the breast. Ultrasound Med Biol. 1982; 8: 127−143.
Cosgrove D. Doppler competes for breast evaluation role. Diagn Ima-
ging. 1992; 8: 40−41.
Delorme S. Dopplersonographie des Mammakarzinoms. Radiologe.
1993; 33: 287−291.
Dock W. Duplex sonography of mammary tumors. Prospective study
of 75 Patients. J Ultrasound Med. 1993; 12: 79−82.
Duda VF, Rode G, Schlief R. Echocontrast agent enhanced color flow
imaging of the breast. Ultrasound Obstet Gynecol. 1993; 3: 191−
194.
Folkman J, Klagsbrun M. Angiogenic factors. Science Vol.1987; 235 p:
442−447.
Folkman J, Merler E, Albernathy C, Williams G. Isolation of a tumor
factor responsible for angiogenesis. J. Exp Med. 1971; 133: 275−
288.
Goldmann E. The growth of malignant disease in man and the lower
animals. Lancet. 1907; 2: 1236−1240.
Horak E, Leek R, Klenk N, Le Jeune S, Smith K, Stuart N, Greenall M,
Stepniewska K, Harris AL. Angiogenesis, assessed by platelet/endothelial cell adhesion molecule antibodies, as indicator of node
metastases and survival in breast cancer. Lancet. 1992; 340: 1120−
112 4 .
Huber S, Delorme S, Knopp MV et al. Computer assisted quantitative
assessment of color Doppler sonography in the evaluation of breast tumors. Bildgebung Imaging 60. 1993; 2, Suppl: 18.
Jellins J. Combining imaging and vascularity assessment of breast le-
sions. Ultrasound Med Biol. 1988; 14: 121−130.
Kaiser WA, Diedrich K, Reiser M, Krebs D. Moderne Diagnostik der
Mamma. Geburtsh und Frauenheilk. 1993; 53: 1−14.
Konishi YK. Clinical application of color Doppler imaging to the dia-
gnosis of breast disease. Toshiba Med Rev. 1992; 42: 12−27.
Kurjak A, Salihac A, Kupesic-Urek S. Clinical value of assessment of
gynaecological tumour angogenesis by transvaginal colour Dopp-
ler. Ann Med. 1992; 24: 97−102.
Leucht D, Madjar H. Lehratlas der Mammasonographie, 2. Aufl. Stutt-
gart: Thieme; 1995: Kap. 9: 241−245.
Madjar H, Gufler H, Prömpeler HJ, Reuss C, Holz K, Schlief R. Einsatz
von Levovist in der Mammadiagnostik. Jahrb. der Gyn und Ge-
burtsh. Biermann Verlag FRG; 1997/98.
Madjar H, Prömpeler H, Schürmann R et al. Verbesserung der Durch-
blutungsdiagnostik von Brusttumoren durch Echo-Kontrastmittel.
Geburtsh und Frauenheilk.: 1993; 53: 866−869.
Madjar H, Schillinger H. Einführung in die Doppleranalyse zur Mam-
madiagnostik. In: Hansmann M, ed. Ultraschalldiagnostik. Berlin:
Springer; 1986.
Madjar H, Sauerbrei W, Münch S et al. Methodenanalyse zur Dopp-
leruntersuchung der weiblichen Brust. Ultraschall. 1989; 10: 196−
201.
Madjar H, Sauerbrei W, Rachowska A, Pfleiderer A. Vergleich von
hochauflösender Sonographie und Mammographie. Ultraschall
Klin Prax. 1991a; 6: 290−297.
Madjar H, Sauerbrei W, Münch S, Schillinger H. Continous wave and
pulsed Doppler studies of the breast: clinical results and effect of
transducer frequency. Ultrasound Med Biol. 1991b; 17: 31−39.
Madjar H, Vetter M, Prömpeler HJ et al. Untersuchungen zur norma-
len Vaskularisation der weiblichen Brust durch Doppler-Ultraschall. Ultraschall Med. 1992; 13: 171−177.
