Purpose
Vitamin B deficiency has been identified as a risk factor for vascular events. However, the reduction of vascular events was not shown in large randomized controlled trials evaluating ...B‐Vitamin therapy. There is an important requirement to develop sensitive biomarkers to be used as efficacy targets for B‐Vitamin therapy as well as other dietary treatments and lifestyle regimes that are being developed. Carotid vessel‐wall‐plus‐plaque thickness change (VWT‐Change) measured from 3D ultrasound has been shown to be sensitive to atorvastatin therapies in previous studies. However, B‐Vitamin treatment is expected to confer a smaller beneficial effect in carotid atherosclerosis than the strong dose of atorvastatin. This paper introduces a sensitive atherosclerosis biomarker based on the weighted mean VWT‐Change measurement from 3D ultrasound with a purpose to detect statistically significant effect of B‐Vitamin therapy.
Methods
Of the 56 subjects analyzed in this study, 27 were randomized to receive a B‐Vitamin tablet daily and 29 received a placebo tablet daily. Participants were scanned at baseline and 1.9 ± 0.8 yr later. The 3D VWT map at each scanning session was computed by matching the outer wall and lumen surfaces on a point‐by‐point basis. The 3D annual VWT‐Change maps were obtained by first registering the 3D VWT maps obtained at the baseline and follow‐up scanning sessions, and then taking the point‐wise difference in VWT and dividing the result by the years elapsed from the baseline to the follow‐up scanning session. The 3D VWT‐Change maps constructed for all patients were mapped to a 2D carotid template to adjust for the anatomic variability of the arteries. A weight at each point of the carotid template was assigned based on the degree of correlation between the VWT‐Change measurements exhibited at that point and the treatment received (i.e., B‐Vitamin or placebo) quantified by mutual information. The weighted mean of VWT‐Change for each patient, denoted by ΔVWT¯Weighted, was computed according to this weight. T‐tests were performed to compare the sensitivity of ΔVWT¯Weighted with existing biomarkers in detecting treatment effects. These biomarkers included changes in intima‐media thickness (IMT), total plaque area (TPA), vessel wall volume (VWV), unweighted average of VWT‐Change (ΔVWT¯) and a previously described biomarker, denoted by ΔVWT¯S, that quantifies the mean VWT‐Change specific to regions of interest identified by a feature selection algorithm.
Results
Among the six biomarkers evaluated, the effect of B Vitamins was detected only by ΔVWT¯Weighted in this cohort (P=4.4×10−3). The sample sizes per treatment group required to detect an effect as large as exhibited in this study were 139, 178, 41 for ΔVWV, ΔVWT¯ and ΔVWT¯Weighted respectively.
Conclusion
The proposed weighted mean of VWT‐Change is more sensitive than existing biomarkers in detecting treatment effects. This measurement tool will allow for many proof‐of‐principal studies to be performed for various novel treatments before a more costly study involving a larger population is held to validate the results.
Can a novel deep learning-based follicle volume biomarker using three-dimensional ultrasound (3D-US) be established to aid in the assessment of oocyte maturity, timing of HCG administration and the ...individual prediction of ovarian hyper-response?
A total of 515 IVF cases were enrolled, and 3D-US scanning was carried out on HCG administration day. A follicle volume biomarker established by means of a deep learning-based segmentation algorithm was used to calculate optimal leading follicle volume for predicting number of mature oocytes retrieved and optimizing HCG trigger timing. Performance of the novel biomarker cut-off value was compared with conventional two-dimensional ultrasound (2D-US) follicular diameter measurements in assessing oocyte retrieval outcome. Moreover, demographics, infertility work-up and ultrasound biomarkers were used to build models for predicting ovarian hyper-response.
On the basis of the deep learning method, the optimal cut-off value of the follicle volume biomarker was determined to be 0.5 cm3 for predicting number of mature oocytes retrieved; its performance was significantly better than the conventional method (two-dimensional diameter measurement ≥10 mm). The cut-off value for leading follicle volume to optimize HCG trigger timing was determined to be 3.0 cm3 and was significantly associated with a higher number of mature oocytes retrieved (P = 0.01). Accuracy of the multi-layer perceptron model was better than two-dimensional diameter measurement (0.890 versus 0.785) and other multivariate classifiers in predicting ovarian hyper-response (P < 0.001).
Deep learning segmentation methods and multivariate classifiers based on 3D-US were found to be potentially effective approaches for assessing mature oocyte retrieval outcome and individual prediction of ovarian hyper-response.
Introduction
Obesity rates have reached an epidemic level and bariatric surgery is the most effective method of sustainable weight loss. Pregnancy following bariatric surgery is associated with an ...increased prevalence of small babies. The objective of the study is to compare the fetal fat distribution, as assessed by fractional arm and thigh volume using three‐dimensional ultrasonography, in pregnancies following maternal bariatric surgery with those without such history.
Material and methods
This is a prospective, longitudinal, observational study conducted in a Maternity Unit in the UK. The study included 189 pregnant women; 63 with previous bariatric surgery 27 restrictive (13 with gastric band, 14 with sleeve gastrectomy) and 36 malabsorptive procedures and 126 with no previous surgery but similar maternal booking body mass index. Fetal arm and thigh volume were obtained at 30‐33 and 35‐37 weeks’ gestation and fractional limb volumes were calculated using a commercially available software. Women underwent a 75 g, 2 h oral glucose tolerance test at 28‐31 weeks of gestation.
Results
Overall, adjusted fetal arm and thigh volume were smaller in the post‐bariatric, compared to the no surgery, group and this was more marked in women who had undergone a previous sleeve gastrectomy (P < .001 and P = .002, respectively) or a malabsorptive procedure (P < .001 for both). There was a strong positive correlation between maternal fasting/post‐prandial (2 h) glucose levels, at the time of the oral glucose tolerance test, and arm and thigh volume at both 30‐33 and 35‐37 weeks (P < .01 for all).
Conclusions
The study has demonstrated that in the third trimester of pregnancy, fetuses of women with previous bariatric surgery have smaller fractional limb volumes, therefore less soft tissue, compared to fetuses of women without such surgery and this may be related to the lower maternal glucose levels seen in the former pregnancies.
Adenomyosis is linked to infertility, but the mechanisms behind this relationship are not clearly established. Similarly, the impact of adenomyosis on ART outcome is not fully understood. Our main ...objective was to use ultrasound imaging to investigate adenomyosis prevalence and severity in a population of infertile women, as well as specifically among women experiencing recurrent miscarriages (RM) or repeated implantation failure (RIF) in ART.
Cross-sectional study conducted in 1015 patients undergoing ART from January 2009 to December 2013 and referred for 3D ultrasound to complete study prior to initiating an ART cycle, or after ≥3 IVF failures or ≥2 miscarriages at diagnostic imaging unit at university-affiliated private IVF unit. Adenomyosis was diagnosed in presence of globular uterine configuration, myometrial anterior-posterior asymmetry, heterogeneous myometrial echotexture, poor definition of the endometrial-myometrial interface (junction zone) or subendometrial cysts. Shape of endometrial cavity was classified in three categories: 1.-normal (triangular morphology); 2.- moderate distortion of the triangular aspect and 3.- "pseudo T-shaped" morphology.
The prevalence of adenomyosis was 24.4 % (n = 248) 29.7 % (94/316) in women aged ≥40 y.o and 22 % (154/699) in women aged <40 y.o., p = 0.003). Its prevalence was higher in those cases of recurrent pregnancy loss 38.2 % (26/68) vs 22.3 % (172/769), p < 0.005 and previous ART failure 34.7 % (107/308) vs 24.4 % (248/1015), p < 0.0001. The presence of adenomyosis has been shown to be associated to endometriosis 35.1 % (34/97). Adenomyosis was diagnosed as a primary finding "de novo" in 80.6 % (n = 200) of the infertile patients. The impact on the uterine cavity was mild, moderate and severe in 63.7, 22.6 and 10.1 % of the cases, respectively.
Our results indicate that adenomyosis is a clinical condition with a high prevalence that may affect the reproductive results. The described severity criteria may help future validating studies for better counseling of infertile couples.
Abstract
STUDY QUESTION
Does IVF with or without ICSI (IVF/ICSI) treatment impact the development of embryonic brain structures?
SUMMARY ANSWER
Our results show associations between IVF/ICSI ...treatment, smoking and slightly increased sizes of early human embryonic brain structures.
WHAT IS KNOWN ALREADY
The number of IVF/ICSI procedures is increasing worldwide and is associated with higher risks of obstetric and perinatal complications in pregnancies.
STUDY DESIGN, SIZE, DURATION
One hundred seventy-five women with a singleton pregnancy were included in the Rotterdam Periconceptional Cohort (Predict study).
