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Objectives: This study aims to correlate pelvic ultrasound with female puberty and evaluate the usual ultrasound parameters as diagnostic tests for the onset of puberty and, in particular, a less studied parameter: the Doppler evaluation of the uterine arteries. Methods: Cross-sectional study with girls aged from one to less than eighteen years old, with normal pubertal development, who underwent pelvic ultrasound examination from November 2020 to December 2021. The presence of thelarche was the clinical criterion to distinguish pubescent from non-pubescent girls. The sonographic parameters were evaluated using the ROC curve and the cutoff point defined through the Youden index (J). Results: 60 girls were included in the study. Uterine volume ≥ 2.45mL had a sensitivity of 93%, specificity of 90%, PPV of 90%, NPV of 93% and accuracy of 91% (AUC 0.972) for predicting the onset of puberty. Mean ovarian volume ≥ 1.48mL had a sensitivity of 96%, specificity of 90%, PPV of 90%, NPV of 97% and accuracy of 93% (AUC 0.966). Mean PI ≤ 2.75 had 100% sensitivity, 48% specificity, 62% PPV, 100% NPV and 72% accuracy (AUC 0.756) for predicting the onset of puberty. Conclusion: Pelvic ultrasound proved to be an excellent tool for female pubertal assessment and uterine and ovarian volume, the best ultrasound parameters for detecting the onset of puberty. The PI of the uterine arteries, in this study, although useful in the pubertal evaluation, showed lower accuracy in relation to the uterine and ovarian volume.
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Pubertad , Humanos , Femenino , Estudios Transversales , Niño , Pubertad/fisiología , Adolescente , Preescolar , Útero/diagnóstico por imagen , Útero/irrigación sanguínea , Lactante , Sensibilidad y Especificidad , Arteria Uterina/diagnóstico por imagen , Ovario/diagnóstico por imagen , Ovario/irrigación sanguínea , Pelvis/diagnóstico por imagen , Pelvis/irrigación sanguínea , Ultrasonografía , Curva ROCRESUMEN
Abstract Objectives: This study aims to correlate pelvic ultrasound with female puberty and evaluate the usual ultrasound parameters as diagnostic tests for the onset of puberty and, in particular, a less studied parameter: the Doppler evaluation of the uterine arteries. Methods: Cross-sectional study with girls aged from one to less than eighteen years old, with normal pubertal development, who underwent pelvic ultrasound examination from November 2020 to December 2021. The presence of thelarche was the clinical criterion to distinguish pubescent from non-pubescent girls. The sonographic parameters were evaluated using the ROC curve and the cutoff point defined through the Youden index (J). Results: 60 girls were included in the study. Uterine volume ≥ 2.45mL had a sensitivity of 93%, specificity of 90%, PPV of 90%, NPV of 93% and accuracy of 91% (AUC 0.972) for predicting the onset of puberty. Mean ovarian volume ≥ 1.48mL had a sensitivity of 96%, specificity of 90%, PPV of 90%, NPV of 97% and accuracy of 93% (AUC 0.966). Mean PI ≤ 2.75 had 100% sensitivity, 48% specificity, 62% PPV, 100% NPV and 72% accuracy (AUC 0.756) for predicting the onset of puberty. Conclusion: Pelvic ultrasound proved to be an excellent tool for female pubertal assessment and uterine and ovarian volume, the best ultrasound parameters for detecting the onset of puberty. The PI of the uterine arteries, in this study, although useful in the pubertal evaluation, showed lower accuracy in relation to the uterine and ovarian volume.
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Humanos , Femenino , Niño , Pubertad Precoz/diagnóstico por imagen , Ultrasonografía , Ultrasonografía Doppler en Color , Arteria UterinaRESUMEN
SUMMARY OBJECTIVE: Round shape is generally considered to reduce the risk of malignancy according to recent guidelines. On the contrary, according to some reports, spherically shaped thyroid nodules are associated with a higher risk of malignancy. Thus, we aimed to evaluate the malignancy risk of solid round isoechoic nodules detected at thyroid ultrasonography and compare it with that of solid ovoid isoechoic nodules. METHODS: Between 2017 and 2022, solitary solid round isoechoic nodules with diameters ³10 and £25 mm at thyroid ultrasonography were retrospectively selected and enrolled in the study. Age, size, nodule volume, serum thyrotropin levels, thyroid antibody levels, and cytopathological and histopathological results were recorded. RESULTS: A total of 457 solitary solid isoechoechoic nodules from 457 patients (262 females and 195 males; median age, 59 [31-70] years) were selected, of which 203 were solid round isoechoic nodules, and 254 were solid ovoid isoechoic nodules. A total of 54 surgical operations were performed on 457 nodules, and 31 of them resulted in malignancy. From the 31 malignant results, 25 originated from solid round isoechoic nodules and the remaining 6 originated from solid ovoid isoechoic nodules (p<0.025). CONCLUSION: We found that round nodules have higher malignancy rates than ovoid nodules. We think that ultrasonographic risk stratification systems used to target the most suitable nodules for the necessary biopsies can be dynamically updated, and sphericity can be added as a parameter in patient-based decision-making.
