Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

Abstract

Objectives: This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated.

Methods: A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening.

Results: Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r² = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r² = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r² = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r² = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r² = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010).

Conclusions: Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

Keywords: aortic isthmus; fetus; first-trimester screening; high-definition flow imaging (HDFI); isthmic flow index; isthmic systolic index; power Doppler ultrasound.

Figure 1

Study Flow Diagram of This Study.

Figure 2

Power Doppler HDFI and aortic pulse Doppler spectral analysis were employed in a normal fetus at a gestational age of 12 + 1 weeks. The thin pinkish arrow indicates the reverse small prominent spike, while the thick yellowish arrow highlights the constant forward flow and possibly the “incisura”.

Figure 3

(A–F) Relationship between 6 Doppler indices of the fetal aortic artery and gestational age. (G) Relationship between IFI of the fetal aortic artery and gestational age. (H) Association between ISI of the fetal aortic artery and gestational age.

Figure 4

It illustrates the correlation between sonographic parameters, encompassing the fetal aortic artery’s six Doppler indices, IFI, and ISI, and clinical characteristics such as MA, NT, CRL, and FHB. Pearson’s correlation coefficient was utilized for this analysis. In the correlation matrix, negative correlation coefficient values are denoted in pink, while positive correlation coefficient values are represented in purple. A correlation coefficient value of zero is depicted in white. Significant correlations at the 0.05 level (two-tailed) are indicated by an asterisk (*).