Peters-Engl C, Medl M, Leodolter S. The use of colour-coded and
spectral Doppler ultrasound in the differentiation of benign and
malignant breast lesion. Brit. J. Cancer. 1995; 71: 137−139.
Plate KH. Angiogenese und Anti-Angiogenese. Dtsch. Aerztebl. 1993;
90: A 2987−2995.
Possover M, Morawski A, Müller E, Hettenbach A. Perspektiven des
Farb-Ultraschalls in der Mamma-Diagnostik. Geburtsh und Frauenheilk. 1994; 54: 432−436.
Samejima N, Yamazaki K. A study on the vascular proliferation in tis-
sues around the tumor in breast cancer. Japanese Journal of Sur-
gery. 1988; Vol. 18 No. 3 p. 235−242.
Schild R, Fendel H. Die dopplersonographische Differenzierung von
benignen und malignen Mammatumoren. Geburtsh und Frauenheilk. 1991; 51: 969−972.
Schild R, Schroers B, Funk A et al. Dopplersonographische Untersu-
chungen von Mammatumoren in CW-Technik. Zentralbl Gynaekol.
1993; 115: 483−487.
Schlief R. Ultrasound contrast agents. Current opinion Radiol. 1991;
198−207.
Schlief R. Diagnostic potential of intravenous contrast enhancement
in various areas of cardiovascular doppler ultrasound: efficiancy
results of a multinational clinical trial with the galactose-based
agent SH U 508 A. Echocardiography. 1993; 10, 6: 665−682.
Sohn C, Baudendistel A, Bastert G. Dignitätsdiagnostik von Mamma-
tumoren anhand des Stimmfremitus in der Sonographie. Bildgebung, 1994a; 61: 291−294.
Sohn C, Baudendistel A, Kaufmann M, Bastert G. Der positiveStimm-
fremitus beim malignen Brusttumor in der sonographischen FarbMEM-Darstellung − ein aufregender Artefakt zur Diagnosesicherung? Geburtsh und Frauenheilk. 1994b; 54: 427−431.
Sohn C, Grischke EM, Stolz W, Bastert G. Untersuchungen zum Zu-
sammenhang zwischen dem Grad der Durchblutung und dem biologischen Verhalten von Mammatumoren. Ultraschall Klin Prax.
1993; 8: 11−14.
Sohn C, Grischke EM, Wallwiener D, Kaufmann M, von Fournier D,
Bastert G. Die sonographische Durchblutungdiagnostik gut- und
bösartiger Brusttumoren. Geburtsh und Frauenheilk. 1992a; 52:
397−403.
Sohn C, Meyberg G. Erste Erfahrungen mit einer neuen Farbtechnik:
die Ultraschall-Angiographie Zbl Gynäkol. 1995; 117: 90−96.
Sohn C, Stolz W, Grischke EM, Wallwiener D, Bastert G, von Fournier
D. Die dopplersonographische Untersuchung von Mammatumoren mit Hilfe der Farbdopplersonographie, der Duplexsonographie
und des CW-Dopplers. Zentbl Gynäkol. 1992b; 114: 249−253.
Sohn C, Weskott HP, Schießer M. Sensitivität neuer Farbsysteme:
“Maximum entropy method” und Angiofarbe. Ultraschall in Med.
1996; 17: 138−142.
Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis
and metastasis-correlation in invasive breast carcinoma. The New
England Journal of Medicine. 1191; Vol. 324 No. 1: 1−8.
Index
Note: As Doppler ultrasound is the subject of the book, all entries refer to Doppler ultrasound unless otherwise
indicated. Page numbers followed by “f” and “t” refer to figures and tables respectively.