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In a companion paper, Ojeda-Rojas et al. (2021) [1] describe a stochastic agent-based simulation (ABS) model of a cow-calf operation on a commercial farm in São Paulo, Brazil. The model's parameterization was based on data collected from two sources: a real beef cattle herd and related scientific literature. Based on the mentioned simulation model, this study aims to assess the economic outcome of 10 different reproductive scenarios: Natural mating only (ONM); one timed artificial insemination (TAI) plus natural mating (NM) (1TAI + NM); two TAI plus NM, with 24, 32, and 40 days between TAI (2TAI/24 + NM, 2TAI/32 + NM, and 2TAI/40 + NM, respectively); three TAI without NM, with 24, 32, and 40 days between TAI (3TAI/24, 3TAI/32, and 3TAI/40, respectively); and three TAI plus NM, with an interval between TAI of 24 (3TAI/24 + NM) and 32 days (3TAI/32 + NM). The simulation was performed on an animal-by-animal basis over a time horizon of 5000 days. Each scenario had 32 farms, and each farm kept up to 400 adult females. According to the scenario, a bull population was composed of 0, 7, or 15 individuals. The outcomes, represented as means ± standard deviations, were assessed after reaching a steady-state (1825 days). The model outcomes showed that the 3TAI/24 + NM scenario resulted in higher incomes (US$ 96,479.19 ± 709.81), whereas the ONM scenario had the lowest incomes (US$ 79,753.37 ± 741.87). The 3TAI/24 + NM (US$ 101.720.63 ± 79.21) and ONM (US$ 90.898.58 ± 59.17) scenarios presented the highest and lowest total operating costs (TOC), respectively. However, when TOC was evaluated per kg of the weaned calf, the highest and lowest costs were associated with the ONM (US$ 2.81 ± 0.03/kg) and 2TAI/24 + NM (US$ 2.17 ± 0,04/kg) scenarios, respectively. Our model suggests that reproductive strategies that use TAI have a better economic performance than those under NM. However, when performing three TAI with an interval of 40 days, the benefit was lower; in some cases, it was even worse than the ONM. Combining TAI with early pregnancy diagnosis resulted in better economic performance than other TAI programs and NM. The 2TAI/24 + NM scenario outperformed the others due to the contrast between its high income and moderate costs. Beef cattle production is a highly complex system. Simulations models, specifically ABS models, could make the decision-making process on complex systems straightforward and effective. Furthermore, ABS models can overcome the limitations of conventional research approaches, such as high costs and long experimentation periods.
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Industria Lechera , Sincronización del Estro , Inseminación Artificial , Animales , Brasil , Bovinos , Industria Lechera/métodos , Sincronización del Estro/métodos , Femenino , Inseminación Artificial/métodos , Inseminación Artificial/veterinaria , Masculino , Embarazo , ReproducciónRESUMEN
The objective of this study was to create a stochastic, agent-based simulation model of a synthetic population of beef cattle, and then use it to compare the technical performance of different reproductive strategies. The model was parameterized using data from a real beef cattle herd and from the peer-reviewed scientific literature to represent a Nelore cattle herd in the state of São Paulo, Brazil. Ten scenarios were evaluated: natural mating (NM) only (ONM); one timed artificial insemination (TAI) plus NM (1TAI + NM); two TAI plus NM, with 24, 32, and 40 days between inseminations (2TAI/24 + NM, 2TAI/32 + NM, and 2TAI/40 + NM, respectively); three TAI without NM, with 24, 32, and 40 days between TAI (3TAI/24, 3TAI/32, and 3TAI/40, respectively); and three TAI plus NM, with 24 and 32 days (3TAI/24 + NM and 3TAI/32 + NM, respectively). NM began 10 days after the last TAI and was performed until the end of the breeding season. The size of the female herd was set to contain up to 400 individuals. The bull population was established at 0, 7, or 15 bulls depending on the used scenario. Simulation was performed for 5000 days. The outcomes for each scenario are means ± S.E. assessed on 32 farms at 1-day time intervals and on an animal-by-animal basis after steady state was reached (1825 days). The 3TAI/24 + NM scenario resulted in a greater number of births (279.85 ± 0.47 births), while the ONM scenario had the least value (202.38 ± 0.43 births). The heaviest males and females at weaning belonged to 3TAI/24, with 190.85 ± 0.17 kg for males and 173.89 ± 0.13 kg for females. The ONM scenario had the lightest males (166.84 ± 0.18 kg) and females (151.75 ± 0.16 kg). The greatest and least total pregnancy rates were found in 3TAI/24 + NM (0.91 ± 0.00) and ONM (0.62 ± 0.00), respectively. The ONM scenario required 52.5 days more than scenarios that included TAI to reach 50% of pregnancy. The greatest ages at culling for cows was 3TAI/24 + NM (3658.88 ± 10.41 days). In contrast, the lowest age at culling was found in ONM (2823.93 ± 8.28 days). We concluded that the proposed model represents the main interactions of a real beef cattle herd. It has all the advantages of a physical experiment, but does not require incurring significant expenses nor altering the real system. This study offers evidence that the scenarios that present the best technical performance are those that used TAI with a 24-day interval between inseminations.
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Sincronización del Estro , Inseminación Artificial , Animales , Brasil , Bovinos , Femenino , Inseminación Artificial/veterinaria , Masculino , Embarazo , Índice de Embarazo , ReproducciónRESUMEN
BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. METHODS: Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. RESULTS: Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. CONCLUSIONS: USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
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ABSTRACT: Carotid stenosis usually results from the accumulation of atherosclerotic plaque in the carotid artery wall and is an important risk factor for ischemic cerebral vascular accident (CVA). This study describes the importance of diagnostic imaging exams used in dentistry for the early identification of atheroma plaques in the extracranial and intracranial internal carotid artery. A male patient was referred to a radiology clinic to perform panoramic radiography (PR) and a cone beam computed tomography (CBCT) to develop treatment plan options. In the PR and CBCT a radiopaque image, suggestive of atheroma in the extracranial internal carotid artery, was observed on the right side. The diagnosis was confirmed by color DOPPLER ultrasonography. In the CBCT, the presence of calcifications in the intracranial internal carotid artery was also observed. Diagnostic imaging exams used in dentistry allow the identification of asymptomatic individuals, facilitating early intervention and consequent reduction in the risk of ischemic CVA.