PARTICIPANTS/MATERIALS, SETTING, METHODS
Self-reported questionnaires, verified by a research assistant at enrollment, provided information on periconceptional maternal characteristics and mode of conception. Three-dimensional ultrasound (3D-US) examinations were performed at 9 and 11 weeks of gestational age (GA). Diencephalon total diameter (DTD), mesencephalon total diameter (MTD) and telencephalon thickness on the left and right site (TTL/TTR) were measured offline in standardized planes using 4D View software. Linear regression models with adjustment for GA, maternal age, body mass index, moment of initiation of folic acid supplement use and smoking were used to study associations between mode of conception and embryonic brain measurements at 9 and 11 weeks of GA.
MAIN RESULTS AND ROLE OF CHANCE
A total of 276 3D-US scans of 166 participants, of which 50 conceived through IVF/ICSI, were included for embryonic brain measurements. Success rates of the DTD and MTD measurements were between 67% and 73% and of the TTL/TTR between 52% and 57%. In the fully adjusted model, we found that at 11 weeks of GA, the MTD (ß = 0.264, 95% CI = 0.101; 0.427, P < 0.01) and TTR (ß = 0.075, 95% CI = 0.001; 0.149, P < 0.05) sizes were larger in IVF/ICSI pregnancies. In addition, smoking also resulted in larger TTL measurements at 11 weeks of GA (ß = 0.095, 95% CI= 0.005; 0.186, P < 0.05).
LIMITATIONS, REASONS FOR CAUTION
The implications of these small deviations on brain functioning need further investigation.
WIDER IMPLICATIONS OF THE FINDINGS
Enlargement of attention for prenatal brain development and postnatal neurodevelopmental outcome after IVF/ICSI treatment.
STUDY FUNDING/COMPETING INTERESTS
This study was funded by the Department of Obstetrics and Gynecology, Erasmus MC, and Sophia research foundation for Medical Research, Rotterdam, the Netherlands (SSWO grant number 644). No competing interests are declared.
TRIAL REGISTRATION NUMBER
N/A
Three-dimensional ultrasound (3D-US) examination is a relatively new modality that can be used for abdominal aortic aneurysm (AAA) surveillance, and may offer improved reproducibility over ...conventional two-dimensional ultrasound (2D-US) examination. The aim of this study was to evaluate the interoperator reproducibility of maximum anterior-to-posterior diameter by nonphysician ultrasound technicians in a typical vascular laboratory setting, on patients with infrarenal AAAs using 3D-US and 2D-US examination.
A total of 134 consecutive patients with asymptomatic infrarenal AAAs were screened. Of the 134 patients, 28 (21%) were screen failures. From the remaining 106 patients, 3 (2.8%) had missing data and 13 (12.3%) had technically unacceptable image quality. As a result, 90 patients were included for final analysis. Ultrasound image acquisitions were performed during the single visit. The 2D-US images were evaluated at the time of examination by the respective ultrasound technicians who acquired them. All 3D-US images were evaluated offline by both ultrasound technicians after a wash-out period of at least 6 weeks.
Excellent interoperator reproducibility was observed for measuring maximum diameter using 3D-US (intraclass correlation coefficient, 0.97), and good agreement among ultrasound technicians (mean difference, −0.08 mm; limits of agreement, −3.17; 3.00 mm). When using 3D-US examination, 74 of the 90 patients (82%) were estimated within 2 mm of interoperator variability. Of 90 patients, 52 (58%) were estimated to be within the same variability by 2D-US examination. Estimating AAA diameter using 3D-US was superior to 2D-US with respect to interoperator reproducibility.
Both 3D-US and 2D-US examination demonstrated good reproducibility among two vascular ultrasound technicians with superior agreement from 3D-US examination. The present results support the broader use of 3D-US in standard AAA surveillance programs.
Ex vivo ultrasound (US) of human tissues has been used for decades on the study of the acoustic physical aspects of the US, to the study of the morphology of the organs. Using three‐dimensional (3D) ...US, we demonstrate the possibilities to study surgical specimens from gynecological conditions. 3D images of the surgical specimen were collected and virtually segmented according to the contrast of its images, providing a 3D image of the ectopic pregnancy and its effects on the fallopian tube.
Three‐dimensional (3D) ultrasound can provide high‐definition images of ex vivo gynecological conditions. From acoustic properties to morphological studies, these images can be segmented, creating 3D images with the spatial relationship between normal and abnormal tissues. In this case, we segmented an ectopic pregnancy, enhancing its main features sing an open‐source software.
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