Intraexaminer and Interexaminer Variability in 3D Fetal Volume Measurements During the Second and Third Trimesters of Pregnancy

Simcox, Louise; Higgins, Lucy; Myers, Jenny; Johnstone, Edward

doi:10.7863/ultra.16.03045

Cited by 10 publications

(9 citation statements)

References 48 publications

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“…We previously demonstrated that TVol is highly reproducible in clinical practice 30 and this holds true for measurements obtained late in the third trimester. 51 Few studies evaluated the interobserver reliability of ultrasound-derived EFW 52 but this can vary by as much as 15-20% from actual birthweight.…”

Section: Commentmentioning

confidence: 73%

“…Reproducibility of TVol measurements has previously been examined in 25 women in the second trimester and 33 women in the third trimester, and across both trimesters in 40 women in separate studies. 30 , 32 The intraclass correlations were 0.992 for intraexaminer variability and 0.943 for interexaminer variability. 30 …”

Section: Methodsmentioning

confidence: 88%

“… 30 , 32 The intraclass correlations were 0.992 for intraexaminer variability and 0.943 for interexaminer variability. 30 …”

Section: Methodsmentioning

confidence: 88%

“…and E.D.J. [Royal College of Radiologists accredited]) with ≥4 years of experience with obstetric ultrasound, 30 using a Voluson E6 (GE Healthcare, Chicago, IL) with 3D 4- to 8-Hz curvilinear probe. The study protocol included a scan for 2D fetal biometry (biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], femur length [FL]), and 3D TVol at 14-16, 20-22, 26-28, and 34-36 weeks’ gestation.…”

Section: Methodsmentioning

confidence: 99%

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Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy

Simcox

Myers

Cole

et al. 2017

American Journal of Obstetrics and Gynecology

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BackgroundCurrently, 2-dimensional ultrasound estimation of fetal size rather than fetal growth is used to define fetal growth restriction, but single estimates in late pregnancy lack sensitivity and may identify small for gestational age rather than growth restriction. Single or longitudinal measures of 3-dimensional fractional thigh volume may address this problem.ObjectiveWe sought to derive normal values for 3-dimensional fractional thigh volume in the third trimester, determine if fractional thigh volume is superior to 2-dimensional ultrasound biometry alone for detecting fetal growth restriction, and determine whether individualized growth assessment parameters have the potential to identify fetal growth restriction remote from term delivery.Study DesignThis was a longitudinal prospective cohort study of 115 unselected pregnancies in a tertiary referral unit (St Mary’s Hospital, Manchester, United Kingdom). Standard 2-dimensional ultrasound biometry measurements were obtained, along with fractional thigh volume measurements (based on 50% of the femoral diaphysis length). Measurements were used to calculate estimated fetal weight (Hadlock). Individualized growth assessment parameters and percentage deviations in longitudinally measured biometrics were determined using a Web-based system (iGAP; http://iGAP.research.bcm.edu). Small for gestational age was defined <10th and fetal growth restriction <3rd customized birthweight centile. Logistic regression was used to compare estimated fetal weight (Hadlock), estimated fetal weight (biparietal diameter–abdominal circumference–fractional thigh volume), fractional thigh volume, and abdominal circumference for the prediction of small for gestational age or fetal growth restriction at birth. Screening performance was assessed using area under the receiver operating characteristic curve.ResultsThere was a better correlation between fractional thigh volume and estimated fetal weight ((biparietal diameter–abdominal circumference–fractional thigh volume) obtained at 34-36 weeks with birthweight than between 2-dimensional biometry measures such as abdominal circumference and estimated fetal weight (Hadlock). There was also a modest improvement in the detection of both small for gestational age and fetal growth restriction using fractional thigh volume–derived measures compared to standard 2-dimensional measurements (area under receiver operating characteristic curve, 0.86; 95% confidence interval, 0.79–0.94, and area under receiver operating characteristic curve, 0.92; 95% confidence interval, 0.85–0.99, respectively).ConclusionFractional thigh volume measurements offer some improvement over 2-dimensional biometry for the detection of late-onset fetal growth restriction at 34-36 weeks.