RESUMEN: La estenosis carotídea generalmente es consecuencia de la acumulación de placa aterosclerótica en la pared de la arteria carótida y es un factor de riesgo importante para el accidente cerebral vascular (ACV) isquémico. Este estudio describe la importancia de los exámenes de diagnóstico por imágenes utilizados en odontología para la identificación precoz de placas de ateroma en la arteria carótida interna, a nivel extracraneal e intracraneal. Un paciente masculino fue remitido a una clínica de radiología para realizar una radiografía panorámica (RP) y tomografía computarizada de haz cónico (TCHC) para analizar opciones de tratamiento. En el RP y TCHC se observó una imagen radiopaca, sugestiva de ateroma en la arteria carótida, extracraneal, en el lado derecho. El diagnóstico fue confirmado por ultrasonido DOPPLER color carotídeo. En el TCHC, también se observó la presencia de calcificaciones en la arteria carótida interna, intracraneal. Los exámenes de imagenología diagnóstica utilizados en odontología permiten la identificación de individuos asintomáticos, lo que facilita la intervención temprana y la consiguiente reducción en el riesgo de ACV isquémico.
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Humanos , Masculino , Anciano , Radiografía Panorámica , Arterias Carótidas/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Placa Aterosclerótica/diagnóstico por imagen , Ultrasonografía Doppler en Color , Accidente Cerebrovascular/prevención & control , Diagnóstico PrecozRESUMEN
Establishment of pregnancy after embryo transfer is the ultimate goal of an embryo transfer program and increasing pregnancy rates and reducing pregnancy loss are mandatory. The utilization of treatments to improve conception rates in recipient mares has been the focus of several research groups over the last years and the results are controversial. Some studies using human chorionic gonadotrophin (hCG) found promising results. Our hypothesis was that hCG administration would cause an additional stimulation on luteal function, uterine and luteal vascularization and progesterone concentration, and the mares would have increased uterine and cervix tone. Therefore, in the present study the effects of hCG administration to induce ovulation, on day 0 (day of ovulation) or day 5 postovulation were evaluated on corpus luteum characteristics, reproductive tract vascularization, and serum progesterone concentration from ovulation until day 15 postovulation. Groups were: G1: (control) - no hCG; G2: 2500 IU of hCG to induce ovulation when a follicle greater than 35mm and uterine edema were detected; G3: 2500 IU hCG on day 0; G4: 2500 IU hCG on day 5 postovulation. Twelve mares were randomly assigned to each group, during consecutive cycles, in a Latin Square experimental design, in a total of 48 cycles. Doppler ultrasound evaluations were performed daily from day 0 until day 15 postovulation, including mesometrial vascularity, endometrial vascularity and corpus luteum vascularity. Blood samples were collected for serum progesterone concentration. Data was analyzed using the Proc Glimmix SAS Procedure for nonparametric variables and Proc Mixed for parametric parameters. There was no treatment effect for all variables studied (P > 0.05). Characteristics were only affected by day (P < 0.05). It can be concluded that hCG administration at the time points suggested in the current study did not alter the characteristics evaluated.
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Establishment of pregnancy after embryo transfer is the ultimate goal of an embryo transfer program and increasing pregnancy rates and reducing pregnancy loss are mandatory. The utilization of treatments to improve conception rates in recipient mares has been the focus of several research groups over the last years and the results are controversial. Some studies using human chorionic gonadotrophin (hCG) found promising results. Our hypothesis was that hCG administration would cause an additional stimulation on luteal function, uterine and luteal vascularization and progesterone concentration, and the mares would have increased uterine and cervix tone. Therefore, in the present study the effects of hCG administration to induce ovulation, on day 0 (day of ovulation) or day 5 postovulation were evaluated on corpus luteum characteristics, reproductive tract vascularization, and serum progesterone concentration from ovulation until day 15 postovulation. Groups were: G1: (control) - no hCG; G2: 2500 IU of hCG to induce ovulation when a follicle greater than 35mm and uterine edema were detected; G3: 2500 IU hCG on day 0; G4: 2500 IU hCG on day 5 postovulation. Twelve mares were randomly assigned to each group, during consecutive cycles, in a Latin Square experimental design, in a total of 48 cycles. Doppler ultrasound evaluations were performed daily from day 0 until day 15 postovulation, including mesometrial vascularity, endometrial vascularity and corpus luteum vascularity. Blood samples were collected for serum progesterone concentration. Data was analyzed using the Proc Glimmix SAS Procedure for nonparametric variables and Proc Mixed for parametric parameters. There was no treatment effect for all variables studied (P > 0.05). Characteristics were only affected by day (P < 0.05). It can be concluded that hCG administration at the time points suggested in the current study did not alter the characteristics evaluated.
