VALUE OF THREE-DIMENSIONAL POWER DOPPLER ANGIOGRAPHY IN CONGENITAL FETAL OBSTRUCTIVE UROPATHIES

Objective. To assess the role of three-dimensional (3D) power Doppler angiography in obstructive uropathies, the relationship of vascular indices to fetal renal artery blood flow values and the magnitude of dilation of the renal collecting system in the antenatal period and to determine whether the findings can be used to predict the neonatal status. Subject and methods. A prospective case-control analysis was made in 45 fetuses with obstructive defects of the urinary tract and in 45 fetuses without any malformations at 20 to 40 weeks of gestation, in whom renal volume, dilatation of the calycopelvic system (CPS), renal artery blood flow values, and 3D power Doppler angiographic parameters were analyzed. The set of neonatal studies included physical examination, echography, and contrast-enhanced magnetic resonance imaging of the urinary tract. Results. In the study group, the renal volumes measured by 3D echography were found to differ from those calculated using three linear dimensions. Pulsed wave Doppler imaging of the renal artery demonstrated statistically significant differences in blood flow values in the study groups, starting at 25 weeks of pregnancy. Analysis of 3D power Doppler angiographic findings showed that the vascular indices (VI, FI, and VFI) in the unaltered kidneys were directly proportional to pregnancy duration, organ volume, and parenchymal thickness. These indices were substantially decreased in obstructive uropathies as compared to the control group regardless of gestational age. Correlation analysis indicated that renal volume, CPS dilation and volume, and parenchymal thickness preservation affected VI and VFI values in obstructive uropathies.

VOCAL, three-dimensional power Doppler angiography, VOCAL, obstructive uropathies, hydronephrosis, Doppler imaging, congenital malformations