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Section: Commentmentioning

confidence: 73%

Section: Methodsmentioning

confidence: 88%

“… 30 , 32 The intraclass correlations were 0.992 for intraexaminer variability and 0.943 for interexaminer variability. 30 …”

Section: Methodsmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

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Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy

Simcox

Myers

Cole

et al. 2017

American Journal of Obstetrics and Gynecology

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“…27,[60][61][62][63][64] While previous studies have found the intra-and interexaminer variability to be increased in the second trimester assessment, measurements in our study showed good reproducibility with high correlation coefficients across trimesters. 65 Alternatively, although several studies have demonstrated good reproducibility of 3DPD indices, 11,19,66,67 we found that 3DPD indices can be quite variable. 68 An advancing gestation, increased placental size and difficulty delineating the myometrial border from the placenta can lead to variation in placental volume and vascularity measurements using the VOCAL technique with means of vascular indices varying greatly in different studies.…”

Section: Discussionmentioning

confidence: 52%

The Impact of Aspirin on Ultrasound Markers of Uteroplacental Flow in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT

et al. 2018

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Objective This article evaluates the effect of low-dose aspirin on uterine artery (UtA) Doppler, placental volume, and vascularization flow indices in low-risk pregnancy. Study Design In this secondary analysis of the TEST randomized controlled trial, low-risk nulliparous women were originally randomized at 11 weeks to: (1) routine aspirin 75 mg; (2) no aspirin; and (3) aspirin based upon the preeclampsia Fetal Medicine Foundation screening test. UtA Doppler, three-dimensional (3D) placental volume, and vascularization flow indices were assessed prior to and 6 weeks postaspirin commencement. Results A total of 546 women were included (aspirin n = 192, no aspirin n = 354). Between first and second trimesters, aspirin use was not associated with a change in UtA Doppler, placental volume, or vascular flow indices. There was no significant difference in the change in UtA Doppler pulsatility index (PI) Z-scores or notching (PI Z-score –0.2 vs. –0.2, p = 0.17), nor was there a significant change in placental volume Z-score and vascular flow indices (volume Z-score change: 0.74 vs. 0.62, p = 0.34). Conclusion Low-dose aspirin commenced at 11 weeks in low-risk women does not appear to improve uterine and placental perfusion or placental volume. Any perceived effect on uteroplacental vasculature is not reflected in changes in placental volume nor uteroplacental flow as assessed by two-dimensional and 3D ultrasound.

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Applying spatial–temporal image correlation to the fetal kidney: Repeatability of 3D segmentation and volumetric impedance indices

Stevenson

Ferreira

Pathirana

et al. 2018

Australas J Ultrason Med

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Introduction: Spatiotemporal image correlation (STIC) can evaluate fetal renal impedance using four-dimensional volumetric indices. We assessed repeatability of three-dimensional kidney segmentation and the repeatability of the resultant indices. Methods: In each of 57 healthy pregnant women, three renal artery pulsed-wave Doppler (PWD) traces and three STIC volumes were acquired from the same fetal kidney and segmented by two observers. Vascularisation-flow index (VFI) and fractional moving blood volume (FMBV) were calculated for every STIC frame and used to determine the volumetric pulsatility index (vPI), volumetric resistance index (vRI) and volumetric systolic/diastolic ratio (vS/D). Segmentation performance was assessed using Dice similarity coefficients (DSCs), Hausdorff distances, coefficient of variation (CoV) and the intraclass correlation coefficient (ICC). Intra/Inter volumetric index repeatability was assessed using ICCs. Results: Forty-eight cases (84%) provided full data. Mean intra-and interobserver DSCs were 0.90 and 0.81. Mean intra-and interobserver Hausdorff distances were 3.88 mm and 5.27 mm. Average kidney volumes for observers 1 and 2 were 9.88 mL and 8.54 mL (mean difference 16.1%). Mean intra-observer volumetric CoVs were 5.3% and 8.1%. Intra-and interobserver ICCs for kidney volume (same STIC volume) were 0.97 and 0.85. When assessing volume variation between STIC volumes, intra-observer ICC was 0.97. ICCs were 0.77-0.81 for VFI-derived volumetric indices and 0.61-0.62 for FMBV-derived indices; ICCs for all PWD indices were between 0.58 and 0.59. Conclusions: Periodical variation in vascularity was demonstrated in the fetal kidney, and three-dimensional segmentation was highly repeatable. Derived volumetric impedance indices show moderate variability but outperform corresponding two-dimensional PWD indices in terms of reproducibility.

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Intraexaminer and Interexaminer Variability in 3D Fetal Volume Measurements During the Second and Third Trimesters of Pregnancy

Cited by 10 publications

References 48 publications

Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy

Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy

The Impact of Aspirin on Ultrasound Markers of Uteroplacental Flow in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT

Applying spatial–temporal image correlation to the fetal kidney: Repeatability of 3D segmentation and volumetric impedance indices

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