A
Abdomen (fetal), 160f
wall malformations, 114−115
Abdominal diameter (AD)
antiphospholipid-antibody syn-
drome, 172f
IUGR assessment, 92−93, 92f
A blood flow, 163, 163f
A/B ratio, 26−27, 39
aorta (fetal), 38f
cerebral artery (middle), 38 f, 100f
percentiles, 37f
umbilical artery, 100f
Absent or reversed end-diastolic flow
(ARED), preeclampsia, 106
Absorption, 6
Acardius, 122 f, 126
Acetylsalicylic acid (ASA), 47
preeclampsia, 105
Acidosis, 152
clinical significance of Doppler ul-
trasound, 141
Doppler ultrasound, vs. cardiotoco-
gram, 139−140, 139t
labor, 148
Acoustic output, 21
Acoustic power, 21
Acranius, 126
Adnexal tumor, 85, 89f
Air, resistance to sound waves, 13
Alias phenomenon, 18, 18f, 19f
Allergic reactions, contrast medium,
197
Amniocentesis, 61
Amniotic fluid, 61
anhydramnios, 119, 119f, 120f
hydramnios-oligohydramnios, 127−
128
pregnancy, late stages, 143
reduction, 56
Amniotic fluid index (AFI), 178
A-mode (amplitude mode), 7, 7f
Amplitude-coded flow display, 19−20
Anastomatoses, portal vein, 159
Anemia
fetal, 61, 129−131, 130t
hemodynamic consequences,
129 t
indications, 129t
intraperitoneal transfusion, 130−
131
monitoring treatment, 130
noninvasive procedures, 129−131
maternal, 58
Aneurysm(s)
differential diagnosis, 111
intra-abdominal, 115
Anhydramnios, 119, 119f, 120f
Annular phased array transducer, 13
Antibody titer, 129
Antihypertensives, uteroplacental
hemodynamics, 63−64
Antiphospholipid-antibody syn-
drome, 172−176, 173−176f
anatomical measurements, 172f
aorta, 175f
deep vein thrombosis (DVT), 172
ductus venosus, 176f
inferior vena cava, 176f
middle cerebral artery, 173f, 175f
placental-cerebral ratio, 173f
pulsatility index, 174f, 175f
resistance index, 172
time average maximum velocity
(TAMX), 174f, 175f
umbilical artery, 174f
uterine arteries, 173f, 174f
Aorta (fetal)
A/B ratio, 38f
antiphospholipid-antibody syn-
drome, 175f
arrhythmia, 60 f
bifurcation, 120f
blood flow, 59−60, 59 f
classification, 32
end-diastolic block, 48−49
evaluation criteria, 59
late pregnancy, 143−144t, 144f,
144 t
physiological changes, 60
qualitative analysis, 144, 144 t
quantitative analysis, 143, 144t
reference values, 59−60, 60 t
waveform, notches, 57
blood redistribution, (brain-spar-
ing), 107−108
correct display, 69 f
diagnostic significance of ultra-
sound, 152
Doppler angle, 70f
endarteritis obliterans, 168f
fetal anemia, 130, 130f
fetal growth restriction, 167f, 177f
feto-fetal transfusion syndrome
acceptor, 180f
donor, 179f
index quotient, 37, 38 f
multiple pregnancies, 124
Potter syndrome, 169f
pulsatility index (PI), 38 f
renal arteries, absence, 120 f
resistance index (RI), 38 f, 49, 59t
near term, 148
second/third trimesters, 48−49, 49 f
advantages, 49
bifurcation, 49f, 50 f
diastolic reverse flow, 50f
mean values and standard devia-
tion, 50f
resistance index (RI), 49
reverse flow in inferior vena
cava, 50 f
term effect, 146, 146f, 148
ultrasound errors, 74−75f
Doppler angle, 70f
Aorta (ovarian), 41
Aortic arch, 44 f, 49 f, 176f
Aortic isthmus, 146, 147f
Arcuate artery, ectopic pregnancy,
87−88
Arterial pressure, fetal anemia, 131
Arteries see individual arteries
Arteriovenous shunts, 57−58
Artifacts, 13−15
distal acoustic shadowing, 13, 13f
dorsal sound amplification, 13, 13f
geometrical distortion, 15
margin shadow, 14, 14f
repetition artifact, 14−15, 14f
side lobe, 14, 14f
slice thickness artifact, 14, 14f
Ascites, 118f
Asphyxia (fetal), 139, 148
cesarean section, 141
clinical significance of Doppler ul-
trasound, 141
Index
213