title: Operator auditory perception and spectral quantification of umbilical artery Doppler ultrasound signals.
abstract: OBJECTIVE
  An experienced sonographer can by listening to the Doppler audio signals perceive various timbres that distinguish different types of umbilical artery flow despite an unchanged pulsatility index (PI). Our aim was to develop an objective measure of the Doppler audio signals recorded from fetoplacental circulation in a sheep model.
  
  
  METHODS
  Various degrees of pathological flow velocity waveforms in the umbilical artery, similar to those in human complicated pregnancies, were induced by microsphere embolization of the placental bed (embolization model, 7 lamb fetuses, 370 Doppler recordings) or by fetal hemodilution (anemia model, 4 lamb fetuses, 184 recordings). A subjective 11-step operator auditory scale (OAS) was related to conventional Doppler parameters, PI and time average mean velocity (TAM), and to sound frequency analysis of Doppler signals (sound frequency with the maximum energy content [MAXpeak] and frequency band at maximum level minus 15 dB [MAXpeak-15 dB] over several heart cycles).
  
  
  RESULTS
  WE FOUND A NEGATIVE CORRELATION BETWEEN THE OAS AND PI: median Rho -0.73 (range -0.35- -0.94) and -0.68 (range -0.57- -0.78) in the two lamb models, respectively. There was a positive correlation between OAS and TAM in both models: median Rho 0.80 (range 0.58-0.95) and 0.90 (range 0.78-0.95), respectively. A strong correlation was found between TAM and the results of sound spectrum analysis; in the embolization model the median r was 0.91 (range 0.88-0.97) for MAXpeak and 0.91 (range 0.82-0.98) for MAXpeak-15 dB. In the anemia model, the corresponding values were 0.92 (range 0.78-0.96) and 0.96 (range 0.89-0.98), respectively.
  
  
  CONCLUSIONS
  Audio-spectrum analysis reflects the subjective perception of Doppler sound signals in the umbilical artery and has a strong correlation to TAM-velocity. This information might be of importance for clinical management of complicated pregnancies as an addition to conventional Doppler parameters.
authors.affiliation: Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden. ann.thuring@med.lu.se
authors.forename: Ann
authors.initials: A
authors.lastname: Thuring
authors.forename: K Jonas
authors.initials: KJ
authors.lastname: Brännström
authors.forename: Maria
authors.initials: M
authors.lastname: Ewerlöf
authors.forename: Edgar
authors.initials: E
authors.lastname: Hernandez-Andrade
authors.forename: David
authors.initials: D
authors.lastname: Ley
authors.forename: Göran
authors.initials: G
authors.lastname: Lingman
authors.forename: Karina
authors.initials: K
authors.lastname: Liuba
authors.forename: Karel
authors.initials: K
authors.lastname: Maršál
authors.forename: Tomas
authors.initials: T
authors.lastname: Jansson
mesh_terms: D000818:Animals; D001307:Auditory Perception; D001783:Blood Flow Velocity; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005311:Fetal Hypoxia / Q000000981:diagnostic imaging; D005333:Fetus / Q000098:blood supply; D006801:Humans; D017056:Medical Laboratory Personnel; D021041:Placental Circulation; D011247:Pregnancy; D012756:Sheep; D013018:Sound Spectrography; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging*