title: Evaluation of fetal cerebral blood flow perfusion using power Doppler ultrasound angiography (3D-PDA) in growth-restricted fetuses.
abstract: OBJECTIVE
  to explore the potential of 3D Power Doppler Angiography (3D PDA) to evaluate the cerebral circulation in normal and growth restricted fetuses (IUGR).
  
  
  METHODS
  in a pilot study, we enrolled 51 appropriate for gestational age (AGA) pregnancies and 17 singleton pregnancies presenting IUGR, all between 22 and 38 weeks of gestation. Using 3D power Doppler ultrasound, a -volume acquisition of the fetal brain was performed. Two regions of interest (ROI) were defined within the fetal brain. Zone 1 is anterior to the cavum septi pellucidi (CSP). Zone 2 is defined by a rectangle obtained tracing a contour -between the temporal bones as wide as the CSP, corresponding to the area of the middle cerebral artery. The Flow Index (FI), the Vascularization Index (VI), the Vascularization and Flow Index (VFI) were determined in both areas in both IUGR and AGA fetuses by a single operator. IUGR fetuses were divided into three groups: Group 1, with normal pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV); Group 2, IUGR fetuses with abnormal UA PI, normal MCA PI, normal DV PI; in Group 3, IUGR fetuses with abnormal UA PI, MCA PI and DV PI.
  
  
  RESULTS
  FI and VFI values of zone 1 were increased in Group 1.Values of VFI in zone 2 were increased in Group 2.
  
  
  CONCLUSIONS
  Our findings are in line with recent studies in growth-restricted fetuses suggesting that the anterior -cerebral artery shows Doppler signs of vasodilatation before these are observed in the MCA, demonstrating the "frontal brain sparing effect".
authors.affiliation: Department of Obstetrics and Gynecology, University of Udine, Piazza Misericordia 15, 33100 Udine (Italy).
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Obstetrics and Gynecology, University of Udine, Piazza Misericordia 15, 33100 Udine (Italy).
authors.forename: I
authors.initials: I
authors.lastname: Romanello
authors.affiliation: Department of Obstetrics and Gynecology, University of Udine, Piazza Misericordia 15, 33100 Udine (Italy).
authors.forename: L
authors.initials: L
authors.lastname: Forzano
authors.affiliation: Department of Obstetrics and Gynecology, University of Udine, Piazza Misericordia 15, 33100 Udine (Italy).
authors.forename: G
authors.initials: G
authors.lastname: Fachechi
authors.affiliation: Department of Obstetrics and Gynecology, University of Udine, Piazza Misericordia 15, 33100 Udine (Italy).
authors.forename: D
authors.initials: D
authors.lastname: Marchesoni
keywords: Growth restricted fetus; brain sparing effect; three dimensional power Doppler angiography
references.citation: Ultrasound Obstet Gynecol. 2002 Aug;20(2):117-21
references.pmid: 12153660
references.citation: Croat Med J. 2005 Oct;46(5):765-71
references.pmid: 16158469
references.citation: Ultrasound Obstet Gynecol. 2008 Jul;32(1):71-6
references.pmid: 18570240
references.citation: Ultrasound Obstet Gynecol. 2001 Dec;18(6):571-7
references.pmid: 11844191
references.citation: Curr Opin Obstet Gynecol. 2001 Apr;13(2):161-8
references.pmid: 11315871
references.citation: Am J Obstet Gynecol. 2010 Jun;202(6):522-8
references.pmid: 20074690
references.citation: Ultrasound Obstet Gynecol. 2002 May;19(5):438-42
references.pmid: 11982974
references.citation: Am J Obstet Gynecol. 1985 Feb 1;151(3):333-7
references.pmid: 3881966
references.citation: Radiology. 1995 Oct;197(1):183-90
references.pmid: 7568820
references.citation: J Perinat Med. 2004;32(3):228-33
references.pmid: 15188796
references.citation: J Neurocytol. 2002 Mar-Jun;31(3-5):373-85
references.pmid: 12815254
references.citation: Pediatrics. 2000 Feb;105(2):385-91
references.pmid: 10654960
references.citation: Am J Obstet Gynecol. 2005 Feb;192(2):497-503
references.pmid: 15695993
references.citation: Acta Obstet Gynecol Scand. 1988;67(4):347-54
references.pmid: 3051883
references.citation: Ultrasound Obstet Gynecol. 2000 Oct;16(5):407-13
references.pmid: 11169323
references.citation: Acta Obstet Gynecol Scand. 1996 Aug;75(7):612-9
references.pmid: 8822652
references.citation: Ultrasound Obstet Gynecol. 1999 Aug;14(2):139-43
references.pmid: 10492874
references.citation: Curr Opin Obstet Gynecol. 2002 Apr;14(2):127-35
references.pmid: 11914689
references.citation: Ultrasound Obstet Gynecol. 2007 Sep;30(3):297-302
references.pmid: 17661428
references.citation: Radiology. 1994 Mar;190(3):853-6
references.pmid: 8115639
references.citation: Ultrasound Med Biol. 2003 Jan;29(1):19-23
references.pmid: 12604113
references.citation: Pediatrics. 2006 Jul;118(1):91-100
references.pmid: 16818553
references.citation: Brain Res. 2006 Oct 30;1117(1):186-94
references.pmid: 16962082
references.citation: Angiology. 1971 Jan;22(1):52-5
references.pmid: 5101050
references.citation: Ultrasound Obstet Gynecol. 2008 Dec;32(7):877-83
references.pmid: 18991324
references.citation: Am J Obstet Gynecol. 1992 Apr;166(4):1262-70
references.pmid: 1566783