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Femenino , Animales , Bovinos , Biomarcadores/análisis , Caballos/fisiología , Ciclo Estral/fisiología , Gonadotropina Coriónica/análisis , Transferencia de Embrión/veterinaria , Cuerpo Lúteo/fisiologíaRESUMEN
Establishment of pregnancy after embryo transfer is the ultimate goal of an embryo transfer program and increasing pregnancy rates and reducing pregnancy loss are mandatory. The utilization of treatments to improve conception rates in recipient mares has been the focus of several research groups over the last years and the results are controversial. Some studies using human chorionic gonadotrophin (hCG) found promising results. Our hypothesis was that hCG administration would cause an additional stimulation on luteal function, uterine and luteal vascularization and progesterone concentration, and the mares would have increased uterine and cervix tone. Therefore, in the present study the effects of hCG administration to induce ovulation, on day 0 (day of ovulation) or day 5 postovulation were evaluated on corpus luteum characteristics, reproductive tract vascularization, and serum progesterone concentration from ovulation until day 15 postovulation. Groups were: G1: (control) - no hCG; G2: 2500 IU of hCG to induce ovulation when a follicle greater than 35mm and uterine edema were detected; G3: 2500 IU hCG on day 0; G4: 2500 IU hCG on day 5 postovulation. Twelve mares were randomly assigned to each group, during consecutive cycles, in a Latin Square experimental design, in a total of 48 cycles. Doppler ultrasound evaluations were performed daily from day 0 until day 15 postovulation, including mesometrial vascularity, endometrial vascularity and corpus luteum vascularity. Blood samples were collected for serum progesterone concentration. Data was analyzed using the Proc Glimmix SAS Procedure for nonparametric variables and Proc Mixed for parametric parameters. There was no treatment effect for all variables studied (P > 0.05). Characteristics were only affected by day (P < 0.05). It can be concluded that hCG administration at the time points suggested in the current study did not alter the characteristics evaluated.(AU)
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Animales , Femenino , Bovinos , Gonadotropina Coriónica/análisis , Ciclo Estral/fisiología , Biomarcadores/análisis , Caballos/fisiología , Transferencia de Embrión/veterinaria , Cuerpo Lúteo/fisiologíaRESUMEN
Resumo Contexto A doença venosa crônica requer avaliação clínica, quantificação dos efeitos hemodinâmicos e definição da distribuição anatômica para decisão diagnóstica e tratamento. Métodos Estudo prospectivo realizado em 2015 com amostra de 1.384 pacientes (2.669 membros) com idade entre 17 e 85 anos, sendo 1.227 do sexo feminino. Nas respostas do questionário aplicado, os sintomas pesquisados eram dor, cansaço, sensação de peso, queimação, câimbras e formigamento. Para a formação dos grupos, foi considerado o número de membros, distribuídos em relação ao gênero, ao índice de massa corporal e à idade. Após a definição grupos e a realização do eco-Doppler para estudo da veia safena magna (VSM), os pacientes foram distribuídos em três grupos (I: sintomas presentes e varizes ausentes, II: sintomas ausentes e varizes presentes e III: sintomas presentes e varizes presentes). A análise estatística utilizou o teste qui-quadrado ou exato de Fisher para verificar a homogeneidade entre os grupos. Em caso de associação com significância de 5%, foi calculada a razão de chances. Resultados Para ambos os gêneros, foi observada chance de insuficiência da VSM 11,2 vezes maior no grupo III. Por sua vez, os casos de obesidade mórbida ocorreram 9,1 vezes mais no mesmo grupo. Além disso, pacientes na faixa etária entre 30 e 50 anos desse grupo apresentaram chance de insuficiência da VSM 43,1 vezes maior. Conclusões A insuficiência da VSM foi significantemente mais frequente no grupo III, tanto globalmente como considerando apenas os casos de obesidade mórbida e a faixa etária mais elevada.
Abstract Background Chronic venous disease demands clinical assessment, quantification of hemodynamic effects, and definition of anatomic distribution before diagnostic and treatment decisions can be made. Methods This is a prospective study conducted in 2015 with a sample of 1,384 patients (2,669 limbs) aged from 17 to 85 years, 1,227 of whom were female. The most common symptoms reported in response to the questionnaire were pain, tiredness, feelings of heaviness, burning, cramps, and tingling. Subsets were formed on the basis of number of limbs distributed by sex, body mass index, and age. After definition of subsets, Doppler ultrasonography was used to conduct examinations of the great saphenous vein (GSV) and patients were distributed into three clinical groups (I: symptoms present and varicose veins absent, II: symptoms absent and varicose veins present and III: symptoms present and varicose veins present). Statistical analysis employed the chi-square test or Fisher’s exact test to test for homogeneity between groups. When associations significant to 5% were detected, odds ratios were calculated. Results For both sexes, the chance of GSV insufficiency was 11.2 times greater in group III. Among cases with morbid obesity, the chance was 9.1 times greater in the same group. Additionally, patients in this group with ages ranging from 30 to 50 years exhibited a 43.1 times greater chance of GSV insufficiency. Conclusions Insufficiency of the GSV was significantly more frequent in group III, both overall and when considering only cases with morbid obesity, or cases in older age groups.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Vena Safena/fisiopatología , Vena Safena/cirugía , Signos y Síntomas , Ultrasonografía Doppler/métodos , Várices/diagnóstico , Várices/fisiopatología , Insuficiencia Venosa/diagnóstico , Factores de Edad , Extremidad Inferior , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Interpretación Estadística de Datos , Trombosis de la VenaRESUMEN
OBJECTIVE: To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging. METHODS: A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables. RESULTS: Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p <0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p =0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p =0.675 and p =0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p =0.027). The pulse index in the central retinal vein was lower in male patients (p =0.017) and in eyes with optic nerve invasion (p =0.0088). CONCLUSIONS: TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.
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Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Arteria Retiniana/fisiopatología , Neoplasias de la Retina/fisiopatología , Vena Retiniana/fisiopatología , Retinoblastoma/fisiopatología , Velocidad del Flujo Sanguíneo , Enucleación del Ojo , Imagen por Resonancia Magnética , Invasividad Neoplásica/patología , Invasividad Neoplásica/fisiopatología , Neoplasias del Nervio Óptico/irrigación sanguínea , Neoplasias del Nervio Óptico/patología , Neoplasias del Nervio Óptico/fisiopatología , Estudios Prospectivos , Factores de Riesgo , Arteria Retiniana/patología , Arteria Retiniana , Neoplasias de la Retina/irrigación sanguínea , Neoplasias de la Retina/patología , Vena Retiniana/patología , Vena Retiniana , Retinoblastoma/irrigación sanguínea , Retinoblastoma/patología , Estadísticas no Paramétricas , Carga Tumoral , Ultrasonografía Doppler en Color/métodosRESUMEN
Há diferenças individuais no diâmetro da veia safena magna (VSM) em membros normais e doentes; sendo possível a identificação dessas alterações pelo ecocolor Doppler.ObjetivoAvaliar a associação da aplasia segmentar da VSM com a presença de varizes e/ou insuficiência da mesma em membros inferiores, usando o ecocolor Doppler em pacientes com clínica de doença venosa crônica (DVC).Métodos1.408 pacientes com queixas compatíveis de DVC de membros inferiores, sendo 1.286 do sexo feminino, com idade entre 17 e 85 anos, examinados com ecocolor Doppler. Foram incluídos aqueles com classificação CEAP clínica C0 a C4. Pela avaliação clínica, a amostra foi distribuída em grupo A, pacientes com varizes, e grupo B, aqueles sem varizes. O ecocolor Doppler determinou se havia aplasia da VSM pela análise do seu trajeto no compartimento safeno e presença de veias varicosas nos diferentes sítios. Para estatística, foram considerados os testes Qui-quadrado ou Exato de Fisher e uma análise de resíduos em tabelas, com nível de significância de 5%.ResultadosNo grupo A houve 479 (83,9%) de VSM insuficientes, 169 (38,2%) com aplasia e 71 (80,7%) com insuficiência e aplasia associadas. No grupo B, houve 92 (16,1%) de VSM insuficientes, 273 (61,8%) com aplasia e 17 (19,3%) com insuficiência e aplasia associadas.ConclusãoA aplasia segmentar da VSM ocorre mais em membros inferiores que não apresentam varizes e/ou insuficiência da mesma, mas considerando-se a presença da associação de aplasia e insuficiência, houve maior incidência no grupo de membros que apresentavam varizes.
There are individual differences in the diameter of the great saphenous vein (GSV) in both normal and non-functional limbs and it is possible to identify these differences using color Doppler ultrasonography.ObjectivesTo assess the association between segmental GSV aplasia and the presence of varicose veins and/or GSV insufficiency in lower limbs using color Doppler ultrasonography, in patients with chronic venous disease (CVD).MethodsA total of 1,408 patients with complaints compatible with CVD of lower limbs were examined using color Doppler ultrasonography. The age range of the sample was from 17 to 85 and 1,286 of the patients were female. People with clinical classifications (CEAP) ranging from C0 to C4 were included. On the basis of clinical examination, the sample was subdivided as follows: group A patients had varicose veins and group B patients were free from varicose veins. Color Doppler ultrasonography was used to determine whether there was GSV aplasia, by analysis of its route into the saphenous compartment, and the presence of varicose veins in different sites. Statistical analysis was conducted using the chi-square test or Fishers exact tests followed by an analysis of residuals in tables, with a 5% significance level.ResultsIn group A, there were 479 (83.9%) patients with GSV insufficiency, 169 (38.2%) with aplasia and 71 (80.7%) with both insufficiency and aplasia. In group B, there were 92 (16.1%) patients with GSV insufficiency, 273 (61.8%) with aplasia and 17 (19.3%) with both insufficiency and aplasia.ConclusionSegmental GSV aplasia was more common in lower limbs with no varicose veins and/or insufficiency, but there was a higher incidence of patients with both aplasia and insufficiency in the group with varicose veins.
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Humanos , Masculino , Femenino , Adolescente , Anciano , Anciano de 80 o más Años , Insuficiencia Venosa/etiología , Várices/diagnóstico , Várices , Estudios Transversales , Extremidad Inferior , Factores de Tiempo , Ultrasonografía Doppler en Color/métodosRESUMEN
BACKGROUND: Ultrasound-guided foam sclerotherapy plays a major role in treatment of chronic venous insufficiency, providing clinical and hemodynamic improvement to patients undergoing treatment.OBJECTIVES: To examine the relationships between venous refilling time and impact of venous disease on quality of life and between changes in venous refilling time and improvement of symptoms after ultrasound-guided foam sclerotherapy for chronic venous insufficiency. METHODS: Thirty-two patients classified as C4, C5 or C6 answered a questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy.RESULTS: Statistically significant improvements were observed in quality of life scores and in venous filling time and in the following symptoms: aching, heavy legs, restless legs, swelling, burning sensations, and throbbing (p<0.0001). A similar improvement was also seen in the work and social domains of quality of life (p<0.0001).CONCLUSIONS: As confirmed by questionnaire scores and venous refilling times, ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels and low rates of major complications.
CONTEXTO: A escleroterapia com espuma guiada por ultrassom (EGUS) ocupa lugar de destaque no tratamento da insuficiência venosa crônica (IVC), proporcionando melhora clínica e hemodinâmica aos pacientes submetidos ao tratamento.OBJETIVOS: Verificar a correlação entre dados obtidos por questionário de qualidade de vida e de sintomas com dados obtidos por fotopletismografia (FPG), antes e depois do tratamento por escleroterapia com espuma guiada por ultrassom (EGUS) da insuficiência venosa crônica (IVC). MÉTODOS: Um grupo de 32 pacientes, classificados como C4, C5 e C6, foi submetido à aplicação de questionário de qualidade de vida e sintomas, sendo aferido o tempo de enchimento venoso (TEV) por FPG antes e 45 dias depois do tratamento da IVC através de EGUS. O teste do sinal foi utilizado para análise estatística da melhora dos escores dos questionários e do TEV. O teste de McNemar foi utilizado para avaliação da melhora nos sintomas e do impacto do tratamento nas atividades laborais e sociais dos pacientes.RESULTADOS: Houve melhora nos escores dos questionários de qualidade de vida e no TEV, com significância estatística (p<0,0001). Houve melhora estatisticamente significativa nos sintomas: dor, cansaço, edema, queimação, pernas inquietas e latejamento (p<0,0001). Incremento na qualidade laboral e social após o tratamento apresentou melhora estatisticamente significativa (p<0,0001). Não ocorreram complicações maiores ou efeitos adversos nesta série.CONCLUSÕES: A EGUS mostrou-se eficaz, com alto índice de satisfação e baixas taxas de complicacões maiores, ratificada pelos escores dos questionários e pelos TEVs aferidos pela FPG.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Escleroterapia/métodos , Fotopletismografía/métodos , Insuficiencia Venosa/terapia , Calidad de Vida , Extremidad Inferior , Encuestas y Cuestionarios , Interpretación Estadística de Datos , Soluciones Esclerosantes/uso terapéutico , Ultrasonografía Doppler en Color/métodos , VáricesRESUMEN
Background: Venous insufficiency is a very prevalent disease. Some decades ago a group of patients was identified that had symptoms of venous insufficiency, but no visible anatomic abnormalities. Studies showed that this subset had reduced venous tone, and their condition became known as hypotonic phlebopathy. Objective: To investigate prevalence, age group and variations in body mass index (BMI) among patients with hypotonic phlebopathy. Methodology: A total of 1,960 limbs were examined in 1,017 patients who had been referred for complaints compatible with venous insufficiency. Patients with BMI ≥ 30 were defined as obese. The patients were examined using color Doppler ultrasonography to detect presence or absence of reflux in veins of the lower limbs and were then distributed into two groups as follows: patients with CEAP ≤ 1 and no reflux, diagnosed with hypotonic phlebopathy; or patients with CEAP ≥ 2 and reflux. Results: The study sample comprised 89.7% women and 10.3% men with a mean age of 44.9 years. Hypotonic phlebopathy was more common among the women (p = 0.0001). Obese women were more likely than women who were not obese to have venous symptom etiology involving trunk lesions (p = 0.0017). Among the men, obesity was unrelated to etiology of symptoms (p = 0.5991). Symptomology was more likely to be related to trunk vein damage among older age groups than among younger age groups (p-valor <0.0001). Conclusions: Hypotonic phlebopathy was very prevalent, particularly among young women who were not obese...
Contexto: A insuficiência venosa é uma doença muito prevalente. Há algumas décadas, evidenciou-se a existência de um grupo que, embora apresentasse sintomas de insuficiência venosa, não possuía alterações anatômicas visíveis. Estudos mostraram redução no tônus venoso nesses indivíduos, denominando-os portadores de flebopatia hipotônica. Objetivo: Estudar a prevalência, a faixa etária e as variações do índice de massa corporal (IMC) em pacientes portadores de flebopatia hipotônica. Metodologia: Foram examinados 1.960 membros de 1.017 pacientes, devido a queixas compatíveis com insuficiência venosa. Foram considerados obesos aqueles com IMC ≥ 30. Foram avaliados com ecocolor Doppler, para se detectar a presença ou não de refluxo em veias dos membros inferiores, sendo então distribuídos em dois grupos: aqueles com CEAP ≤ 1, além de excluído refluxo, os portadores de flebopatia hipotônica, e outros com CEAP ≥ 2 e com refluxo. Resultados: A amostra foi composta por 89,7% de mulheres e 10,3% de homens, com faixa etária média de 44,9 anos. A flebopatia hipotônica foi mais comum em mulheres (p-valor = 0,0001). Naquelas obesas, houve mais lesão troncular como etiologia dos sintomas venosos do que nas não obesas (p-valor = 0,0017). Dentre os homens, a presença de obesidade não influenciou na etiologia dos sintomas (p-valor = 0,5991). Nos grupos etários de idade mais avançada, a presença de sintomatologia teve como origem etiológica a lesão venosa troncular com mais frequência do que nas faixas etárias mais jovens (p-valor <0,0001). Conclusão: A flebopatia hipotônica se mostrou muito prevalente, principalmente em mulheres jovens não obesas...
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedades Vasculares Periféricas/etiología , Enfermedades Vasculares Periféricas , Extremidad Inferior , Insuficiencia Venosa/etiología , Insuficiencia Venosa/fisiopatología , Várices/complicaciones , Ecocardiografía Doppler/métodos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJETIVO: avaliar a ocorrência do refluxo da safena magna através da ultrassonografia com Doppler colorido em sujeitos submetidos ao tratamento da insuficiência da junção safeno-femoral por ligadura simples ou por ligadura com secção da crossa. MÉTODOS: foram realizadas 60 operações (45 sujeitos) de varizes com insuficiência da junção safeno-femoral (JSF), pertencentes à classificação clínica do CEAP 2 a 5, que foram distribuídos aleatoriamente em dois grupos. Um grupo denominado C, com ligadura e secção da crossa, e um grupo denominado L, com ligadura simples sem secção da crossa da veia safena magna. Foi então pesquisada a ocorrência do refluxo da safena magna nos grupos C e L através da ultrassonografia doppler colorida após o tratamento cirúrgico com intervalos de seis meses a um ano. RESULTADOS: dos 60 membros submetidos à abordagem da crossa da safena magna, 57 foram avaliados pela ultrassonografia doppler pós-operatório, pois dois sujeitos (três membros) não retornaram e foram excluídos do estudo. A média de idade foi 54 anos, 93% do sexo feminino e predominância da classificação (CEAP) C2 de 60,5%. Das 57 operações para o tratamento do refluxo da crossa da safena, 43,9% apresentaram refluxo no pós-operatório, sendo 14,1% do grupo C e 29,8% no grupo L (p<0,05). O risco relativo de apresentar refluxo da crossa da safena no grupo L foi 2,03 vezes maior em comparação com o grupo C. CONCLUSÃO: a secção da crossa da safena magna apresenta menos refluxo pós-operatório do que a ligadura simples no tratamento da insuficiência da crossa da veia safena magna.
OBJECTIVE: To evaluate the occurrence of reflux from the great saphenous vein by color Doppler ultrasonography in subjects undergoing treatment of insufficiency of the saphenofemoral junction by simple ligation or ligation with section of the saphenous arch. METHODS: We performed 60 operations (in 45 subjects) of varicose insufficiency of the saphenofemoral junction (SFJ), belonging to the CEAP clinical classification of 2-5, who were randomly divided into two groups. A group called C, with ligature and section of the saphenous arch, and a group called L, with simple ligation of the saphenous vein and no sectioning of its arch. We then investigated the occurrence of reflux from the great saphenous vein in groups C and L through postoperative color Doppler ultrasonography at intervals of six months to one year. RESULTS: Of the 60 members submitted to the approach of the saphenous arch, 57 were evaluated by postoperative doppler ultrasound, since two subjects (three limbs) did not return and were excluded from the study. The mean age was 54 years, with 93% females and predominance of CEAP classification 2 in 60.5%. Of the 57 operations for the treatment of reflux of the saphenous arch, 43.9% had reflux postoperatively,14.1% in group C and 29.8% in group L (p < 0,05). The relative risk of reflux of the saphenous arch in group L was 2.03 times higher compared with group C. CONCLUSION: the section of the arch of the great saphenous vein causes less postoperative reflux than simple ligation in treatment of insufficiency of the great saphenous vein.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Vena Femoral/cirugía , Vena Femoral , Complicaciones Posoperatorias , Vena Safena/cirugía , Vena Safena , Ultrasonografía Doppler en Color , Insuficiencia Venosa/cirugía , Ligadura , Complicaciones Posoperatorias/fisiopatología , Flujo Sanguíneo Regional , Vena Safena/fisiopatologíaRESUMEN
Recentemente, a ultrassonografia vem ganhando prestígio como método adjuvante no diagnóstico e no acompanhamento terapêutico da artrite reumatoide, embora a radiografia ainda seja a modalidade de imagem tradicionalmente utilizada em larga escala com esses propósitos. O grande trunfo do estudo ultrassonográfico, que vem motivando pesquisas entusiastas na área, reside em sua capacidade de detectar sinovite e erosão óssea em fase pré-radiográfica, o que tem sido cada vez mais valorizado na prevenção do dano estrutural tardio e definitivo. Por ser um assunto relativamente novo, vários artigos científicos vêm sendo publicados em anos recentes sobre as potenciais aplicações da ultrassonografia em portadores de artrite reumatoide, alguns voltados a pesquisadores, outros voltados ao reumatologista clínico. O objetivo deste artigo é depurar a bibliografia atualmente disponível e descrever apenas os conceitos de aplicabilidade prática na rotina diária do reumatologista clínico.
Ultrasonography has recently gained prestige as an adjuvant method for the diagnosis and therapeutic follow-up of rheumatoid arthritis, although radiography remains the imaging modality traditionally and widely used for those purposes. The great advantage of the ultrasonographic study, which has motivated enthusiastic research in the area, resides in its capacity to detect synovitis and bone erosion at a pre-radiographic phase, which has been increasingly valued in preventing late and definitive structural damage. Because that is a relatively new subject, several scientific articles have been published in recent years about the potential applications of ultrasonography in individuals with rheumatoid arthritis, some of which directed to researchers and others to clinical rheumatologists. This study aimed at assessing the currently available bibliography on the subject and at describing only the concepts that are of practical applicability in the daily routine of clinical rheumatologists.
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Humanos , Artritis Reumatoide , Artritis Reumatoide/complicaciones , Reumatología , Sinovitis/etiología , SinovitisRESUMEN
Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.
Asunto(s)
Humanos , Diagnóstico por Imagen/métodos , Enfermedad de Graves/diagnóstico , Enfermedades del Nervio Óptico/diagnósticoRESUMEN
OBJETIVO: Avaliar a prevalência de estenose hemodinamicamente significativa na revascularização infrainguinal realizada com a veia safena magna reversa. MÉTODOS: No período compreendido entre março de 2008 e março de 2009, foram realizadas 56 revascularizações infrainguinais com a veia safena magna reversa em 56 pacientes, dos quais 32 foram avaliados com ultrassonografia vascular no 30º dia de pós- operatório. Foi analisada a prevalência de estenoses significativas nos enxertos e sua relação com as características clínico-cirúrgicas dos pacientes. Os parâmetros avaliados foram a localização das estenoses ao longo do enxerto, fatores de risco associados e a relação existente entre a ultrassonografia vascular e o índice tornozelo-braço no diagnóstico de estenoses. RESULTADOS: Houve prevalência de 48,4 por cento de estenoses significativas nos enxertos avaliados, com 19,4 por cento de estenoses graves e 29 por cento de estenoses leve a moderada. Não foram encontradas associações significativas entre sexo, diabetes mellitus, hipertensão arterial, hipercolesterolemia, diâmetro do enxerto, localização da anastomose distal, composição do enxerto e a constatação de estenoses significativas. Observou-se fraca correlação entre os métodos no diagnóstico das estenoses em geral (K = 0,30; IC95 por cento 0,232-0,473; p = 0,018), mas razoável concordância no diagnóstico das estenoses graves (K = 0,75; IC95 por cento 0,655-0,811; p = 0,0001). CONCLUSÃO: Este estudo demonstrou elevada prevalência de estenoses no 30º dia do pós-operatório, com localização predominante na metade proximal do enxerto. O índice tornozelo-braço e a ultrassonografia vascular apresentaram concordância, sobretudo no diagnóstico das estenoses graves, mas o índice tornozelo-braço, isoladamente, mostrou-se insuficiente na vigilância dos enxertos de veia safena magna reversa.
OBJECTIVE: The aim of this study was to evaluate the prevalence of hemodynamically significant infrainguinal bypasses stenosis using reverse great saphenous vein graft. METHODS: From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 out of 56 patients were submitted to vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition, the diagnosis of stenosis was related to the clinical and surgical characteristics of the patients. The variables analyzed at the moment of diagnosis were the localization of the graft stenosis, the risk factors associated with stenosis and the association of vascular ultrasonography findings with ankle brachial pressure index (ABI). RESULTS: The overall prevalence of significant graft stenosis was 48.4 percent. Out of the total number of observed stenosis, 19.4 percent were considered severe, and 29 percent mild or moderate. There was no significant association between the presence of significant stenosis and the following variables: gender, diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. There was a weak agreement between ABI and vascular ultrasonography in detecting stenosis in general (K = 0.30; CL95 percent 0.232 - 0.473; p = 0.018). However, there was a substantial agreement in detecting severe stenosis (K = 0.75; CL95 percent 0.655 - 0.811; p = 0.0001). CONCLUSION: There was a high prevalence of stenosis on the 30th post-operative day, mostly localized in the proximal half of the vein graft. There was no significant association of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had weak agreement with the diagnosis of stenosis in general and an important agreement for the diagnosis of severe stenosis.
Asunto(s)
Femenino , Humanos , Masculino , Constricción Patológica/etiología , Oclusión de Injerto Vascular/epidemiología , Vena Safena/trasplante , Índice Tobillo Braquial , Arterias , Constricción Patológica/epidemiología , Constricción Patológica , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular , Prevalencia , Factores de Riesgo , Vena Safena , Ultrasonografía Doppler DúplexRESUMEN
OBJETIVO: Avaliar a reprodutibilidade interobservador dos índices de vascularização do Doppler de amplitude tridimensional (Doppler de amplitude 3D) no primeiro trimestre de gestação. MATERIAIS E MÉTODOS: Realizou-se estudo de reprodutibilidade com 32 gestantes normais entre 7 e 10 semanas e 6 dias. Para o cálculo do volume tridimensional dos embriões utilizou-se o método VOCAL (Virtual Organ Computer-aided AnaLysis) com ângulo de rotação de 12°. Em seguida obtiveram-se, automaticamente, os três índices vasculares do Doppler de amplitude 3D: índice de vascularização (VI), índice de fluxo (FI) e índice de vascularização e fluxo (VFI). Para o cálculo da variabilidade interobservador, um examinador realizou uma segunda medida dos 32 embriões e um segundo examinador realizou uma terceira medida dos mesmos volumes, ambos desconhecendo os resultados do outro. Utilizaram-se, para análise estatística, o coeficiente de correlação intraclasse (CCI) e gráficos de Bland-Altman. RESULTADOS: Observou-se boa reprodutibilidade interobservador dos três índices vasculares. O VI apresentou CCI = 0,9 e média da diferença = -1,1; o FI apresentou CCI = 0,9 e média da diferença = -0,5; e o VFI apresentou CCI = 0,9 e média da diferença = -1,1. CONCLUSÃO: Os índices vasculares do Doppler de amplitude 3D do embrião no primeiro trimestre de gestação foram altamente reprodutíveis, em especial o FI.
OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = -1.1. For the FI, the ICC was 0.9 and mean difference = -0.5. The VFI presented ICC = 0.9 and mean difference = -1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Doppler ultrasonography at the first trimester of gestation demonstrated a high reproducibility.